Publications

@article{yu_population_2017,
	title = {Population trends in the incidence and initial management of osteoarthritis: age-period-cohort analysis of the {Clinical} {Practice} {Research} {Datalink}, 1992–2013},
	volume = {56},
	issn = {1462-0324},
	shorttitle = {Population trends in the incidence and initial management of osteoarthritis},
	url = {https://academic.oup.com/rheumatology/article/56/11/1902/4065207},
	doi = {10.1093/rheumatology/kex270},
	abstract = {ObjectiveTo determine recent trends in the rate and management of new cases of OA presenting to primary healthcare using UK nationally representative data.MethodsUsing the Clinical Practice Research Datalink we identified new cases of diagnosed OA and clinical OA (including OA-relevant peripheral joint pain in those aged over 45 years) using established code lists. For both definitions we estimated annual incidence density using exact person-time, and undertook descriptive analysis and age-period-cohort modelling. Demographic characteristics and management were described for incident cases in each calendar year. Sensitivity analyses explored the robustness of the findings to key assumptions.ResultsBetween 1992 and 2013 the annual age-sex standardized incidence rate for clinical OA increased from 29.2 to 40.5/1000 person-years. After controlling for period effects, the consultation incidence of clinical OA was higher for successive cohorts born after the mid-1950s, particularly women. In contrast, with the exception of hand OA, we observed no increase in the incidence of diagnosed OA: 8.6/1000 person-years in 2004 down to 6.3 in 2013. In 2013, 16.4\% of clinical OA cases had an X-ray referral. While NSAID prescriptions fell from 2004, the proportion prescribed opioid analgesia rose markedly (0.1\% of diagnosed OA in 1992 to 1.9\% in 2013).ConclusionRising rates of clinical OA, continued use of plain radiography and a shift towards opioid analgesic prescription are concerning. Our findings support the search for policies to tackle this common problem that promote joint pain prevention while avoiding excessive and inappropriate health care.},
	number = {11},
	urldate = {2017-11-07},
	journal = {Rheumatology},
	author = {Yu, Dahai and Jordan, Kelvin P. and Bedson, John and Englund, Martin and Blyth, Fiona and Turkiewicz, Aleksandra and Prieto-Alhambra, Daniel and Peat, George},
	month = nov,
	year = {2017},
	pages = {1902--1917},
}

ObjectiveTo determine recent trends in the rate and management of new cases of OA presenting to primary healthcare using UK nationally representative data.MethodsUsing the Clinical Practice Research Datalink we identified new cases of diagnosed OA and clinical OA (including OA-relevant peripheral joint pain in those aged over 45 years) using established code lists. For both definitions we estimated annual incidence density using exact person-time, and undertook descriptive analysis and age-period-cohort modelling. Demographic characteristics and management were described for incident cases in each calendar year. Sensitivity analyses explored the robustness of the findings to key assumptions.ResultsBetween 1992 and 2013 the annual age-sex standardized incidence rate for clinical OA increased from 29.2 to 40.5/1000 person-years. After controlling for period effects, the consultation incidence of clinical OA was higher for successive cohorts born after the mid-1950s, particularly women. In contrast, with the exception of hand OA, we observed no increase in the incidence of diagnosed OA: 8.6/1000 person-years in 2004 down to 6.3 in 2013. In 2013, 16.4% of clinical OA cases had an X-ray referral. While NSAID prescriptions fell from 2004, the proportion prescribed opioid analgesia rose markedly (0.1% of diagnosed OA in 1992 to 1.9% in 2013).ConclusionRising rates of clinical OA, continued use of plain radiography and a shift towards opioid analgesic prescription are concerning. Our findings support the search for policies to tackle this common problem that promote joint pain prevention while avoiding excessive and inappropriate health care.

@article{turkiewicz_knee_2017,
	title = {Knee extensor strength and body weight in adolescent men and the risk of knee osteoarthritis by middle age.},
	volume = {76},
	copyright = {© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.},
	issn = {0003-4967, 1468-2060},
	url = {http://ard.bmj.com/content/76/10/1657},
	doi = {10.1136/annrheumdis-2016-210888},
	abstract = {Objectives To assess the extent to which knee extensor strength and weight in adolescence are associated with knee osteoarthritis (OA) by middle age.
Methods We studied a cohort of 40 121 men who at age 18 years in 1969/1970 underwent mandatory conscription in Sweden. We retrieved data on isometric knee extensor strength, weight, height, smoking, alcohol consumption, parental education and adult occupation from Swedish registries. We identified participants diagnosed with knee OA or knee injury from 1987 to 2010 through the National Patient Register. We estimated the HR of knee OA using multivariable-adjusted Cox proportional regression model. To assess the influence of adult knee injury and occupation, we performed a formal mediation analysis.
Results The mean (SD) knee extensor strength was 234 (47) Nm, the mean (SD) weight was 66 (9.3) kg. During 24 years (median) of follow-up starting at the age of 35 years, 2049 persons were diagnosed with knee OA. The adjusted HR (95\% CI) of incident knee OA was 1.12 (1.06 to 1.18) for each SD of knee extensor strength and 1.18 (1.15 to 1.21) per 5 kg of body weight. Fifteen per cent of the increase in OA risk due to higher knee extensor strength could be attributed to knee injury and adult occupation.
Conclusion Higher knee extensor strength in adolescent men was associated with increased risk of knee OA by middle age, challenging the current tenet of low muscle strength being a risk factor for OA. We confirmed higher weight to be a strong risk factor for knee OA.},
	language = {en},
	number = {10},
	urldate = {2017-10-06},
	journal = {Annals of the Rheumatic Diseases},
	author = {Turkiewicz, Aleksandra and Timpka, Simon and Thorlund, Jonas Bloch and Ageberg, Eva and Englund, Martin},
	month = oct,
	year = {2017},
	pmid = {28487313},
	keywords = {Adolescent, Adult, Body Weight, Epidemiology, Follow-Up Studies, Humans, Incidence, Isometric Contraction, Knee Injuries, Knee osteoarthritis, Male, Middle Aged, Muscle Strength, Occupational Diseases, Osteoarthritis, Osteoarthritis, Knee, Quadriceps Muscle, Risk Factors, Sweden},
	pages = {1657--1661},
}

Objectives To assess the extent to which knee extensor strength and weight in adolescence are associated with knee osteoarthritis (OA) by middle age. Methods We studied a cohort of 40 121 men who at age 18 years in 1969/1970 underwent mandatory conscription in Sweden. We retrieved data on isometric knee extensor strength, weight, height, smoking, alcohol consumption, parental education and adult occupation from Swedish registries. We identified participants diagnosed with knee OA or knee injury from 1987 to 2010 through the National Patient Register. We estimated the HR of knee OA using multivariable-adjusted Cox proportional regression model. To assess the influence of adult knee injury and occupation, we performed a formal mediation analysis. Results The mean (SD) knee extensor strength was 234 (47) Nm, the mean (SD) weight was 66 (9.3) kg. During 24 years (median) of follow-up starting at the age of 35 years, 2049 persons were diagnosed with knee OA. The adjusted HR (95% CI) of incident knee OA was 1.12 (1.06 to 1.18) for each SD of knee extensor strength and 1.18 (1.15 to 1.21) per 5 kg of body weight. Fifteen per cent of the increase in OA risk due to higher knee extensor strength could be attributed to knee injury and adult occupation. Conclusion Higher knee extensor strength in adolescent men was associated with increased risk of knee OA by middle age, challenging the current tenet of low muscle strength being a risk factor for OA. We confirmed higher weight to be a strong risk factor for knee OA.

@article{haugen_prevalence_2017,
	title = {The prevalence, incidence, and progression of hand osteoarthritis in relation to body mass index, smoking, and alcohol consumption.},
	volume = {44},
	copyright = {© 2017},
	issn = {0315-162X, 1499-2752},
	url = {http://www.jrheum.org/content/44/9/1402},
	doi = {10.3899/jrheum.170026},
	abstract = {Objective. To estimate the extent that overweight/obesity, smoking, and alcohol are associated with prevalence and longitudinal changes of radiographic hand osteoarthritis (OA).
Methods. Participants from the Osteoarthritis Initiative (n = 1232) were included, of whom 994 had 4-year followup data. In analyses on incident hand OA, only persons without hand OA at baseline were included (n = 406). Our exposure variables were overweight/obesity [body mass index (BMI), waist circumference], smoking (current/former, smoking pack-yrs), and alcohol consumption (drinks/week). Using linear and logistic regression analyses, we analyzed possible associations between baseline exposure variables and radiographic hand OA severity, erosive hand OA, incidence of hand OA, and radiographic changes. Analyses were adjusted for age, sex, and education.
Results. Neither overweight nor obesity were associated with hand OA. Current smoking was associated with less hand OA in cross-sectional analyses, whereas longitudinal analyses suggested higher odds of incident hand OA in current smokers (OR 2.20, 95\% CI 1.02–4.77). Moderate alcohol consumption was associated with higher Kellgren-Lawrence sum score at baseline (1–3 drinks: 1.55, 95\% CI 0.43–2.67) and increasing sum score during 4-year followup (4–7 drinks: 0.33, 95\% CI 0.01–0.64). Moderate alcohol consumption (1–7 drinks/week) was associated with 2-fold higher odds of erosive hand OA, which was statistically significant. Additional adjustment for BMI gave similar strengths of associations.
Conclusion. Overweight/obesity were not associated with hand OA. Contrasting results were observed for smoking and hand OA, suggesting lack of association. Moderate alcohol consumption was associated with hand OA severity, radiographic changes, and erosive hand OA, warranting further investigation.},
	language = {en},
	number = {9},
	urldate = {2017-09-04},
	journal = {The Journal of Rheumatology},
	author = {Haugen, Ida K. and Magnusson, Karin and Turkiewicz, Aleksandra and Englund, Martin},
	month = sep,
	year = {2017},
	pmid = {28711879},
	keywords = {Epidemiology, Hand, Obesity, Osteoarthritis, Risk Factors},
	pages = {1402--1409},
}

Objective. To estimate the extent that overweight/obesity, smoking, and alcohol are associated with prevalence and longitudinal changes of radiographic hand osteoarthritis (OA). Methods. Participants from the Osteoarthritis Initiative (n = 1232) were included, of whom 994 had 4-year followup data. In analyses on incident hand OA, only persons without hand OA at baseline were included (n = 406). Our exposure variables were overweight/obesity [body mass index (BMI), waist circumference], smoking (current/former, smoking pack-yrs), and alcohol consumption (drinks/week). Using linear and logistic regression analyses, we analyzed possible associations between baseline exposure variables and radiographic hand OA severity, erosive hand OA, incidence of hand OA, and radiographic changes. Analyses were adjusted for age, sex, and education. Results. Neither overweight nor obesity were associated with hand OA. Current smoking was associated with less hand OA in cross-sectional analyses, whereas longitudinal analyses suggested higher odds of incident hand OA in current smokers (OR 2.20, 95% CI 1.02–4.77). Moderate alcohol consumption was associated with higher Kellgren-Lawrence sum score at baseline (1–3 drinks: 1.55, 95% CI 0.43–2.67) and increasing sum score during 4-year followup (4–7 drinks: 0.33, 95% CI 0.01–0.64). Moderate alcohol consumption (1–7 drinks/week) was associated with 2-fold higher odds of erosive hand OA, which was statistically significant. Additional adjustment for BMI gave similar strengths of associations. Conclusion. Overweight/obesity were not associated with hand OA. Contrasting results were observed for smoking and hand OA, suggesting lack of association. Moderate alcohol consumption was associated with hand OA severity, radiographic changes, and erosive hand OA, warranting further investigation.

@article{michaelsson_association_2017,
	title = {Association between statin use and consultation or surgery for osteoarthritis of the hip or knee: {A} pooled analysis of four cohort studies.},
	volume = {25},
	issn = {1063-4584},
	shorttitle = {Association between statin use and consultation or surgery for osteoarthritis of the hip or knee},
	url = {http://www.sciencedirect.com/science/article/pii/S1063458417311020},
	doi = {10.1016/j.joca.2017.07.013},
	abstract = {Experimental findings and previous observational data have suggested lower risk of osteoarthritis (OA) with statin use but results are inconsistent. Large-scale studies with a clinically important outcome are needed. Thus, we aimed to determine whether statin use is associated with a reduced risk of developing clinically-defined hip or knee OA. Pooled analysis based on time-to-event analysis of four population-based large cohorts, encompassing in total 132,607 persons aged 57–91 years resident in southern and central Sweden. We studied the association between statin use and time to consultation or surgery for OA of the hip or knee by time-dependent exposure analysis and Cox regression. During 7.5 years of follow-up, we identified 7468 out- or inpatient treated cases of hip or knee OA. Compared with never use, current use of statins conferred no overall reduction in the risk of OA with an adjusted pooled hazard ratio (HR) of 1.04 (95\% confidence intervals [95\% CI] 0.99–1.10). We found no dose–response relation between duration of current statin use and the risk of OA, with similar HRs among patients with less than 1 year of use (HR 1.09; 95\% CI 0.92–1.32) as in patients with use for 3 years or more (HR 1.05; 0.93–1.16). Results were comparable in those with low, medium and high dose of current statin use, without indications of heterogeneity of study results. Statin use is not associated with reduced risk of consultation or surgery for OA of the hip or knee.},
	number = {11},
	journal = {Osteoarthritis and Cartilage},
	author = {Michaëlsson, K. and Lohmander, L. S. and Turkiewicz, A. and Wolk, A. and Nilsson, P. and Englund, M.},
	month = nov,
	year = {2017},
	keywords = {Cohort, Meta-analysis, Osteoarthritis, Pooled analysis, Statin},
	pages = {1804--1813},
}

Experimental findings and previous observational data have suggested lower risk of osteoarthritis (OA) with statin use but results are inconsistent. Large-scale studies with a clinically important outcome are needed. Thus, we aimed to determine whether statin use is associated with a reduced risk of developing clinically-defined hip or knee OA. Pooled analysis based on time-to-event analysis of four population-based large cohorts, encompassing in total 132,607 persons aged 57–91 years resident in southern and central Sweden. We studied the association between statin use and time to consultation or surgery for OA of the hip or knee by time-dependent exposure analysis and Cox regression. During 7.5 years of follow-up, we identified 7468 out- or inpatient treated cases of hip or knee OA. Compared with never use, current use of statins conferred no overall reduction in the risk of OA with an adjusted pooled hazard ratio (HR) of 1.04 (95% confidence intervals [95% CI] 0.99–1.10). We found no dose–response relation between duration of current statin use and the risk of OA, with similar HRs among patients with less than 1 year of use (HR 1.09; 95% CI 0.92–1.32) as in patients with use for 3 years or more (HR 1.05; 0.93–1.16). Results were comparable in those with low, medium and high dose of current statin use, without indications of heterogeneity of study results. Statin use is not associated with reduced risk of consultation or surgery for OA of the hip or knee.

@article{kiadaliri_burden_2017,
	title = {Burden of rheumatoid arthritis in the {Nordic} region, 1990-2015: {A} comparative analysis using the {Global} {Burden} of {Disease} {Study} 2015.},
	volume = {47},
	issn = {1502-7732},
	shorttitle = {Burden of rheumatoid arthritis in the {Nordic} region, 1990-2015},
	url = {http://dx.doi.org/10.1080%2F03009742.2017.1314002},
	doi = {10.1080/03009742.2017.1314002},
	abstract = {OBJECTIVE: To report mortality and disability due to rheumatoid arthritis (RA) in the Nordic region (Denmark, Finland, Greenland, Iceland, Norway, and Sweden) using data from the Global Burden of Disease Study (GBD) 2015.
METHOD: Using the results of GBD 2015, we present rates and trends in prevalence, mortality, years of life lost, years lived with disability (YLD), and disability-adjusted life-years (DALYs) of RA in the Nordic region during 1990-2015.
RESULTS: In 2015, the age-standardized prevalence of RA was higher in the Nordic region than the global level (0.44\%, 95\% uncertainty interval 0.40-0.48\%, vs 0.35\%, 0.32-0.38\%). For women (men), DALYs increased by 2.4\% (12.9\%), from 29 263 (10 909) in 1990 to 29 966 (12 311) in 2015. The burden of RA as a proportion of total DALYs in women (men) increased from 0.90\% (0.29\%) in 1990 to 0.94\% (0.36\%) in 2015. Age-standardized DALY rates declined in all countries except Denmark and Greenland between 1990 and 2015. Of 315 conditions studied, RA was ranked as the 16th (37th) leading cause of YLD in women (men) in the region. Of 195 countries studied, Greenland, Finland, Denmark, Norway, Sweden, and Iceland had the 7th, 11th, 28th, 38th, 48th, and 78th highest age-standardized YLD rates for RA, respectively.
CONCLUSIONS: The prevalence of RA in the Nordic region is higher than the global average. Current trends in population growth and ageing suggest a potential increase in RA burden in the coming decades in the region that should be considered in healthcare resources allocation.},
	language = {eng},
	number = {2},
	journal = {Scandinavian Journal of Rheumatology},
	author = {Kiadaliri, A. A. and Kristensen, L.-E. and Englund, M.},
	month = aug,
	year = {2017},
	pmid = {28766390},
	pages = {95--101},
}

OBJECTIVE: To report mortality and disability due to rheumatoid arthritis (RA) in the Nordic region (Denmark, Finland, Greenland, Iceland, Norway, and Sweden) using data from the Global Burden of Disease Study (GBD) 2015. METHOD: Using the results of GBD 2015, we present rates and trends in prevalence, mortality, years of life lost, years lived with disability (YLD), and disability-adjusted life-years (DALYs) of RA in the Nordic region during 1990-2015. RESULTS: In 2015, the age-standardized prevalence of RA was higher in the Nordic region than the global level (0.44%, 95% uncertainty interval 0.40-0.48%, vs 0.35%, 0.32-0.38%). For women (men), DALYs increased by 2.4% (12.9%), from 29 263 (10 909) in 1990 to 29 966 (12 311) in 2015. The burden of RA as a proportion of total DALYs in women (men) increased from 0.90% (0.29%) in 1990 to 0.94% (0.36%) in 2015. Age-standardized DALY rates declined in all countries except Denmark and Greenland between 1990 and 2015. Of 315 conditions studied, RA was ranked as the 16th (37th) leading cause of YLD in women (men) in the region. Of 195 countries studied, Greenland, Finland, Denmark, Norway, Sweden, and Iceland had the 7th, 11th, 28th, 38th, 48th, and 78th highest age-standardized YLD rates for RA, respectively. CONCLUSIONS: The prevalence of RA in the Nordic region is higher than the global average. Current trends in population growth and ageing suggest a potential increase in RA burden in the coming decades in the region that should be considered in healthcare resources allocation.

@article{mohammad_severe_2017,
	title = {Severe infection in antineutrophil cytoplasmic antibody-associated vasculitis.},
	volume = {44},
	copyright = {© 2017 The Journal of Rheumatology},
	issn = {0315-162X, 1499-2752},
	url = {http://www.jrheum.org/content/early/2017/07/26/jrheum.160909},
	doi = {10.3899/jrheum.160909},
	abstract = {Objective To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV.
Methods The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age- and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring hospitalization. Rate ratios were calculated by dividing the rate in AAV by the rate among the reference subjects.
Results The rate ratio for all severe infections was 4.53 (95\% CI 3.39–6.00). The highest rate ratios were found for upper respiratory tract: 8.88 (3.54–25.9), Clostridium difficile: 5.35 (1.54–23.8), nonspecific septicemia 4.55 (1.60–13.8), and skin 5.35 (1.69–19.8). Of the severe infections, 38.4\% occurred within 6 months of diagnosis, 30.2\% from 7–24 months, and 31.4\% after 24 months. High serum creatinine and older age at diagnosis were associated with severe infection (p {\textless} 0.001). Of those with severe infection, 46.5\% died during followup compared to 26\% of patients without severe infection (p = 0.004).
Conclusion Patients with AAV have markedly higher rates of severe infection compared with the background population, especially patients with older age and impaired renal function. The risk of severe infection is particularly high in the first 6 months following the diagnosis of vasculitis.},
	language = {en},
	number = {10},
	urldate = {2017-09-04},
	journal = {The Journal of Rheumatology},
	author = {Mohammad, Aladdin J. and Segelmark, Mårten and Smith, Rona and Englund, Martin and Nilsson, Jan-Åke and Westman, Kerstin and Merkel, Peter A. and Jayne, David R. W.},
	month = aug,
	year = {2017},
	pmid = {28765251},
	pages = {1468--1475},
}

Objective To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV. Methods The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age- and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring hospitalization. Rate ratios were calculated by dividing the rate in AAV by the rate among the reference subjects. Results The rate ratio for all severe infections was 4.53 (95% CI 3.39–6.00). The highest rate ratios were found for upper respiratory tract: 8.88 (3.54–25.9), Clostridium difficile: 5.35 (1.54–23.8), nonspecific septicemia 4.55 (1.60–13.8), and skin 5.35 (1.69–19.8). Of the severe infections, 38.4% occurred within 6 months of diagnosis, 30.2% from 7–24 months, and 31.4% after 24 months. High serum creatinine and older age at diagnosis were associated with severe infection (p \textless 0.001). Of those with severe infection, 46.5% died during followup compared to 26% of patients without severe infection (p = 0.004). Conclusion Patients with AAV have markedly higher rates of severe infection compared with the background population, especially patients with older age and impaired renal function. The risk of severe infection is particularly high in the first 6 months following the diagnosis of vasculitis.

@article{kiadaliri_rheumatoid_2017,
	title = {Rheumatoid arthritis as underlying cause of death in 31 countries, 1987-2011: {Trend} analysis of {WHO} mortality database.},
	volume = {69},
	issn = {2326-5205},
	shorttitle = {Brief {Report}},
	url = {http://onlinelibrary.wiley.com/doi/10.1002/art.40091/abstract},
	doi = {10.1002/art.40091},
	abstract = {Objective

To examine trends in rheumatoid arthritis (RA) as an underlying cause of death (UCD) in 31 countries across the world from 1987 to 2011.


Methods

Data on mortality and population were collected from the World Health Organization mortality database and from the United Nations Population Prospects database. Age-standardized mortality rates (ASMRs) were calculated by means of direct standardization. We applied joinpoint regression analysis to identify trends. Between-country disparities were examined using between-country variance and the Gini coefficient. Due to low numbers of deaths, we smoothed the ASMRs using a 3-year moving average. Changes in the number of RA deaths between 1987 and 2011 were decomposed using 2 counterfactual scenarios.


Results

The absolute number of deaths with RA registered as the UCD decreased from 9,281 (0.12\% of all-cause deaths) in 1987 to 8,428 (0.09\% of all-cause deaths) in 2011. The mean ASMR decreased from 7.1 million person-years in 1987–1989 to 3.7 million person-years in 2009–2011 (48.2\% reduction). A reduction of ≥25\% in the ASMR occurred in 21 countries, while a corresponding increase was observed in 3 countries. There was a persistent reduction in RA mortality, and on average, the ASMR declined by 3.0\% per year. The absolute and relative between-country disparities decreased during the study period.


Conclusion

The rates of mortality attributable to RA have declined globally. However, we observed substantial between-country disparities in RA mortality, although these disparities decreased over time. Population aging combined with a decline in RA mortality may lead to an increase in the economic burden of disease that should be taken into consideration in policy-making.},
	language = {en},
	number = {8},
	journal = {Arthritis \& Rheumatology},
	author = {Kiadaliri, Aliasghar A. and Felson, David T. and Neogi, Tuhina and Englund, Martin},
	month = aug,
	year = {2017},
	pages = {1560--1565},
}

Objective To examine trends in rheumatoid arthritis (RA) as an underlying cause of death (UCD) in 31 countries across the world from 1987 to 2011. Methods Data on mortality and population were collected from the World Health Organization mortality database and from the United Nations Population Prospects database. Age-standardized mortality rates (ASMRs) were calculated by means of direct standardization. We applied joinpoint regression analysis to identify trends. Between-country disparities were examined using between-country variance and the Gini coefficient. Due to low numbers of deaths, we smoothed the ASMRs using a 3-year moving average. Changes in the number of RA deaths between 1987 and 2011 were decomposed using 2 counterfactual scenarios. Results The absolute number of deaths with RA registered as the UCD decreased from 9,281 (0.12% of all-cause deaths) in 1987 to 8,428 (0.09% of all-cause deaths) in 2011. The mean ASMR decreased from 7.1 million person-years in 1987–1989 to 3.7 million person-years in 2009–2011 (48.2% reduction). A reduction of ≥25% in the ASMR occurred in 21 countries, while a corresponding increase was observed in 3 countries. There was a persistent reduction in RA mortality, and on average, the ASMR declined by 3.0% per year. The absolute and relative between-country disparities decreased during the study period. Conclusion The rates of mortality attributable to RA have declined globally. However, we observed substantial between-country disparities in RA mortality, although these disparities decreased over time. Population aging combined with a decline in RA mortality may lead to an increase in the economic burden of disease that should be taken into consideration in policy-making.

@article{kiadaliri_socioeconomic_2017,
	title = {Socioeconomic inequalities in knee pain, knee osteoarthritis, and health-related quality of life: {A} population-based cohort study in southern {Sweden}.},
	volume = {46},
	issn = {1502-7732},
	shorttitle = {Socioeconomic inequalities in knee pain, knee osteoarthritis, and health-related quality of life},
	url = {http://dx.doi.org/10.1080%2F03009742.2016.1181203},
	doi = {10.1080/03009742.2016.1181203},
	abstract = {OBJECTIVES: To determine socioeconomic inequalities in frequent knee pain (FKP), knee osteoarthritis (OA), and associated health-related quality of life (HRQoL) in Sweden.
METHOD: In 2007 a postal questionnaire about knee pain was sent to a random sample of 10 000 residents of Malmö, Sweden (7402 individuals responded). Subjects reporting pain with duration ≥ 4 weeks in one or both knees in the past 12 months were classified as having FKP. A random sample of 1527 subjects with and without FKP attended a clinical and radiographic knee examination and responded to generic and disease-specific HRQoL questionnaires. We used the individuals' level of education and occupation as socioeconomic status (SES) measures, and we calculated the relative index of inequality (RII) using Poisson regression with robust standard errors adjusted for age and gender. We applied weighting to account for a possible selection bias that might arise from non-responses in the study.
RESULTS: With education, the RIIs for FKP and knee OA were 0.71 [95\% confidence interval (CI) 0.61-0.84] and 0.56 (95\% CI 0.34-0.93), respectively. With occupation, the corresponding figures were 0.70 (95\% CI 0.60-0.82) and 0.59 (95\% CI 0.37-0.94), respectively. There were socioeconomic gradients in HRQoL in favour of people with better SES. RIIs for FKP and HRQoL but not knee OA were essentially similar after additional adjustment for mediators.
CONCLUSIONS: In Sweden there are socioeconomic gradients related to both FKP and knee OA as well as HRQoL in favour of people with better SES. SES should be taken into account in health resource allocation pertaining to knee-related disorders.},
	language = {eng},
	number = {2},
	journal = {Scandinavian Journal of Rheumatology},
	author = {Kiadaliri, A. A. and Gerhardsson de Verdier, M. and Turkiewicz, A. and Lohmander, L. S. and Englund, M.},
	month = mar,
	year = {2017},
	pmid = {27385007},
	keywords = {Aged, Arthralgia, Cohort Studies, Female, Humans, Male, Middle Aged, Osteoarthritis, Knee, Quality of Life, Social Class, Socioeconomic Factors},
	pages = {143--151},
}

OBJECTIVES: To determine socioeconomic inequalities in frequent knee pain (FKP), knee osteoarthritis (OA), and associated health-related quality of life (HRQoL) in Sweden. METHOD: In 2007 a postal questionnaire about knee pain was sent to a random sample of 10 000 residents of Malmö, Sweden (7402 individuals responded). Subjects reporting pain with duration ≥ 4 weeks in one or both knees in the past 12 months were classified as having FKP. A random sample of 1527 subjects with and without FKP attended a clinical and radiographic knee examination and responded to generic and disease-specific HRQoL questionnaires. We used the individuals' level of education and occupation as socioeconomic status (SES) measures, and we calculated the relative index of inequality (RII) using Poisson regression with robust standard errors adjusted for age and gender. We applied weighting to account for a possible selection bias that might arise from non-responses in the study. RESULTS: With education, the RIIs for FKP and knee OA were 0.71 [95% confidence interval (CI) 0.61-0.84] and 0.56 (95% CI 0.34-0.93), respectively. With occupation, the corresponding figures were 0.70 (95% CI 0.60-0.82) and 0.59 (95% CI 0.37-0.94), respectively. There were socioeconomic gradients in HRQoL in favour of people with better SES. RIIs for FKP and HRQoL but not knee OA were essentially similar after additional adjustment for mediators. CONCLUSIONS: In Sweden there are socioeconomic gradients related to both FKP and knee OA as well as HRQoL in favour of people with better SES. SES should be taken into account in health resource allocation pertaining to knee-related disorders.

@article{thorlund_patient_2017,
	title = {Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: {Comparative} prospective cohort study.},
	volume = {356},
	copyright = {Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.},
	issn = {0959-8138, 1756-1833},
	shorttitle = {Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears},
	url = {http://www.bmj.com/content/356/bmj.j356},
	doi = {10.1136/bmj.j356},
	abstract = {Objectives To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears.
Design Comparative prospective cohort study.
Setting Four public orthopaedic departments in the Region of Southern Denmark. Participants were recruited between 1 February 2013 and 31 January 2014, and at one of the original four hospitals from 1 February 2014 to 31 January 2015.
Participants Individuals selected from Knee Arthroscopy Cohort Southern Denmark, aged 18-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset).
Interventions Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information on knee pathology. Patient reported outcomes were recorded via online questionnaires.
Main outcome measures Primary outcome was the average between-group difference in change on four of five subscales of the knee injury and osteoarthritis outcome score (KOOS). The four subscales covered pain, symptoms, sport and recreational function, and quality of life (KOOS4). A 95\% confidence interval excluding differences greater than 10 KOOS points between groups was interpreted as absence of a clinically meaningful difference. Analyses adjusted for age, sex, and body mass index.
Results 397 eligible adults (42\% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14\%) patients were lost to follow-up. Statistically, participants with degenerative meniscal tears had a significantly larger improvement in KOOS4 scores than those with traumatic tears (adjusted between-group difference −5.1 (95\% confidence interval −8.9 to −1.3); P=0.008). In the analysis including KOOS4 score at all time points, a significant time-by-group interaction was observed in both the unadjusted (P=0.025) and adjusted analysis (P=0.024), indicating better self-reported outcomes in participants with degenerative tears. However, the difference between groups was at no time point considered clinically meaningful.
Conclusions These results question the current tenet that patients with traumatic meniscal tears experience greater improvements in patient reported outcomes after arthroscopic partial meniscectomy than patients with degenerative tears.
Trial registration ClinicalTrials.gov identifier NCT01871272.},
	language = {en},
	urldate = {2017-02-14},
	journal = {BMJ},
	author = {Thorlund, Jonas Bloch and Englund, Martin and Christensen, Robin and Nissen, Nis and Pihl, Kenneth and Jørgensen, Uffe and Schjerning, Jeppe and Lohmander, L. Stefan},
	month = feb,
	year = {2017},
	pmid = {28153861},
	pages = {j356},
}

Objectives To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears. Design Comparative prospective cohort study. Setting Four public orthopaedic departments in the Region of Southern Denmark. Participants were recruited between 1 February 2013 and 31 January 2014, and at one of the original four hospitals from 1 February 2014 to 31 January 2015. Participants Individuals selected from Knee Arthroscopy Cohort Southern Denmark, aged 18-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset). Interventions Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information on knee pathology. Patient reported outcomes were recorded via online questionnaires. Main outcome measures Primary outcome was the average between-group difference in change on four of five subscales of the knee injury and osteoarthritis outcome score (KOOS). The four subscales covered pain, symptoms, sport and recreational function, and quality of life (KOOS4). A 95% confidence interval excluding differences greater than 10 KOOS points between groups was interpreted as absence of a clinically meaningful difference. Analyses adjusted for age, sex, and body mass index. Results 397 eligible adults (42% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14%) patients were lost to follow-up. Statistically, participants with degenerative meniscal tears had a significantly larger improvement in KOOS4 scores than those with traumatic tears (adjusted between-group difference −5.1 (95% confidence interval −8.9 to −1.3); P=0.008). In the analysis including KOOS4 score at all time points, a significant time-by-group interaction was observed in both the unadjusted (P=0.025) and adjusted analysis (P=0.024), indicating better self-reported outcomes in participants with degenerative tears. However, the difference between groups was at no time point considered clinically meaningful. Conclusions These results question the current tenet that patients with traumatic meniscal tears experience greater improvements in patient reported outcomes after arthroscopic partial meniscectomy than patients with degenerative tears. Trial registration ClinicalTrials.gov identifier NCT01871272.

@article{siemieniuk_arthroscopic_2017,
	title = {Arthroscopic surgery for degenerative knee arthritis and meniscal tears: {A} clinical practice guideline.},
	volume = {357},
	issn = {1756-1833},
	shorttitle = {Arthroscopic surgery for degenerative knee arthritis and meniscal tears},
	url = {https://doi.org/10.1136/bmj.j1982},
	doi = {10.1136/bmj.j1982},
	language = {eng},
	journal = {BMJ (Clinical research ed.)},
	author = {Siemieniuk, Reed A. C. and Harris, Ian A. and Agoritsas, Thomas and Poolman, Rudolf W. and Brignardello-Petersen, Romina and Van de Velde, Stijn and Buchbinder, Rachelle and Englund, Martin and Lytvyn, Lyubov and Quinlan, Casey and Helsingen, Lise and Knutsen, Gunnar and Olsen, Nina Rydland and Macdonald, Helen and Hailey, Louise and Wilson, Hazel M. and Lydiatt, Anne and Kristiansen, Annette},
	month = may,
	year = {2017},
	pmid = {28490431},
	pmcid = {PMC5426368},
	pages = {j1982},
}

@article{zhang_factors_2017,
	title = {Factors associated with meniscal body extrusion on knee {MRI} in overweight and obese women.},
	volume = {25},
	issn = {1522-9653},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2016.12.001},
	doi = {10.1016/j.joca.2016.12.001},
	abstract = {OBJECTIVE: To determine factors associated with higher degree of meniscal body extrusion in overweight and obese women at high risk of knee osteoarthritis (OA).
DESIGN: We used baseline data of the PRevention of knee Osteoarthritis in Overweight Females (PROOF) study, Netherlands, comprising overweight or obese women aged 50-60 years, free of clinical knee OA. All subjects completed a questionnaire on knee complaints and physical activity, underwent physical examination, radiography, and 1.5 T magnetic resonance imaging (MRI) of both knees. Using the mid-coronal MRI slice, one blinded observer measured tibial plateau width and meniscal body extrusion of both menisci in both knees. The association between baseline factors and meniscal extrusion, were analyzed with a random effects regression model. In addition, we used a fixed effect regression model for evaluation of knee-specific factors.
RESULTS: Mean age of the included women (n = 395) was 55.7 years and mean body mass index (BMI) 32.4 kg/m(2). Of all knees, 23\% had an absolute medial meniscus body extrusion ≥3.0 mm and 4\% had lateral meniscus body extrusion ≥3.0 mm. In the multivariable model, the medial meniscus extrusion was increased by 0.44 mm (95\% confidence interval [CI] 0.11, 0.77) when a medial meniscus tear was present, by 0.20 mm per 5 kg/m(2) (95\% CI 0.05, 0.35) increase in BMI and by 0.25 in the presence of mild knee symptoms (95\% CI 0.05 to 0.44). Kellgren-Lawrence (KL) grade ≥1 and tibia width were associated with increased both medial and lateral extrusion.
CONCLUSION: In women, ipsilateral meniscus tear and high BMI are factors associated with medial meniscus body extrusion.},
	language = {eng},
	number = {5},
	journal = {Osteoarthritis and Cartilage},
	author = {Zhang, F. and Bierma-Zeinstra, S. M. and Oei, E. H. G. and Turkiewicz, A. and Englund, M. and Runhaar, J.},
	month = may,
	year = {2017},
	pmid = {27939623},
	keywords = {Knee, Magnetic resonance imaging, Meniscus, Osteoarthritis, women},
	pages = {694--699},
}

OBJECTIVE: To determine factors associated with higher degree of meniscal body extrusion in overweight and obese women at high risk of knee osteoarthritis (OA). DESIGN: We used baseline data of the PRevention of knee Osteoarthritis in Overweight Females (PROOF) study, Netherlands, comprising overweight or obese women aged 50-60 years, free of clinical knee OA. All subjects completed a questionnaire on knee complaints and physical activity, underwent physical examination, radiography, and 1.5 T magnetic resonance imaging (MRI) of both knees. Using the mid-coronal MRI slice, one blinded observer measured tibial plateau width and meniscal body extrusion of both menisci in both knees. The association between baseline factors and meniscal extrusion, were analyzed with a random effects regression model. In addition, we used a fixed effect regression model for evaluation of knee-specific factors. RESULTS: Mean age of the included women (n = 395) was 55.7 years and mean body mass index (BMI) 32.4 kg/m(2). Of all knees, 23% had an absolute medial meniscus body extrusion ≥3.0 mm and 4% had lateral meniscus body extrusion ≥3.0 mm. In the multivariable model, the medial meniscus extrusion was increased by 0.44 mm (95% confidence interval [CI] 0.11, 0.77) when a medial meniscus tear was present, by 0.20 mm per 5 kg/m(2) (95% CI 0.05, 0.35) increase in BMI and by 0.25 in the presence of mild knee symptoms (95% CI 0.05 to 0.44). Kellgren-Lawrence (KL) grade ≥1 and tibia width were associated with increased both medial and lateral extrusion. CONCLUSION: In women, ipsilateral meniscus tear and high BMI are factors associated with medial meniscus body extrusion.

@article{kiadaliri_mortality_2017,
	title = {Mortality from musculoskeletal disorders including rheumatoid arthritis in southern {Sweden}: {A} multiple-cause-of-death analysis, 1998–2014.},
	volume = {44},
	issn = {0315-162X},
	shorttitle = {Mortality from {Musculoskeletal} {Disorders} {Including} {Rheumatoid} {Arthritis} in {Southern} {Sweden}},
	url = {http://dx.doi.org/10.3899%2Fjrheum.161219},
	doi = {10.3899/jrheum.161219},
	abstract = {OBJECTIVE: To assess mortality related to musculoskeletal (MSK) disorders and rheumatoid arthritis (RA), specifically, among adults (aged ≥ 20 yrs) in southern Sweden using the multiple-cause-of-death approach.
METHODS: All death certificates (DC; n = 201,488) from 1998 to 2014 for adults in the region of Skåne were analyzed when mortality from MSK disorders and RA was listed as the underlying and nonunderlying cause of death (UCD/NUCD). Trends in age-standardized mortality rates (ASMR) were evaluated using joinpoint regression, and associated causes were identified by age- and sex-adjusted observed/expected ratios.
RESULTS: MSK (RA) was mentioned on 2.8\% (0.8\%) of all DC and selected as UCD in 0.6\% (0.2\%), with higher values among women. Proportion of MSK disorder deaths from all deaths increased from 2.7\% in 1998 to 3.1\% in 2014, and declined from 0.9\% to 0.5\% for RA. The mean age at death was higher in DC with mention of MSK/RA than in DC without. The mean ASMR for MSK (RA) was 15.5 (4.3) per 100,000 person-years and declined by 1.1\% (3.8\%) per year during 1998-2014. When MSK/RA were UCD, pneumonia and heart failure were the main NUCD. When MSK/RA were NUCD, the leading UCD were ischemic heart disease and neoplasms. The greatest observed/expected ratios were seen for infectious diseases (including sepsis) and blood diseases.
CONCLUSION: We observed significant reduction in MSK and RA mortality rates and increase in the mean age at death. Further analyses are required to investigate determinants of these improvements in MSK/RA survival and their potential effect on the Swedish healthcare systems.},
	language = {eng},
	number = {5},
	journal = {The Journal of Rheumatology},
	author = {Kiadaliri, Aliasghar A. and Turkiewicz, Aleksandra and Englund, Martin},
	month = may,
	year = {2017},
	pmid = {28250137},
	keywords = {MULTIPLE CAUSES OF DEATH, Mortality, Musculoskeletal disorders, Rheumatoid Arthritis, Sweden},
	pages = {571--579},
}

OBJECTIVE: To assess mortality related to musculoskeletal (MSK) disorders and rheumatoid arthritis (RA), specifically, among adults (aged ≥ 20 yrs) in southern Sweden using the multiple-cause-of-death approach. METHODS: All death certificates (DC; n = 201,488) from 1998 to 2014 for adults in the region of Skåne were analyzed when mortality from MSK disorders and RA was listed as the underlying and nonunderlying cause of death (UCD/NUCD). Trends in age-standardized mortality rates (ASMR) were evaluated using joinpoint regression, and associated causes were identified by age- and sex-adjusted observed/expected ratios. RESULTS: MSK (RA) was mentioned on 2.8% (0.8%) of all DC and selected as UCD in 0.6% (0.2%), with higher values among women. Proportion of MSK disorder deaths from all deaths increased from 2.7% in 1998 to 3.1% in 2014, and declined from 0.9% to 0.5% for RA. The mean age at death was higher in DC with mention of MSK/RA than in DC without. The mean ASMR for MSK (RA) was 15.5 (4.3) per 100,000 person-years and declined by 1.1% (3.8%) per year during 1998-2014. When MSK/RA were UCD, pneumonia and heart failure were the main NUCD. When MSK/RA were NUCD, the leading UCD were ischemic heart disease and neoplasms. The greatest observed/expected ratios were seen for infectious diseases (including sepsis) and blood diseases. CONCLUSION: We observed significant reduction in MSK and RA mortality rates and increase in the mean age at death. Further analyses are required to investigate determinants of these improvements in MSK/RA survival and their potential effect on the Swedish healthcare systems.

@article{neuman_concentrations_2017,
	title = {Concentrations of synovial fluid biomarkers and the prediction of knee osteoarthritis 16 years after anterior cruciate ligament injury.},
	volume = {25},
	issn = {1522-9653},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2016.09.008},
	doi = {10.1016/j.joca.2016.09.008},
	abstract = {OBJECTIVE: To describe the longitudinal patterns of release, and investigate the association between a set of synovial fluid biomarkers at the acute and chronic stage and the development of radiographic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury.
DESIGN: Synovial fluid was aspirated from the acutely ACL-injured knee within the first 2weeks (acute samples), and yearly (chronic samples) up to 7.5 years after injury in 88 subjects (60\% men). Non-injured subjects (n = 12) were used as reference group. Aggrecan, cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3 and tissue inhibitor of metalloproteinase (TIMP)-1 in synovial fluid were quantified by immunoassays. The presence of radiographic tibiofemoral (TF) or patellofemoral (PF) OA [Kellgren and Lawrence (K\&L) ≥2] was examined with weight-bearing knee radiography 16 years after the ACL injury.
RESULTS: The average acute and chronic SF concentrations of COMP and aggrecan were elevated in comparison with the reference group (P {\textless} 0.001). The levels of COMP and aggrecan clearly decreased approximately half a year after the ACL injury, and returned to reference values during the 7.5 years of follow-up. Using logistic regression analysis neither acute nor chronic concentrations of the four biomarkers were associated with the development of radiographic knee OA at the 16 year follow-up.
CONCLUSION: Increased synovial fluid concentrations of aggrecan and COMP was related to knee injury, but acute and chronic synovial fluid concentrations of aggrecan, COMP, MMP-3 and TIMP-1 failed to predict knee OA 16 years after ACL injury.},
	language = {eng},
	number = {4},
	journal = {Osteoarthritis and Cartilage},
	author = {Neuman, P. and Dahlberg, L. E. and Englund, M. and Struglics, A.},
	month = apr,
	year = {2017},
	pmid = {27654964},
	keywords = {ACL, Biomarkers, Knee OA, Synovial Fluid},
	pages = {492--498},
}

OBJECTIVE: To describe the longitudinal patterns of release, and investigate the association between a set of synovial fluid biomarkers at the acute and chronic stage and the development of radiographic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. DESIGN: Synovial fluid was aspirated from the acutely ACL-injured knee within the first 2weeks (acute samples), and yearly (chronic samples) up to 7.5 years after injury in 88 subjects (60% men). Non-injured subjects (n = 12) were used as reference group. Aggrecan, cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3 and tissue inhibitor of metalloproteinase (TIMP)-1 in synovial fluid were quantified by immunoassays. The presence of radiographic tibiofemoral (TF) or patellofemoral (PF) OA [Kellgren and Lawrence (K&L) ≥2] was examined with weight-bearing knee radiography 16 years after the ACL injury. RESULTS: The average acute and chronic SF concentrations of COMP and aggrecan were elevated in comparison with the reference group (P \textless 0.001). The levels of COMP and aggrecan clearly decreased approximately half a year after the ACL injury, and returned to reference values during the 7.5 years of follow-up. Using logistic regression analysis neither acute nor chronic concentrations of the four biomarkers were associated with the development of radiographic knee OA at the 16 year follow-up. CONCLUSION: Increased synovial fluid concentrations of aggrecan and COMP was related to knee injury, but acute and chronic synovial fluid concentrations of aggrecan, COMP, MMP-3 and TIMP-1 failed to predict knee OA 16 years after ACL injury.

@article{jarraya_meniscus_2017,
	title = {Meniscus morphology: {Does} tear type matter? {A} narrative review with focus on relevance for osteoarthritis research.},
	volume = {46},
	issn = {1532-866X},
	shorttitle = {Meniscus morphology},
	url = {http://dx.doi.org/10.1016%2Fj.semarthrit.2016.11.005},
	doi = {10.1016/j.semarthrit.2016.11.005},
	abstract = {OBJECTIVE: To give a narrative overview of meniscal tears with a radiologic emphasis on the morphologic type, technical considerations, and on the relevance of the type of meniscal tear in the context of osteoarthritis (OA) research.
DESIGN: Total 20 years of the PubMed database were searched for epidemiological, radiological, arthroscopic and biomechanical reports, and review articles focusing on meniscal tears in middle-aged and older individuals, in the setting of OA. Case reports, publications on meniscal tears in young active individuals, and publications not in English were excluded.
RESULTS: Meniscal intra-substance signal abnormalities are associated with an increased risk of a degenerative meniscal tear in the same segment. Posterior radial tears of the medial meniscus appear to be a highly relevant event in OA of the knee, with associated cartilage loss and meniscal extrusion. Radial tears are more commonly missed on MRI than other types, and should be carefully looked for on coronal and axial images. While medial meniscus posterior root tears are of "radial" morphology, there is growing interest in looking at them as a separate entity, mainly because they require a different therapeutic approach.
CONCLUSION: There is a lack of data on the relevance of different morphologic types of meniscal tears to the natural history of knee OA, both cross-sectionally and-especially-longitudinally. Further epidemiologic studies should focus on specific meniscal tears based on their morphology to better understand their relevance in the genesis and progression of knee OA.},
	language = {eng},
	number = {5},
	journal = {Seminars in Arthritis and Rheumatism},
	author = {Jarraya, Mohamed and Roemer, Frank W. and Englund, Martin and Crema, Michel D. and Gale, Heather I. and Hayashi, Daichi and Katz, Jeffrey N. and Guermazi, Ali},
	month = apr,
	year = {2017},
	pmid = {28057326},
	keywords = {Degenerative tears, Magnetic resonance imaging, Meniscal tear, Osteoarthritis},
	pages = {552--561},
}

OBJECTIVE: To give a narrative overview of meniscal tears with a radiologic emphasis on the morphologic type, technical considerations, and on the relevance of the type of meniscal tear in the context of osteoarthritis (OA) research. DESIGN: Total 20 years of the PubMed database were searched for epidemiological, radiological, arthroscopic and biomechanical reports, and review articles focusing on meniscal tears in middle-aged and older individuals, in the setting of OA. Case reports, publications on meniscal tears in young active individuals, and publications not in English were excluded. RESULTS: Meniscal intra-substance signal abnormalities are associated with an increased risk of a degenerative meniscal tear in the same segment. Posterior radial tears of the medial meniscus appear to be a highly relevant event in OA of the knee, with associated cartilage loss and meniscal extrusion. Radial tears are more commonly missed on MRI than other types, and should be carefully looked for on coronal and axial images. While medial meniscus posterior root tears are of "radial" morphology, there is growing interest in looking at them as a separate entity, mainly because they require a different therapeutic approach. CONCLUSION: There is a lack of data on the relevance of different morphologic types of meniscal tears to the natural history of knee OA, both cross-sectionally and-especially-longitudinally. Further epidemiologic studies should focus on specific meniscal tears based on their morphology to better understand their relevance in the genesis and progression of knee OA.

@article{stigmar_sick_2017,
	title = {Sick leave in {Sweden} before and after total joint replacement in hip and knee osteoarthritis patients.},
	volume = {88},
	issn = {1745-3674},
	url = {http://dx.doi.org/10.1080/17453674.2016.1269051},
	doi = {10.1080/17453674.2016.1269051},
	abstract = {Background and purpose — Little is know about patterns of sick leave in connection with total hip and knee joint replacement (THR and TKR) in patients with osteoarthritis (OA).Patients and methods — Using registers from southern Sweden, we identified hip and knee OA patients aged 40–59 years who had a THR or TKR in the period 2004–2012. Patients who died or started on disability pension were excluded. We included 1,307 patients with THR (46\% women) and 996 patients with TKR (56\% women). For the period 1 year before until 2 years after the surgery, we linked individual-level data on sick leave from the Swedish Social Insurance Agency. We created a matched reference cohort from the general population by age, birth year, and area of residence (THR: n = 4,604; TKR: n = 3,425). The mean number of days on sick leave and the proportion (\%) on sick leave 12 and 24 months before and after surgery were calculated.Results — The month after surgery, about 90\% of patients in both cohorts were on sick leave. At the two-year follow-up, sick leave was lower for both cohorts than 1 year before surgery, except for men with THR, but about 9\% of the THR patients and 12–17\% of the TKR patients were still sick-listed. In the matched reference cohorts, sick leave was constant at around 4–7\% during the entire study period.Interpretation — A long period of sick leave is common after total joint replacement, especially after TKR. There is a need for better knowledge on how workplace adjustments and rehabilitation can facilitate the return to work and can postpone surgery.},
	number = {2},
	urldate = {2017-04-18},
	journal = {Acta Orthopaedica},
	author = {Stigmar, Kjerstin and Dahlberg, Leif E. and Zhou, Caddie and Lidgren, Helena Jacobson and Petersson, Ingemar F. and Englund, Martin},
	month = mar,
	year = {2017},
	pmid = {27996342},
	pages = {152--157},
}

Background and purpose — Little is know about patterns of sick leave in connection with total hip and knee joint replacement (THR and TKR) in patients with osteoarthritis (OA).Patients and methods — Using registers from southern Sweden, we identified hip and knee OA patients aged 40–59 years who had a THR or TKR in the period 2004–2012. Patients who died or started on disability pension were excluded. We included 1,307 patients with THR (46% women) and 996 patients with TKR (56% women). For the period 1 year before until 2 years after the surgery, we linked individual-level data on sick leave from the Swedish Social Insurance Agency. We created a matched reference cohort from the general population by age, birth year, and area of residence (THR: n = 4,604; TKR: n = 3,425). The mean number of days on sick leave and the proportion (%) on sick leave 12 and 24 months before and after surgery were calculated.Results — The month after surgery, about 90% of patients in both cohorts were on sick leave. At the two-year follow-up, sick leave was lower for both cohorts than 1 year before surgery, except for men with THR, but about 9% of the THR patients and 12–17% of the TKR patients were still sick-listed. In the matched reference cohorts, sick leave was constant at around 4–7% during the entire study period.Interpretation — A long period of sick leave is common after total joint replacement, especially after TKR. There is a need for better knowledge on how workplace adjustments and rehabilitation can facilitate the return to work and can postpone surgery.

@article{tornbjerg_structural_2017,
	title = {Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery.},
	volume = {51},
	copyright = {Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/},
	issn = {0306-3674, 1473-0480},
	url = {http://bjsm.bmj.com/content/51/6/525},
	doi = {10.1136/bjsports-2016-096456},
	abstract = {Background The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal surgery.
Methods This study included 443 patients from the Knee Arthroscopy Cohort Southern Denmark (KACS), a prospective cohort following patients 18 years or older undergoing arthroscopic meniscal surgery at 4 hospitals between 1 February 2013 and 31 January 2014. Patient-reported outcomes, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), were obtained by online questionnaires prior to surgery. Knee pathology was assessed by the operating surgeons using a modified version of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears questionnaire, supplemented with information extracted from surgery reports. Following hypothesis-driven preselection of candidate variables, backward elimination regressions were performed to investigate associations between patient-reported outcomes and structural knee pathologies.
Results Regression models only explained a small proportion of the variability in self-reported pain and function (adjusted R2=0.10−0.12) and this association was mainly driven by age, gender and body mass index.
Conclusions Specific meniscal pathology and other structural joint pathologies found at meniscal surgery were not associated with preoperative self-reported pain and function in patients with meniscal tears questioning inferences made about a direct relationship between these. Our findings question the role of arthroscopic surgery to address structural pathology as a means to improve patient-reported outcomes in patients having surgery for a meniscal tear.},
	language = {en},
	number = {6},
	urldate = {2017-04-11},
	journal = {British Journal of Sports Medicine},
	author = {Tornbjerg, Simon Maretti and Nissen, Nis and Englund, Martin and Jørgensen, Uffe and Schjerning, Jeppe and Lohmander, L. Stefan and Thorlund, Jonas Bloch},
	month = mar,
	year = {2017},
	pmid = {27638845},
	keywords = {Arthroscopy, Knee, Meniscus, Surgery},
	pages = {525--530},
}

Background The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal surgery. Methods This study included 443 patients from the Knee Arthroscopy Cohort Southern Denmark (KACS), a prospective cohort following patients 18 years or older undergoing arthroscopic meniscal surgery at 4 hospitals between 1 February 2013 and 31 January 2014. Patient-reported outcomes, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), were obtained by online questionnaires prior to surgery. Knee pathology was assessed by the operating surgeons using a modified version of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears questionnaire, supplemented with information extracted from surgery reports. Following hypothesis-driven preselection of candidate variables, backward elimination regressions were performed to investigate associations between patient-reported outcomes and structural knee pathologies. Results Regression models only explained a small proportion of the variability in self-reported pain and function (adjusted R2=0.10−0.12) and this association was mainly driven by age, gender and body mass index. Conclusions Specific meniscal pathology and other structural joint pathologies found at meniscal surgery were not associated with preoperative self-reported pain and function in patients with meniscal tears questioning inferences made about a direct relationship between these. Our findings question the role of arthroscopic surgery to address structural pathology as a means to improve patient-reported outcomes in patients having surgery for a meniscal tear.

@article{beaufils_surgical_2017,
	title = {Surgical management of degenerative meniscus lesions: {The} 2016 {ESSKA} meniscus consensus.},
	volume = {25},
	issn = {0942-2056, 1433-7347},
	shorttitle = {Surgical management of degenerative meniscus lesions},
	url = {https://link.springer.com/article/10.1007/s00167-016-4407-4},
	doi = {10.1007/s00167-016-4407-4},
	abstract = {PurposeA degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middle-aged or older person. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic partial meniscectomy compared to non-operative treatment, sham surgery or sham arthroscopic partial meniscectomy. These results introduced controversy in the medical community and made clinical decision-making challenging in the daily clinical practice. To facilitate the clinical decision-making process, a consensus was developed. This initiative was endorsed by ESSKA.MethodsA degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. The project followed the so-called formal consensus process, involving a steering group, a rating group and a peer-review group. A total of 84 surgeons and scientists from 22 European countries were included in the process. Twenty questions, their associated answers and an algorithm based on extensive literature review and clinical expertise, were proposed. Each question and answer set was graded according to the scientific level of the corresponding literature.ResultsThe main finding was that arthroscopic partial meniscectomy should not be proposed as a first line of treatment for degenerative meniscus lesions. Arthroscopic partial meniscectomy should only be considered after a proper standardised clinical and radiological evaluation and when the response to non-operative management has not been satisfactory. Magnetic resonance imaging of the knee is typically not indicated in the first-line work-up, but knee radiography should be used as an imaging tool to support a diagnosis of osteoarthritis or to detect certain rare pathologies, such as tumours or fractures of the knee.DiscussionThe present work offers a clear framework for the management of degenerative meniscus lesions, with the aim to balance information extracted from the scientific evidence and clinical expertise. Because of biases and weaknesses of the current literature and lack of definition of important criteria such as mechanical symptoms, it cannot be considered as an exact treatment algorithm. It summarises the results of the “ESSKA Meniscus Consensus Project” (http://www.esska.org/education/projects) and is the first official European consensus on this topic. The consensus may be updated and refined as more high-quality evidence emerges.Level of evidenceI.},
	language = {en},
	number = {2},
	urldate = {2017-05-09},
	journal = {Knee Surgery, Sports Traumatology, Arthroscopy},
	author = {Beaufils, Ph and Becker, R. and Kopf, S. and Englund, M. and Verdonk, R. and Ollivier, M. and Seil, R.},
	month = feb,
	year = {2017},
	pages = {335--346},
}

PurposeA degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middle-aged or older person. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic partial meniscectomy compared to non-operative treatment, sham surgery or sham arthroscopic partial meniscectomy. These results introduced controversy in the medical community and made clinical decision-making challenging in the daily clinical practice. To facilitate the clinical decision-making process, a consensus was developed. This initiative was endorsed by ESSKA.MethodsA degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. The project followed the so-called formal consensus process, involving a steering group, a rating group and a peer-review group. A total of 84 surgeons and scientists from 22 European countries were included in the process. Twenty questions, their associated answers and an algorithm based on extensive literature review and clinical expertise, were proposed. Each question and answer set was graded according to the scientific level of the corresponding literature.ResultsThe main finding was that arthroscopic partial meniscectomy should not be proposed as a first line of treatment for degenerative meniscus lesions. Arthroscopic partial meniscectomy should only be considered after a proper standardised clinical and radiological evaluation and when the response to non-operative management has not been satisfactory. Magnetic resonance imaging of the knee is typically not indicated in the first-line work-up, but knee radiography should be used as an imaging tool to support a diagnosis of osteoarthritis or to detect certain rare pathologies, such as tumours or fractures of the knee.DiscussionThe present work offers a clear framework for the management of degenerative meniscus lesions, with the aim to balance information extracted from the scientific evidence and clinical expertise. Because of biases and weaknesses of the current literature and lack of definition of important criteria such as mechanical symptoms, it cannot be considered as an exact treatment algorithm. It summarises the results of the “ESSKA Meniscus Consensus Project” (http://www.esska.org/education/projects) and is the first official European consensus on this topic. The consensus may be updated and refined as more high-quality evidence emerges.Level of evidenceI.

@article{suter_projecting_2017,
	title = {Projecting lifetime risk of symptomatic knee osteoarthritis and total knee replacement in individuals sustaining a complete anterior cruciate ligament tear in early adulthood.},
	volume = {69},
	issn = {2151-4658},
	url = {http://dx.doi.org/10.1002%2Facr.22940},
	doi = {10.1002/acr.22940},
	abstract = {OBJECTIVE: To estimate the lifetime risk of knee osteoarthritis (OA) and total knee replacement (TKR) in persons sustaining anterior cruciate ligament (ACL) tear by age 25 years.
METHODS: We used the Osteoarthritis Policy Model to project the cumulative incidence of symptomatic knee OA requiring TKR in varying situations: no prevalent or incident injury; isolated ACL tear, surgically treated; isolated ACL tear, nonoperatively treated; or a prevalent history or surgically treated ACL and meniscal tear (MT). We estimated MT prevalence and incidence and increased risk of knee OA associated with ACL injury and MT from published literature. We conducted a range of sensitivity analyses to examine the impact of uncertainty in input parameters.
RESULTS: Estimated lifetime risk of symptomatic knee OA was 34\% for the cohort with ACL injury and MT, compared to 14\% for the no-injury cohort. ACL injury without MT was associated with a lifetime risk of knee OA between 16\% and 17\%, depending on ACL treatment modality. Estimated lifetime risk of TKR ranged from 6\% in the no-injury cohort to 22\% for the ACL injury and MT cohort. Subjects in the ACL injury and MT cohort developed OA approximately 1.5 years earlier (55.7 versus 57.1) and underwent TKR approximately 2 years earlier (66 versus 68) than the cohort without knee injuries.
CONCLUSION: Sustaining ACL injury early in adulthood leads to greater lifetime risk and earlier onset of knee OA and TKR; concomitant MTs compound this risk. These data provide insight into the impact of sustainable injury prevention interventions in young adults.},
	language = {eng},
	number = {2},
	journal = {Arthritis Care \& Research},
	author = {Suter, Lisa G. and Smith, Savannah R. and Katz, Jeffrey N. and Englund, Martin and Hunter, David J. and Frobell, Richard and Losina, Elena},
	month = feb,
	year = {2017},
	pmid = {27214559},
	pmcid = {PMC5121085},
	keywords = {Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Arthroplasty, Replacement, Knee, Cohort Studies, Computer Simulation, Female, Humans, Male, Osteoarthritis, Knee, Risk, Young Adult},
	pages = {201--208},
}

OBJECTIVE: To estimate the lifetime risk of knee osteoarthritis (OA) and total knee replacement (TKR) in persons sustaining anterior cruciate ligament (ACL) tear by age 25 years. METHODS: We used the Osteoarthritis Policy Model to project the cumulative incidence of symptomatic knee OA requiring TKR in varying situations: no prevalent or incident injury; isolated ACL tear, surgically treated; isolated ACL tear, nonoperatively treated; or a prevalent history or surgically treated ACL and meniscal tear (MT). We estimated MT prevalence and incidence and increased risk of knee OA associated with ACL injury and MT from published literature. We conducted a range of sensitivity analyses to examine the impact of uncertainty in input parameters. RESULTS: Estimated lifetime risk of symptomatic knee OA was 34% for the cohort with ACL injury and MT, compared to 14% for the no-injury cohort. ACL injury without MT was associated with a lifetime risk of knee OA between 16% and 17%, depending on ACL treatment modality. Estimated lifetime risk of TKR ranged from 6% in the no-injury cohort to 22% for the ACL injury and MT cohort. Subjects in the ACL injury and MT cohort developed OA approximately 1.5 years earlier (55.7 versus 57.1) and underwent TKR approximately 2 years earlier (66 versus 68) than the cohort without knee injuries. CONCLUSION: Sustaining ACL injury early in adulthood leads to greater lifetime risk and earlier onset of knee OA and TKR; concomitant MTs compound this risk. These data provide insight into the impact of sustainable injury prevention interventions in young adults.

@article{hubertsson_understanding_2017,
	title = {Understanding occupation, sick leave, and disability pension due to knee and hip osteoarthritis from a sex perspective.},
	volume = {69},
	issn = {2151-4658},
	url = {http://dx.doi.org/10.1002%2Facr.22909},
	doi = {10.1002/acr.22909},
	abstract = {OBJECTIVE: To investigate the association between occupation and risk for sick leave or disability pension due to knee or hip osteoarthritis (OA) from a sex perspective.
METHODS: We conducted a population-based study including residents ages 40-70 years in the Skåne region, Sweden (2007) and working in the included job sectors (n = 165,179). We retrieved data on cause-specific sick leave and disability pension (2007-2012) and linked to individual information on occupation and education (2007). Occupations were classified into job sectors. We calculated sex-specific, age-adjusted odds ratios (ORs) of sick leave and disability pension due to OA in traditionally female-dominated job sectors (health care, child care, and cleaning) and traditionally male-dominated job sectors (construction, farming, metal work, or transportation) compared to business and administration.
RESULTS: Of all eligible subjects, 2,445 had sick leave or disability pension due to knee or hip OA. Adjusted for age, the risk of sick leave due to knee OA was increased for women working in health care, with an OR of 3.3 (95\% confidence interval [95\% CI] 2.6-4.2), child care OR 2.9 (95\% CI 2.2-3.8), and cleaning OR 3.0 (95\% CI 2.2-4.1), as was the risk for disability pension. The risk was increased also for persons working in occupations with higher educational requirements. The risk was similarly increased in male-dominated sectors. In female-dominated job sectors the risk of sick leave and disability pension due to knee OA, but not hip OA, was higher than that for other musculoskeletal diseases.
CONCLUSION: Traditionally female-dominated occupational sectors are associated with an increased risk of sick leave and disability pension due to knee OA.},
	language = {eng},
	number = {2},
	journal = {Arthritis Care \& Research},
	author = {Hubertsson, Jenny and Turkiewicz, Aleksandra and Petersson, Ingemar F. and Englund, Martin},
	month = feb,
	year = {2017},
	pmid = {27110664},
	keywords = {Adult, Aged, Cohort Studies, Disability Evaluation, Female, Humans, Male, Middle Aged, Occupational Exposure, Odds Ratio, Osteoarthritis, Hip, Osteoarthritis, Knee, Sex Factors, Sick leave, Sweden},
	pages = {226--233},
}

OBJECTIVE: To investigate the association between occupation and risk for sick leave or disability pension due to knee or hip osteoarthritis (OA) from a sex perspective. METHODS: We conducted a population-based study including residents ages 40-70 years in the Skåne region, Sweden (2007) and working in the included job sectors (n = 165,179). We retrieved data on cause-specific sick leave and disability pension (2007-2012) and linked to individual information on occupation and education (2007). Occupations were classified into job sectors. We calculated sex-specific, age-adjusted odds ratios (ORs) of sick leave and disability pension due to OA in traditionally female-dominated job sectors (health care, child care, and cleaning) and traditionally male-dominated job sectors (construction, farming, metal work, or transportation) compared to business and administration. RESULTS: Of all eligible subjects, 2,445 had sick leave or disability pension due to knee or hip OA. Adjusted for age, the risk of sick leave due to knee OA was increased for women working in health care, with an OR of 3.3 (95% confidence interval [95% CI] 2.6-4.2), child care OR 2.9 (95% CI 2.2-3.8), and cleaning OR 3.0 (95% CI 2.2-4.1), as was the risk for disability pension. The risk was increased also for persons working in occupations with higher educational requirements. The risk was similarly increased in male-dominated sectors. In female-dominated job sectors the risk of sick leave and disability pension due to knee OA, but not hip OA, was higher than that for other musculoskeletal diseases. CONCLUSION: Traditionally female-dominated occupational sectors are associated with an increased risk of sick leave and disability pension due to knee OA.

@article{nordenskjold_prevalence_2017,
	title = {Prevalence and incidence of doctor-diagnosed {Dupuytren}’s disease: {A} population-based study.},
	volume = {42},
	issn = {1753-1934},
	shorttitle = {Prevalence and incidence of doctor-diagnosed {Dupuytren}’s disease},
	url = {http://dx.doi.org/10.1177/1753193416687914},
	doi = {10.1177/1753193416687914},
	abstract = {The prevalence and incidence of doctor-diagnosed Dupuytren’s disease in the general population is unknown. From the healthcare register for Skåne region (population 1.3 million) in southern Sweden, we identified all residents aged ⩾20 years (on 31 December 2013), who 1998 to 2013 had consulted a doctor and received the diagnosis Dupuytren’s disease (International Classification of Diseases 10th Revision code M720). During the 16 years, 7207 current residents (72\% men) had been diagnosed with Dupuytren’s disease; the prevalence among men was 1.35\% and among women 0.5\%. Of all people diagnosed, 56\% had received treatment (87\% fasciectomy). In 2013, the incidence of first-time doctor-diagnosed Dupuytren’s disease among men was 14 and among women five per 10,000. The annual incidence among men aged ⩾50 years was 27 per 10,000. Clinically important Dupuytren’s disease is common in the general population., Level of evidence: III},
	language = {en},
	number = {7},
	urldate = {2017-02-27},
	journal = {Journal of Hand Surgery (European Volume)},
	author = {Nordenskjöld, J. and Englund, M. and Zhou, C. and Atroshi, I.},
	month = jan,
	year = {2017},
	pages = {673--677},
}

The prevalence and incidence of doctor-diagnosed Dupuytren’s disease in the general population is unknown. From the healthcare register for Skåne region (population 1.3 million) in southern Sweden, we identified all residents aged ⩾20 years (on 31 December 2013), who 1998 to 2013 had consulted a doctor and received the diagnosis Dupuytren’s disease (International Classification of Diseases 10th Revision code M720). During the 16 years, 7207 current residents (72% men) had been diagnosed with Dupuytren’s disease; the prevalence among men was 1.35% and among women 0.5%. Of all people diagnosed, 56% had received treatment (87% fasciectomy). In 2013, the incidence of first-time doctor-diagnosed Dupuytren’s disease among men was 14 and among women five per 10,000. The annual incidence among men aged ⩾50 years was 27 per 10,000. Clinically important Dupuytren’s disease is common in the general population., Level of evidence: III

@article{olofsson_predictors_2017,
	title = {Predictors of work disability after start of anti-{TNF} therapy in a national cohort of {Swedish} patients with rheumatoid arthritis: {Does} early anti-{TNF} therapy bring patients back to work?},
	volume = {76},
	issn = {1468-2060},
	shorttitle = {Predictors of work disability after start of anti-{TNF} therapy in a national cohort of {Swedish} patients with rheumatoid arthritis},
	url = {http://dx.doi.org/10.1136/annrheumdis-2016-210239},
	doi = {10.1136/annrheumdis-2016-210239},
	abstract = {OBJECTIVES: To examine predictors of work ability gain and loss after anti-tumour necrosis factor (TNF) start, respectively, in working-age patients with rheumatoid arthritis (RA) with a special focus on disease duration.
METHODS: Patients with RA, aged 19-62 years, starting their first TNF inhibitor 2006-2009 with full work ability (0 sick leave/disability pension days during 3 months before bio-start; n=1048) or no work ability (90 days; n=753) were identified in the Swedish biologics register (Anti-Rheumatic Treatment In Sweden, ARTIS) and sick leave/disability pension days retrieved from the Social Insurance Agency. Outcome was defined as work ability gain ≥50\% for patients without work ability at bio-start and work ability loss ≥50\% for patients with full work ability, and survival analyses conducted. Baseline predictors including disease duration, age, sex, education level, employment, Health Assessment Questionnaire, Disease Activity Score 28 and relevant comorbidities were estimated using Cox regression.
RESULTS: During 3 years after anti-TNF start, the probability of regaining work ability for totally work-disabled patients was 35\% for those with disease duration {\textless}5 years and 14\% for disease duration ≥5 years (adjusted HR 2.1 (95\% CI 1.4 to 3.2)). For patients with full work ability at bio-start, disease duration did not predict work ability loss. Baseline disability pension was also a strong predictor of work ability gain after treatment start.
CONCLUSIONS: A substantial proportion of work-disabled patients with RA who start anti-TNF therapy regain work ability. Those initiating treatment within 5 years of symptom onset have a more than doubled 3-year probability of regaining work ability compared with later treatment starts. This effect seems largely due to the impact of disease duration on disability pension status.},
	language = {eng},
	number = {7},
	journal = {Annals of the Rheumatic Diseases},
	author = {Olofsson, T. and Petersson, I. F. and Eriksson, J. K. and Englund, M. and Nilsson, J. A. and Geborek, P. and Jacobsson, L. T. H. and Askling, J. and Neovius, M. and {ARTIS Study Group}},
	month = jan,
	year = {2017},
	pmid = {28073801},
	keywords = {Anti-TNF, DMARDs (biologic), Outcomes research, Rheumatoid Arthritis, Social work},
	pages = {1245--1252},
}

OBJECTIVES: To examine predictors of work ability gain and loss after anti-tumour necrosis factor (TNF) start, respectively, in working-age patients with rheumatoid arthritis (RA) with a special focus on disease duration. METHODS: Patients with RA, aged 19-62 years, starting their first TNF inhibitor 2006-2009 with full work ability (0 sick leave/disability pension days during 3 months before bio-start; n=1048) or no work ability (90 days; n=753) were identified in the Swedish biologics register (Anti-Rheumatic Treatment In Sweden, ARTIS) and sick leave/disability pension days retrieved from the Social Insurance Agency. Outcome was defined as work ability gain ≥50% for patients without work ability at bio-start and work ability loss ≥50% for patients with full work ability, and survival analyses conducted. Baseline predictors including disease duration, age, sex, education level, employment, Health Assessment Questionnaire, Disease Activity Score 28 and relevant comorbidities were estimated using Cox regression. RESULTS: During 3 years after anti-TNF start, the probability of regaining work ability for totally work-disabled patients was 35% for those with disease duration \textless5 years and 14% for disease duration ≥5 years (adjusted HR 2.1 (95% CI 1.4 to 3.2)). For patients with full work ability at bio-start, disease duration did not predict work ability loss. Baseline disability pension was also a strong predictor of work ability gain after treatment start. CONCLUSIONS: A substantial proportion of work-disabled patients with RA who start anti-TNF therapy regain work ability. Those initiating treatment within 5 years of symptom onset have a more than doubled 3-year probability of regaining work ability compared with later treatment starts. This effect seems largely due to the impact of disease duration on disability pension status.

@article{roemer_partial_2017,
	title = {Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year.},
	volume = {27},
	issn = {1432-1084},
	url = {http://dx.doi.org/10.1007%2Fs00330-016-4361-z},
	doi = {10.1007/s00330-016-4361-z},
	abstract = {OBJECTIVES: To assess whether partial meniscectomy is associated with increased risk of radiographic osteoarthritis (ROA) and worsening cartilage damage in the following year.
METHODS: We studied 355 knees from the Osteoarthritis Initiative that developed ROA (Kellgren-Lawrence grade ≥ 2), which were matched with control knees. The MR images were assessed using the semi-quantitative MOAKS system. Conditional logistic regression was applied to estimate risk of incident ROA. Logistic regression was used to assess the risk of worsening cartilage damage in knees with partial meniscectomy that developed ROA.
RESULTS: In the group with incident ROA, 4.4 \% underwent partial meniscectomy during the year prior to the case-defining visit, compared with none of the knees that did not develop ROA. All (n = 31) knees that had partial meniscectomy and 58.9 \% (n = 165) of the knees with prevalent meniscal damage developed ROA (OR = 2.51, 95 \% CI [1.73, 3.64]). In knees that developed ROA, partial meniscectomy was associated with an increased risk of worsening cartilage damage (OR = 4.51, 95 \% CI [1.53, 13.33]).
CONCLUSIONS: The probability of having had partial meniscectomy was higher in knees that developed ROA. When looking only at knees that developed ROA, partial meniscectomy was associated with greater risk of worsening cartilage damage.
KEY POINTS: • Partial meniscectomy is a controversial treatment option for degenerative meniscal tears. • Partial meniscectomy is strongly associated with incident osteoarthritis within 1 year. • Partial meniscectomy is associated with increased risk of worsening cartilage damage.},
	language = {eng},
	number = {1},
	journal = {European Radiology},
	author = {Roemer, Frank W. and Kwoh, C. Kent and Hannon, Michael J. and Hunter, David J. and Eckstein, Felix and Grago, Jason and Boudreau, Robert M. and Englund, Martin and Guermazi, Ali},
	month = jan,
	year = {2017},
	pmid = {27121931},
	pmcid = {PMC5083232},
	keywords = {Cartilage Diseases, Cartilage loss, Cartilage, Articular, Female, Humans, Incidental Findings, MRI, Magnetic resonance imaging, Male, Menisci, Tibial, Meniscus, Middle Aged, Osteoarthritis, Osteoarthritis, Knee, Partial meniscectomy, Risk, Tibial Meniscus Injuries},
	pages = {404--413},
}

OBJECTIVES: To assess whether partial meniscectomy is associated with increased risk of radiographic osteoarthritis (ROA) and worsening cartilage damage in the following year. METHODS: We studied 355 knees from the Osteoarthritis Initiative that developed ROA (Kellgren-Lawrence grade ≥ 2), which were matched with control knees. The MR images were assessed using the semi-quantitative MOAKS system. Conditional logistic regression was applied to estimate risk of incident ROA. Logistic regression was used to assess the risk of worsening cartilage damage in knees with partial meniscectomy that developed ROA. RESULTS: In the group with incident ROA, 4.4 % underwent partial meniscectomy during the year prior to the case-defining visit, compared with none of the knees that did not develop ROA. All (n = 31) knees that had partial meniscectomy and 58.9 % (n = 165) of the knees with prevalent meniscal damage developed ROA (OR = 2.51, 95 % CI [1.73, 3.64]). In knees that developed ROA, partial meniscectomy was associated with an increased risk of worsening cartilage damage (OR = 4.51, 95 % CI [1.53, 13.33]). CONCLUSIONS: The probability of having had partial meniscectomy was higher in knees that developed ROA. When looking only at knees that developed ROA, partial meniscectomy was associated with greater risk of worsening cartilage damage. KEY POINTS: • Partial meniscectomy is a controversial treatment option for degenerative meniscal tears. • Partial meniscectomy is strongly associated with incident osteoarthritis within 1 year. • Partial meniscectomy is associated with increased risk of worsening cartilage damage.

@article{mohammad_rate_2017,
	title = {Rate of comorbidities in giant cell arteritis: {A} population-based study.},
	volume = {44},
	issn = {0315-162X},
	shorttitle = {Rate of {Comorbidities} in {Giant} {Cell} {Arteritis}},
	url = {http://dx.doi.org/10.3899%2Fjrheum.160249},
	doi = {10.3899/jrheum.160249},
	abstract = {OBJECTIVE: To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden.
METHODS: The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skåne region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects were identified from the general population and matched for age, sex, area of residence, and date of diagnosis of GCA. Using the Skåne Healthcare Register, comorbidities and severe infections (requiring hospitalization) diagnosed after GCA onset were identified. The rate of the first occurrence of each comorbidity was the result of dividing the number of subjects with a given comorbidity by the person-years of followup. The rate ratio (RR; GCA:reference population) was also calculated.
RESULTS: There were 768 patients (571 women) with GCA and 3066 reference persons included in the study. The RR were significantly elevated for osteoporosis (2.81, 95\% CI 2.33-3.37), followed by venous thromboembolic diseases (2.36, 95\% CI 1.61-3.40), severe infections (1.85, 95\% CI 1.57-2.18), thyroid diseases (1.55, 95\% CI 1.25-1.91), cerebrovascular accidents (1.40, 95\% CI 1.12-1.74), and diabetes mellitus (1.29, 95\% CI 1.05-1.56). The RR for ischemic heart disease was elevated, but did not reach statistical significance (1.20, 95\% CI 1.00-1.44).
CONCLUSION: Patients with GCA have higher rates of selected comorbidities, including severe infections, compared with a reference population. Several of these comorbidities may be related to treatment with glucocorticosteroids, emphasizing the unmet need to find alternative treatments for GCA.},
	language = {eng},
	number = {1},
	journal = {The Journal of Rheumatology},
	author = {Mohammad, Aladdin J. and Englund, Martin and Turesson, Carl and Tomasson, Gunnar and Merkel, Peter A.},
	month = jan,
	year = {2017},
	pmid = {27803140},
	keywords = {CARDIOVASCULAR DISEASES, GIANT CELL ARTERITIS, INFECTIONS, Osteoporosis},
	pages = {84--90},
}

OBJECTIVE: To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden. METHODS: The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skåne region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects were identified from the general population and matched for age, sex, area of residence, and date of diagnosis of GCA. Using the Skåne Healthcare Register, comorbidities and severe infections (requiring hospitalization) diagnosed after GCA onset were identified. The rate of the first occurrence of each comorbidity was the result of dividing the number of subjects with a given comorbidity by the person-years of followup. The rate ratio (RR; GCA:reference population) was also calculated. RESULTS: There were 768 patients (571 women) with GCA and 3066 reference persons included in the study. The RR were significantly elevated for osteoporosis (2.81, 95% CI 2.33-3.37), followed by venous thromboembolic diseases (2.36, 95% CI 1.61-3.40), severe infections (1.85, 95% CI 1.57-2.18), thyroid diseases (1.55, 95% CI 1.25-1.91), cerebrovascular accidents (1.40, 95% CI 1.12-1.74), and diabetes mellitus (1.29, 95% CI 1.05-1.56). The RR for ischemic heart disease was elevated, but did not reach statistical significance (1.20, 95% CI 1.00-1.44). CONCLUSION: Patients with GCA have higher rates of selected comorbidities, including severe infections, compared with a reference population. Several of these comorbidities may be related to treatment with glucocorticosteroids, emphasizing the unmet need to find alternative treatments for GCA.

@article{kiadaliri_musculoskeletal_2017,
	title = {Musculoskeletal disorders as underlying cause of death in 58 countries, 1986–2011: {Trend} analysis of {WHO} mortality database.},
	volume = {18},
	issn = {1471-2474},
	shorttitle = {Musculoskeletal disorders as underlying cause of death in 58 countries, 1986–2011},
	url = {http://dx.doi.org/10.1186/s12891-017-1428-1},
	doi = {10.1186/s12891-017-1428-1},
	abstract = {Due to low mortality rate of musculoskeletal disorders (MSK) less attention has been paid to MSK as underlying cause of death in the general population. The aim was to examine trend in MSK as underlying cause of death in 58 countries across globe during 1986–2011.},
	urldate = {2017-02-14},
	journal = {BMC Musculoskeletal Disorders},
	author = {Kiadaliri, Aliasghar A. and Woolf, Anthony D. and Englund, Martin},
	year = {2017},
	pages = {62},
}

Due to low mortality rate of musculoskeletal disorders (MSK) less attention has been paid to MSK as underlying cause of death in the general population. The aim was to examine trend in MSK as underlying cause of death in 58 countries across globe during 1986–2011.

@article{jerrhag_epidemiology_2017,
	title = {Epidemiology and time trends of distal forearm fractures in adults - {A} study of 11.2 million person-years in {Sweden}.},
	volume = {18},
	issn = {1471-2474},
	url = {http://dx.doi.org/10.1186/s12891-017-1596-z},
	doi = {10.1186/s12891-017-1596-z},
	abstract = {A distal forearm fracture is a very common injury causing both suffering and substantial health care costs. The incidence of this fracture type seemed to increase worldwide until the middle 1980’s, but thereafter most reports have shown stable or decreasing rates. As few large studies have been presented lately we aimed to describe recent epidemiology and time trends of distal forearm fractures in adults. We paid special attention to fractures in working ages as they present challenges in terms of treatment and costs for sick-leave, and have not previously been thoroughly investigated.},
	journal = {BMC Musculoskeletal Disorders},
	author = {Jerrhag, Daniel and Englund, Martin and Karlsson, Magnus K. and Rosengren, Bjorn E.},
	year = {2017},
	keywords = {Distal radius fracture, Epidemiology, Forecast, Time-trends, Wrist fracture},
	pages = {240},
}

A distal forearm fracture is a very common injury causing both suffering and substantial health care costs. The incidence of this fracture type seemed to increase worldwide until the middle 1980’s, but thereafter most reports have shown stable or decreasing rates. As few large studies have been presented lately we aimed to describe recent epidemiology and time trends of distal forearm fractures in adults. We paid special attention to fractures in working ages as they present challenges in terms of treatment and costs for sick-leave, and have not previously been thoroughly investigated.

@article{jorgensen_eq-5d_2017,
	title = {{EQ}-{5D} utility, response and drug survival in rheumatoid arthritis patients on biologic monotherapy: {A} prospective observational study of patients registered in the south {Swedish} {SSATG} registry.},
	volume = {12},
	issn = {1932-6203},
	shorttitle = {{EQ}-{5D} utility, response and drug survival in rheumatoid arthritis patients on biologic monotherapy},
	url = {http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169946},
	doi = {10.1371/journal.pone.0169946},
	abstract = {Objectives Biologic agents have dramatically changed treatment of rheumatoid arthritis (RA). To date only scarce head-to-head data exist especially when the biological therapies are given as monotherapy without concomitant disease modifying drugs (DMARDs). Thus the objective of the current study is to evaluate treatment response of all available biological therapies with special focus on utility (EQ-5D-3L) and drug survival of biologic DMARDs (bDMARDs) prescribed as monotherapy in RA patients in southern Sweden.   Materials and methods All RA patients registered in a regional database as initiating bDMARD as monotherapy, i.e. without concomitant conventional synthetic DMARDs (csDMARDs), from 1st of January 2006 through 31st of December 2012, were included. Patients were followed from initiation of the first dose of bDMARD monotherapy treatment until withdrawal from treatment, loss of follow-up or 31st of December 2012. Descriptive statistics for utility (EQ-5D-3L), effectiveness, and drug survival of bDMARD monotherapy were calculated.   Results During the study period, a total of 554 patients were registered in SSATG as initiating bDMARD monotherapy. Most of the patients were women (81\%), with a mean age of 57 years. The average disease duration was more than 12 years, and on average the patients had previously been treated with approximately four different csDMARDs. Fifty-five percent of the patients were initiating their first bDMARD, 26\% their second, and 19\% their third or more. At baseline the average EQ-5D-3L was 0.34. Most patients had moderate to high disease activity, with a mean DAS28 of 5.0, and were substantially disabled, with an average HAQ score of 1.4. At 6 months´ follow-up, the EQ-5D-3L in patients still on the biologic drug had increased by mean 0.23 (SD 0.4) with no differences between type of bDMARD (p = 0.49). The mean change in EQ-5D-3L ranged from 0.11 (rituximab and infliximab) to 0.42 (tocilizumab). Although the changes were numerically different, no distinct pattern favored any particular bDMARD for EQ-5D-3L (p = 0.49) or other clinical outcomes. Overall, DAS28 defined remission and low disease activity were achieved in 20\% and 43\% of patients, respectively. Drug survival rates were statistically significantly different between bDMARDs (p = 0.01), with the highest rates observed for rituximab, followed by etanercept. After failing first course of anti-TNF, patients switching to another mode of action had significantly higher drug survival than those switching to a second course of anti-TNF therapy (p = 0.02).   Conclusions Utility (EQ-5D-3L) increased after 6 months of all bDMARD treatments in monotherapy, indicating improvement of patients’ quality of life. After failure of anti-TNF treatment in monotherapy, switching to another mode of action may be associated with better drug survival than starting a second TNF-inhibitor.},
	number = {2},
	urldate = {2017-02-14},
	journal = {PloS One},
	author = {Jørgensen, Tanja Schjødt and Turesson, Carl and Kapetanovic, Meliha and Englund, Martin and Turkiewicz, Aleksandra and Christensen, Robin and Bliddal, Henning and Geborek, Pierre and Kristensen, Lars Erik},
	month = feb,
	year = {2017},
	keywords = {Drug adherence, Drug administration, Drug synthesis, Drug therapy, Observational studies, Physicians, Quality of Life, Rheumatoid Arthritis},
	pages = {e0169946},
}

Objectives Biologic agents have dramatically changed treatment of rheumatoid arthritis (RA). To date only scarce head-to-head data exist especially when the biological therapies are given as monotherapy without concomitant disease modifying drugs (DMARDs). Thus the objective of the current study is to evaluate treatment response of all available biological therapies with special focus on utility (EQ-5D-3L) and drug survival of biologic DMARDs (bDMARDs) prescribed as monotherapy in RA patients in southern Sweden. Materials and methods All RA patients registered in a regional database as initiating bDMARD as monotherapy, i.e. without concomitant conventional synthetic DMARDs (csDMARDs), from 1st of January 2006 through 31st of December 2012, were included. Patients were followed from initiation of the first dose of bDMARD monotherapy treatment until withdrawal from treatment, loss of follow-up or 31st of December 2012. Descriptive statistics for utility (EQ-5D-3L), effectiveness, and drug survival of bDMARD monotherapy were calculated. Results During the study period, a total of 554 patients were registered in SSATG as initiating bDMARD monotherapy. Most of the patients were women (81%), with a mean age of 57 years. The average disease duration was more than 12 years, and on average the patients had previously been treated with approximately four different csDMARDs. Fifty-five percent of the patients were initiating their first bDMARD, 26% their second, and 19% their third or more. At baseline the average EQ-5D-3L was 0.34. Most patients had moderate to high disease activity, with a mean DAS28 of 5.0, and were substantially disabled, with an average HAQ score of 1.4. At 6 months´ follow-up, the EQ-5D-3L in patients still on the biologic drug had increased by mean 0.23 (SD 0.4) with no differences between type of bDMARD (p = 0.49). The mean change in EQ-5D-3L ranged from 0.11 (rituximab and infliximab) to 0.42 (tocilizumab). Although the changes were numerically different, no distinct pattern favored any particular bDMARD for EQ-5D-3L (p = 0.49) or other clinical outcomes. Overall, DAS28 defined remission and low disease activity were achieved in 20% and 43% of patients, respectively. Drug survival rates were statistically significantly different between bDMARDs (p = 0.01), with the highest rates observed for rituximab, followed by etanercept. After failing first course of anti-TNF, patients switching to another mode of action had significantly higher drug survival than those switching to a second course of anti-TNF therapy (p = 0.02). Conclusions Utility (EQ-5D-3L) increased after 6 months of all bDMARD treatments in monotherapy, indicating improvement of patients’ quality of life. After failure of anti-TNF treatment in monotherapy, switching to another mode of action may be associated with better drug survival than starting a second TNF-inhibitor.

@article{wolski_automated_2016,
	title = {Automated selection of bone texture regions on hand radiographs: {Data} from the {Osteoarthritis} {Initiative}.},
	volume = {230},
	issn = {0954-4119},
	shorttitle = {Automated selection of bone texture regions on hand radiographs},
	url = {https://doi.org/10.1177/0954411916676219},
	doi = {10.1177/0954411916676219},
	abstract = {Manual selection of finger trabecular bone texture regions on hand X-ray images is time-consuming, tedious, and observer-dependent. Therefore, we developed an automated method for the region selection. The method selects square trabecular bone regions of interest above and below the second to fifth distal and proximal interphalangeal joints. Two regions are selected per joint (16 regions per hand). The method consists of four integral parts: (1) segmentation of a radiograph into hand and background, (2) identification of finger regions, (3) localization of center points of heads of distal phalanges and the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints, and (4) placement of the regions of interest under and above the distal and proximal interphalangeal joints. A gold standard was constructed from regions selected by two observers on 40 hand X-ray images taken from Osteoarthritis Initiative cohort. Datasets of 520 images were generated from the 40 images to study the effects of hand and finger positioning. The accuracy in regions selection and the agreement in calculating five directional fractal parameters were evaluated against the gold standard. The accuracy, agreement, and effects of hand and finger positioning were measured using similarity index (0 for no overlap and 1 for entire overlap) and interclass correlation coefficient as appropriate. A high accuracy in selecting regions (similarity index ≥ 0.79) and a good agreement in fractal parameters (interclass correlation coefficient ≥ 0.58) were achieved. Hand and finger positioning did not affect considerably the region selection (similarity index ≥ 0.70). These results indicate that the method developed selects bone regions on hand X-ray images with accuracy sufficient for fractal analyses of bone texture.},
	language = {en},
	number = {12},
	journal = {Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine},
	author = {Wolski, Marcin and Englund, Martin and Stachowiak, Gwidon and Podsiadlo, Pawel},
	month = dec,
	year = {2016},
	pages = {1117--1132},
}

Manual selection of finger trabecular bone texture regions on hand X-ray images is time-consuming, tedious, and observer-dependent. Therefore, we developed an automated method for the region selection. The method selects square trabecular bone regions of interest above and below the second to fifth distal and proximal interphalangeal joints. Two regions are selected per joint (16 regions per hand). The method consists of four integral parts: (1) segmentation of a radiograph into hand and background, (2) identification of finger regions, (3) localization of center points of heads of distal phalanges and the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints, and (4) placement of the regions of interest under and above the distal and proximal interphalangeal joints. A gold standard was constructed from regions selected by two observers on 40 hand X-ray images taken from Osteoarthritis Initiative cohort. Datasets of 520 images were generated from the 40 images to study the effects of hand and finger positioning. The accuracy in regions selection and the agreement in calculating five directional fractal parameters were evaluated against the gold standard. The accuracy, agreement, and effects of hand and finger positioning were measured using similarity index (0 for no overlap and 1 for entire overlap) and interclass correlation coefficient as appropriate. A high accuracy in selecting regions (similarity index ≥ 0.79) and a good agreement in fractal parameters (interclass correlation coefficient ≥ 0.58) were achieved. Hand and finger positioning did not affect considerably the region selection (similarity index ≥ 0.70). These results indicate that the method developed selects bone regions on hand X-ray images with accuracy sufficient for fractal analyses of bone texture.

@article{thorlund_effect_2016,
	title = {Effect of knee extensor strength on incident radiographic and symptomatic knee osteoarthritis in individuals with meniscal pathology: {Data} from the {Multicenter} {Osteoarthritis} {Study}.},
	volume = {68},
	issn = {2151-4658},
	shorttitle = {Effect of {Knee} {Extensor} {Strength} on {Incident} {Radiographic} and {Symptomatic} {Knee} {Osteoarthritis} in {Individuals} {With} {Meniscal} {Pathology}},
	url = {http://onlinelibrary.wiley.com/doi/10.1002/acr.22889/abstract},
	doi = {10.1002/acr.22889},
	abstract = {Objective

High knee extensor strength may be important to protect against the development of knee osteoarthritis (OA) in populations at elevated risk, such as individuals with meniscal pathology. We investigated the extent to which high knee extensor muscle strength was associated with a decreased risk of developing radiographic or symptomatic knee OA in individuals with medial meniscal pathology.


Methods

We studied knees that at the baseline visit of the Multicenter Osteoarthritis Study had medial meniscal pathology but did not have radiographic knee OA (373 knees in 373 participants) or symptomatic knee OA (combination of radiographic knee OA and frequent knee symptoms; 531 knees in 531 participants). Isokinetic knee extensor strength was measured at baseline, and participants were followed for development of incident radiographic knee OA or incident symptomatic knee OA at 84 months. Separate binomial regression analyses with robust SEs adjusted for age, history of knee surgery, physical activity level, and clinic site were conducted for men and women.


Results

High knee extensor strength (normalized by allometric scaling) was associated with a reduced risk of radiographic knee OA in women (relative risk [RR] 0.52, 95\% confidence interval [95\% CI] 0.29–0.94) but not in men (RR 0.56, 95\% CI 0.27–1.16). High knee extensor strength did not protect against the development of symptomatic knee OA, either in women or men.


Conclusion

The results only partly confirm the hypothesis that high knee extensor muscle strength protects against later development of knee OA in individuals with medial meniscal pathology.},
	language = {en},
	number = {11},
	urldate = {2016-11-02},
	journal = {Arthritis Care \& Research},
	author = {Thorlund, Jonas B. and Felson, David T. and Segal, Neil A. and Nevitt, Michael C. and Niu, Jingbo and Neogi, Tuhina and Lewis, Cora E. and Guermazi, Ali and Roemer, Frank and Englund, Martin},
	month = nov,
	year = {2016},
	pages = {1640--1646},
}

Objective High knee extensor strength may be important to protect against the development of knee osteoarthritis (OA) in populations at elevated risk, such as individuals with meniscal pathology. We investigated the extent to which high knee extensor muscle strength was associated with a decreased risk of developing radiographic or symptomatic knee OA in individuals with medial meniscal pathology. Methods We studied knees that at the baseline visit of the Multicenter Osteoarthritis Study had medial meniscal pathology but did not have radiographic knee OA (373 knees in 373 participants) or symptomatic knee OA (combination of radiographic knee OA and frequent knee symptoms; 531 knees in 531 participants). Isokinetic knee extensor strength was measured at baseline, and participants were followed for development of incident radiographic knee OA or incident symptomatic knee OA at 84 months. Separate binomial regression analyses with robust SEs adjusted for age, history of knee surgery, physical activity level, and clinic site were conducted for men and women. Results High knee extensor strength (normalized by allometric scaling) was associated with a reduced risk of radiographic knee OA in women (relative risk [RR] 0.52, 95% confidence interval [95% CI] 0.29–0.94) but not in men (RR 0.56, 95% CI 0.27–1.16). High knee extensor strength did not protect against the development of symptomatic knee OA, either in women or men. Conclusion The results only partly confirm the hypothesis that high knee extensor muscle strength protects against later development of knee OA in individuals with medial meniscal pathology.

@article{pihl_signs_2016,
	title = {Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear.},
	issn = {1745-3674},
	url = {http://dx.doi.org/10.1080/17453674.2016.1253329},
	doi = {10.1080/17453674.2016.1253329},
	abstract = {Background and purpose — Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients’ characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear.Patients and methods — 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18–77) years, 57\% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue.Results — 43\% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment.Interpretation — Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43\% of patients undergoing knee arthroscopy for meniscal tear.},
	urldate = {2016-11-02},
	journal = {Acta Orthopaedica},
	author = {Pihl, Kenneth and Englund, Martin and Lohmander, L. Stefan and Jørgensen, Uffe and Nissen, Nis and Schjerning, Jeppe and Thorlund, Jonas B.},
	month = nov,
	year = {2016},
	pmid = {27798972},
	pages = {1--6},
}

Background and purpose — Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients’ characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear.Patients and methods — 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18–77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue.Results — 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment.Interpretation — Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.

@article{olsson_epidemiology_2016,
	title = {Epidemiology of intra- and peri-articular structural injuries in traumatic knee joint hemarthrosis - {Data} from 1145 consecutive knees with subacute {MRI}.},
	volume = {24},
	issn = {1522-9653},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2016.06.006},
	doi = {10.1016/j.joca.2016.06.006},
	abstract = {OBJECTIVE: In patients with traumatic knee distorsion and hemarthrosis, to investigate the panorama of structural injury, as visualized on magnetic resonance imaging (MRI).
DESIGN: Cohort study of 1145 consecutive patients with traumatic knee distorsion who underwent MRI within median 8 days after injury. We present structural injury as visualized on MRI in relation to age, sex and activity at injury. Population based gender specific annual incidences of common structural injuries were calculated.
RESULTS: The majority of injuries (72\%) occurred during sports. Overall, anterior cruciate ligament (ACL) rupture was the most common structural injury (52\%), followed by meniscal tear (41\%) and lateral patella dislocation (LPD, 17\%). Only 12\% of ACL tears were isolated with meniscal tear being the most common associated injury (55\%). The annual incidence of ACL injury was 77 (70-85, 95\% CI) per 100,000 inhabitants with significant differences between men (91, 80-103) and women (63, 53-73). In those aged 16 years and younger, LPD was the most frequent structural injury, both in boys (39\%) and girls (43\%). In this age group, the annual incidence of LPD was 88 (68-113) and higher in boys (113, 81-154) than in girls (62, 39-95).
CONCLUSIONS: ACL injury occurs in one out of two knees with traumatic hemarthrosis but only 12\% are without concomitant structural injury. The overall rate of traumatic knee hemarthrosis and ACL injury is higher in men. In those aged 10-19 years, ACL rupture is more common among girls than boys whereas in those 16 years and younger, LPD is more common among boys than girls.},
	language = {eng},
	number = {11},
	journal = {Osteoarthritis and Cartilage},
	author = {Olsson, O. and Isacsson, A. and Englund, M. and Frobell, R. B.},
	month = nov,
	year = {2016},
	pmid = {27374877},
	keywords = {ACL injury, Epidemiology, Hemarthrosis, MRI, Patella dislocation},
	pages = {1890--1897},
}

OBJECTIVE: In patients with traumatic knee distorsion and hemarthrosis, to investigate the panorama of structural injury, as visualized on magnetic resonance imaging (MRI). DESIGN: Cohort study of 1145 consecutive patients with traumatic knee distorsion who underwent MRI within median 8 days after injury. We present structural injury as visualized on MRI in relation to age, sex and activity at injury. Population based gender specific annual incidences of common structural injuries were calculated. RESULTS: The majority of injuries (72%) occurred during sports. Overall, anterior cruciate ligament (ACL) rupture was the most common structural injury (52%), followed by meniscal tear (41%) and lateral patella dislocation (LPD, 17%). Only 12% of ACL tears were isolated with meniscal tear being the most common associated injury (55%). The annual incidence of ACL injury was 77 (70-85, 95% CI) per 100,000 inhabitants with significant differences between men (91, 80-103) and women (63, 53-73). In those aged 16 years and younger, LPD was the most frequent structural injury, both in boys (39%) and girls (43%). In this age group, the annual incidence of LPD was 88 (68-113) and higher in boys (113, 81-154) than in girls (62, 39-95). CONCLUSIONS: ACL injury occurs in one out of two knees with traumatic hemarthrosis but only 12% are without concomitant structural injury. The overall rate of traumatic knee hemarthrosis and ACL injury is higher in men. In those aged 10-19 years, ACL rupture is more common among girls than boys whereas in those 16 years and younger, LPD is more common among boys than girls.

@article{saleh_visual_2016,
	title = {Visual complications in patients with biopsy-proven giant cell arteritis: {A} population-based study.},
	volume = {43},
	issn = {0315-162X 0315-162X},
	url = {http://dx.doi.org/10.3899%2Fjrheum.151033},
	doi = {10.3899/jrheum.151033},
	abstract = {OBJECTIVE: To study the clinical and laboratory characteristics of patients with  biopsy-proven giant cell arteritis (GCA) with visual complications, and to evaluate the incidence rate of visual complications in GCA compared to the background population. METHODS: Data from 840 patients with GCA in the county of  Skane, Sweden, diagnosed between 1997 and 2010, were used for this analysis. Cases with visual complications were identified from a diagnosis registry and confirmed by a review of medical records. The rate of visual complications in patients with GCA was compared with an age- and sex-matched reference population. RESULTS: There were 85 patients (10\%) who developed {\textgreater}/= 1 visual complication after the onset of GCA. Of the patients, 18 (21\%) developed unilateral or bilateral complete visual loss. The mean age at diagnosis was 78 years (+/- 7.3); 69\% were women. Compared with patients without visual complications, those with visual complication had lower C-reactive protein levels at diagnosis and were less likely to have headache, fever, and palpable abnormal temporal artery. The use of beta-adrenergic inhibitors was associated with visual complications. The incidence of visual complications among patients with GCA was 20.9/1000 person-years of followup compared to 6.9/1000 person-years in the reference population, resulting in a rate ratio of 3.0 (95\% CI 2.3-3.8). CONCLUSION: Ten percent of patients with GCA developed visual complications, a rate substantially higher than that of the general population. Patients with GCA who had visual complications had lower inflammatory responses and were more likely to have been  treated with beta-adrenergic inhibitors compared with patients without visual complications.},
	language = {eng},
	number = {8},
	journal = {The Journal of rheumatology},
	author = {Saleh, Muna and Turesson, Carl and Englund, Martin and Merkel, Peter A. and Mohammad, Aladdin J.},
	month = aug,
	year = {2016},
	pmid = {27252424},
	keywords = {CLINICAL CHARACTERISTICS, GIANT CELL ARTERITIS, INFLAMMATION, RATE RATIO, VISUAL COMPLICATIONS, beta-BLOCKERS},
	pages = {1559--1565},
}

OBJECTIVE: To study the clinical and laboratory characteristics of patients with biopsy-proven giant cell arteritis (GCA) with visual complications, and to evaluate the incidence rate of visual complications in GCA compared to the background population. METHODS: Data from 840 patients with GCA in the county of Skane, Sweden, diagnosed between 1997 and 2010, were used for this analysis. Cases with visual complications were identified from a diagnosis registry and confirmed by a review of medical records. The rate of visual complications in patients with GCA was compared with an age- and sex-matched reference population. RESULTS: There were 85 patients (10%) who developed \textgreater/= 1 visual complication after the onset of GCA. Of the patients, 18 (21%) developed unilateral or bilateral complete visual loss. The mean age at diagnosis was 78 years (+/- 7.3); 69% were women. Compared with patients without visual complications, those with visual complication had lower C-reactive protein levels at diagnosis and were less likely to have headache, fever, and palpable abnormal temporal artery. The use of beta-adrenergic inhibitors was associated with visual complications. The incidence of visual complications among patients with GCA was 20.9/1000 person-years of followup compared to 6.9/1000 person-years in the reference population, resulting in a rate ratio of 3.0 (95% CI 2.3-3.8). CONCLUSION: Ten percent of patients with GCA developed visual complications, a rate substantially higher than that of the general population. Patients with GCA who had visual complications had lower inflammatory responses and were more likely to have been treated with beta-adrenergic inhibitors compared with patients without visual complications.

@article{turkiewicz_all-cause_2016,
	title = {All-cause mortality in knee and hip osteoarthritis and rheumatoid arthritis.},
	volume = {27},
	issn = {1531-5487 1044-3983},
	url = {http://dx.doi.org/10.1097/EDE.0000000000000477},
	doi = {10.1097/EDE.0000000000000477},
	abstract = {BACKGROUND: While increased mortality in rheumatoid arthritis (RA) is well established, there is conflicting evidence on the association between osteoarthritis (OA) and mortality. Our aim was to estimate all-cause mortality in Swedish patients with RA and OA compared with the general population. METHODS: Cohort study of the population of Skane region, Sweden (1.3 million), based on physicians' diagnostic codes in a mandatory register covering all health care. We included all subjects aged {\textgreater}/=45 years who between 1998 and 2012 consulted any physician at least once. We identified those who received a diagnosis of RA, knee OA, or hip OA. We followed all subjects until death, relocation outside Skane region, or end of 2013, and analyzed data using Cox proportional hazard regression with attained age as time scale. RESULTS: We identified 8,067 patients with RA, 51,939 with knee OA and 29,442 with hip OA among 524,136 in the population aged {\textgreater}/=45 years. The mortality rates adjusted for sex, socioeconomic  status, and comorbidities were elevated for RA, hazard ratio 1.86 (95\% confidence interval = 1.78, 1.94) but not in knee or hip OA compared with the general population seeking health care, hazard ratio 0.87 (0.85, 0.89) and 0.90 (0.87, 0.92), respectively. Extensive sensitivity analyses supported the conclusion of no increased mortality in OA. CONCLUSIONS: In Sweden, RA is associated with about doubled mortality rate, but we found no increased mortality in patients with knee and hip OA. Possible selection of those seeking physician care for knee or hip pain and/or OA management in health care are plausible explanations.},
	language = {eng},
	number = {4},
	journal = {Epidemiology (Cambridge, Mass.)},
	author = {Turkiewicz, Aleksandra and Neogi, Tuhina and Bjork, Jonas and Peat, George and Englund, Martin},
	month = jul,
	year = {2016},
	pmid = {26986874},
	pages = {479--485},
}

BACKGROUND: While increased mortality in rheumatoid arthritis (RA) is well established, there is conflicting evidence on the association between osteoarthritis (OA) and mortality. Our aim was to estimate all-cause mortality in Swedish patients with RA and OA compared with the general population. METHODS: Cohort study of the population of Skane region, Sweden (1.3 million), based on physicians' diagnostic codes in a mandatory register covering all health care. We included all subjects aged \textgreater/=45 years who between 1998 and 2012 consulted any physician at least once. We identified those who received a diagnosis of RA, knee OA, or hip OA. We followed all subjects until death, relocation outside Skane region, or end of 2013, and analyzed data using Cox proportional hazard regression with attained age as time scale. RESULTS: We identified 8,067 patients with RA, 51,939 with knee OA and 29,442 with hip OA among 524,136 in the population aged \textgreater/=45 years. The mortality rates adjusted for sex, socioeconomic status, and comorbidities were elevated for RA, hazard ratio 1.86 (95% confidence interval = 1.78, 1.94) but not in knee or hip OA compared with the general population seeking health care, hazard ratio 0.87 (0.85, 0.89) and 0.90 (0.87, 0.92), respectively. Extensive sensitivity analyses supported the conclusion of no increased mortality in OA. CONCLUSIONS: In Sweden, RA is associated with about doubled mortality rate, but we found no increased mortality in patients with knee and hip OA. Possible selection of those seeking physician care for knee or hip pain and/or OA management in health care are plausible explanations.

@article{podsiadlo_baseline_2016,
	title = {Baseline trabecular bone and its relation to incident radiographic knee osteoarthritis and increase in joint space narrowing score: {Directional} fractal signature analysis in the {MOST} study.},
	volume = {24},
	issn = {1522-9653},
	shorttitle = {Baseline trabecular bone and its relation to incident radiographic knee osteoarthritis and increase in joint space narrowing score},
	url = {http://dx.doi.org/10.1016/j.joca.2016.05.003},
	doi = {10.1016/j.joca.2016.05.003},
	abstract = {PURPOSE: To explore the association of baseline trabecular bone structure with incident tibiofemoral (TF) osteoarthritis (OA) and with increase in joint space narrowing (JSN) score.
METHODS: The Multicenter Osteoarthritis Study (MOST) includes subjects with or at risk for knee OA. Knee radiographs were scored for Kellgren-Lawrence (KL) grade and JSN at baseline, 30, 60 and 84 months. Knees (KL ≤ 1) at baseline were assessed for incident OA (KL ≥ 2) and increases in JSN score. For each knee image at baseline, a variance orientation transform method (VOT) was applied to subchondral tibial bone regions of medial and lateral compartments. Seventeen fractal parameters were calculated per region. Associations of each parameter with OA incidence and with medial and lateral JSN increases were explored using logistic regression. Analyses were stratified by digitized film (DF) vs computer radiography (CR) and adjusted for confounders.
RESULTS: Of 894 knees with CR and 1158 knees with DF, 195 (22\%) and 303 (26\%) developed incident OA. Higher medial bone roughness was associated with increased odds of OA incidence at 60 and 84 months and also, medial and lateral JSN increases (primarily vertical). Lower medial and lateral anisotropy was associated with increased odds of medial and lateral JSN increase. Compared to DF, CR had more associations and also, similar results at overlapping scales.
CONCLUSION: Baseline trabecular bone texture was associated with incident radiographic OA and increase of JSN scores independently of risk factors for knee OA. Higher roughness and lower anisotropy were associated with increased odds for radiographic OA change.},
	language = {eng},
	number = {10},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Podsiadlo, P. and Nevitt, M. C. and Wolski, M. and Stachowiak, G. W. and Lynch, J. A. and Tolstykh, I. and Felson, D. T. and Segal, N. A. and Lewis, C. E. and Englund, M.},
	month = oct,
	year = {2016},
	pmid = {27163445},
	keywords = {Fractal, Joint space narrowing, Radiographic osteoarthritis, Radiography, Trabecular bone},
	pages = {1736--1744},
}

PURPOSE: To explore the association of baseline trabecular bone structure with incident tibiofemoral (TF) osteoarthritis (OA) and with increase in joint space narrowing (JSN) score. METHODS: The Multicenter Osteoarthritis Study (MOST) includes subjects with or at risk for knee OA. Knee radiographs were scored for Kellgren-Lawrence (KL) grade and JSN at baseline, 30, 60 and 84 months. Knees (KL ≤ 1) at baseline were assessed for incident OA (KL ≥ 2) and increases in JSN score. For each knee image at baseline, a variance orientation transform method (VOT) was applied to subchondral tibial bone regions of medial and lateral compartments. Seventeen fractal parameters were calculated per region. Associations of each parameter with OA incidence and with medial and lateral JSN increases were explored using logistic regression. Analyses were stratified by digitized film (DF) vs computer radiography (CR) and adjusted for confounders. RESULTS: Of 894 knees with CR and 1158 knees with DF, 195 (22%) and 303 (26%) developed incident OA. Higher medial bone roughness was associated with increased odds of OA incidence at 60 and 84 months and also, medial and lateral JSN increases (primarily vertical). Lower medial and lateral anisotropy was associated with increased odds of medial and lateral JSN increase. Compared to DF, CR had more associations and also, similar results at overlapping scales. CONCLUSION: Baseline trabecular bone texture was associated with incident radiographic OA and increase of JSN scores independently of risk factors for knee OA. Higher roughness and lower anisotropy were associated with increased odds for radiographic OA change.

@article{sihvonen_mechanical_2016,
	title = {Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear: {A} prospective cohort study.},
	volume = {24},
	issn = {1522-9653},
	shorttitle = {Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear},
	url = {http://dx.doi.org/10.1016/j.joca.2016.03.013},
	doi = {10.1016/j.joca.2016.03.013},
	abstract = {OBJECTIVE: According to prevailing consensus, patients with mechanical symptoms are those considered to most likely benefit from arthroscopic surgery. The aim of this study was to determine the value of using patients' pre-operative self-reports of mechanical symptoms as a justification surgery in patients with degenerative meniscus tear/knee disease.
DESIGN: Pragmatic prospective cohort of 900 consecutive patients with symptomatic degenerative knee disease and meniscus tear undergoing arthroscopic partial meniscectomy (APM) was collected from one public orthopedic referral center specialized in arthroscopic surgery during 2007-2011. The patients' subjective satisfaction, self-rated improvement, change in Western Ontario Meniscal Evaluation Tool (WOMET) score, and patients' ratings of the knee using a numerical rating scale (NRS) was assessed at 1 year postoperatively. Multivariable regression models, adjusted for possible confounders and intermediates, were used to compare the outcomes in those with and without preoperative mechanical symptoms.
RESULTS: The proportion of patients satisfied with their knee 12 months after arthroscopy was significantly lower among those with preoperative mechanical symptoms than among those without (61\% vs 75\%, multivariable adjusted risk ratio [RR] 0.84; 95\% confidence interval [CI] 0.76, 0.92). Similarly, the proportion reporting improvement was lower (RR 0.91; 95\% CI 0.85, 0.97). No statistically significant difference was found in change in WOMET or NRS between the two groups. Of those with preoperative mechanical symptoms, 47\% reported persistent symptoms at 12 months postoperatively.
CONCLUSIONS: Our observational data contradicts the current tenet of using patients' self-report of mechanical symptoms as a justification for performing arthroscopic surgery on patients with degenerative meniscus tear.},
	language = {eng},
	number = {8},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Sihvonen, R. and Englund, M. and Turkiewicz, A. and Järvinen, T. L. N.},
	month = aug,
	year = {2016},
	pmid = {27038490},
	keywords = {Degenerative knee, Knee arthroscopy, Mechanical symptoms, Meniscus},
	pages = {1367--1375},
}

OBJECTIVE: According to prevailing consensus, patients with mechanical symptoms are those considered to most likely benefit from arthroscopic surgery. The aim of this study was to determine the value of using patients' pre-operative self-reports of mechanical symptoms as a justification surgery in patients with degenerative meniscus tear/knee disease. DESIGN: Pragmatic prospective cohort of 900 consecutive patients with symptomatic degenerative knee disease and meniscus tear undergoing arthroscopic partial meniscectomy (APM) was collected from one public orthopedic referral center specialized in arthroscopic surgery during 2007-2011. The patients' subjective satisfaction, self-rated improvement, change in Western Ontario Meniscal Evaluation Tool (WOMET) score, and patients' ratings of the knee using a numerical rating scale (NRS) was assessed at 1 year postoperatively. Multivariable regression models, adjusted for possible confounders and intermediates, were used to compare the outcomes in those with and without preoperative mechanical symptoms. RESULTS: The proportion of patients satisfied with their knee 12 months after arthroscopy was significantly lower among those with preoperative mechanical symptoms than among those without (61% vs 75%, multivariable adjusted risk ratio [RR] 0.84; 95% confidence interval [CI] 0.76, 0.92). Similarly, the proportion reporting improvement was lower (RR 0.91; 95% CI 0.85, 0.97). No statistically significant difference was found in change in WOMET or NRS between the two groups. Of those with preoperative mechanical symptoms, 47% reported persistent symptoms at 12 months postoperatively. CONCLUSIONS: Our observational data contradicts the current tenet of using patients' self-report of mechanical symptoms as a justification for performing arthroscopic surgery on patients with degenerative meniscus tear.

@article{englund_comorbidities_2016,
	title = {Comorbidities in patients with antineutrophil cytoplasmic antibody-associated vasculitis versus the general population.},
	volume = {43},
	issn = {0315-162X 0315-162X},
	url = {http://www.jrheum.org/content/43/8/1553},
	doi = {10.3899/jrheum.151151},
	abstract = {OBJECTIVE: To evaluate the consultation rates of selected comorbidities in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) compared with the general population in southern Sweden. METHODS: We used data from a population-based cohort of patients with AAV diagnosed between 1998 and 2010 in Southern Sweden (701,000 inhabitants). For each patient we identified 4 reference subjects randomly sampled from the general population and matched for year of birth, sex, area of residence, and index year. Using the population-based Skane Healthcare Register, we identified relevant diagnostic codes, registered between 1998 and 2011, for selected comorbidities assigned after the date of diagnosis of AAV or the index date for the reference subjects. We calculated rate ratios for comorbidities (AAV:reference subjects). RESULTS: There were 186 patients with AAV (95 women, mean age 64.5 yrs) and 744 reference persons included in the analysis. The highest rate ratios (AAV:reference) were obtained for osteoporosis (4.6, 95\% CI 3.0-7.0), followed by venous thromboembolism (4.0,  95\% CI 1.9-8.3), thyroid diseases (2.1, 95\% CI 1.3-3.3), and diabetes mellitus (2.0, 95\% CI 1.3-2.9). For ischemic heart disease, the rate ratio of 1.5 (95\% CI  1.0-2.3) did not reach statistical significance. No statistically significant differences were found for cerebrovascular accidents. CONCLUSION: AAV is associated with increased consultation rates of several comorbidities including osteoporosis and thromboembolic and endocrine disorders. Comorbid conditions should be taken into consideration when planning and providing care for patients  with AAV.},
	language = {eng},
	number = {8},
	journal = {The Journal of rheumatology},
	author = {Englund, Martin and Merkel, Peter A. and Tomasson, Gunnar and Segelmark, Marten and Mohammad, Aladdin J.},
	month = aug,
	year = {2016},
	pmid = {27252425},
	keywords = {ANCA-ASSOCIATED VASCULITIS, ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES, COMORBIDITIES, OUTCOME, POPULATION-BASED STUDY},
	pages = {1553--1558},
}

OBJECTIVE: To evaluate the consultation rates of selected comorbidities in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) compared with the general population in southern Sweden. METHODS: We used data from a population-based cohort of patients with AAV diagnosed between 1998 and 2010 in Southern Sweden (701,000 inhabitants). For each patient we identified 4 reference subjects randomly sampled from the general population and matched for year of birth, sex, area of residence, and index year. Using the population-based Skane Healthcare Register, we identified relevant diagnostic codes, registered between 1998 and 2011, for selected comorbidities assigned after the date of diagnosis of AAV or the index date for the reference subjects. We calculated rate ratios for comorbidities (AAV:reference subjects). RESULTS: There were 186 patients with AAV (95 women, mean age 64.5 yrs) and 744 reference persons included in the analysis. The highest rate ratios (AAV:reference) were obtained for osteoporosis (4.6, 95% CI 3.0-7.0), followed by venous thromboembolism (4.0, 95% CI 1.9-8.3), thyroid diseases (2.1, 95% CI 1.3-3.3), and diabetes mellitus (2.0, 95% CI 1.3-2.9). For ischemic heart disease, the rate ratio of 1.5 (95% CI 1.0-2.3) did not reach statistical significance. No statistically significant differences were found for cerebrovascular accidents. CONCLUSION: AAV is associated with increased consultation rates of several comorbidities including osteoporosis and thromboembolic and endocrine disorders. Comorbid conditions should be taken into consideration when planning and providing care for patients with AAV.

@article{thorlund_changes_2016,
	title = {Changes in knee joint load indices from before to 12 months after arthroscopic partial meniscectomy: {A} prospective cohort study.},
	volume = {24},
	issn = {1522-9653},
	shorttitle = {Changes in knee joint load indices from before to 12 months after arthroscopic partial meniscectomy},
	url = {http://dx.doi.org/10.1016/j.joca.2016.01.987},
	doi = {10.1016/j.joca.2016.01.987},
	abstract = {OBJECTIVE: Patients undergoing arthroscopic partial meniscectomy (APM) are at increased risk of knee osteoarthritis (OA). Meniscal damage and/or surgery may alter knee joint loading to increase OA risk. We investigated changes in knee joint loading following medial APM surgery, compared with the contra-lateral leg.
METHODS: We estimated indices of knee joint loading (external peak knee adduction moment (KAM), KAM impulse and peak knee flexion moment (KFM)) normalized to body size (i.e., body mass (BM) and height (HT)) using 3D gait analysis in 23 patients (17 men, mean (SD) 46.2 (6.4) years, BMI 25.8 (3.4) kg/m(2)) without radiographic knee OA before and 12 months after medial APM. Static alignment was assessed by radiography and self-reported outcomes by Knee injury and Osteoarthritis Outcome Score (KOOS).
RESULTS: Peak KAM and KAM impulse increased in the APM leg compared to the contra-lateral leg from before to 12 months after surgery (change difference: 0.38 Nm/BM*HT\% 95\% CI 0.01 to 0.76 (P = 0.049) and 0.20 Nm*s/BM*HT\% 95\% CI 0.10 to 0.30 (P {\textless} 0.001)). Patients self-reported improvements on all KOOS subscales (KOOS pain improvement: 22.8 95\% CI 14.5 to 31.0 (P {\textless} 0.01)).
CONCLUSIONS: A relative increase in indices of medial compartment loading was observed in the leg undergoing APM compared with the contra-lateral leg from before to 12 months after surgery. This increase may contribute to the elevated risk of knee OA in these patients. Randomized trials including a non-surgical control group are needed to determine if changes in joint loading following APM are caused by surgery or by changes in symptoms.},
	language = {eng},
	number = {7},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Thorlund, J. B. and Holsgaard-Larsen, A. and Creaby, M. W. and Jørgensen, G. M. and Nissen, N. and Englund, M. and Lohmander, L. S.},
	month = jul,
	year = {2016},
	pmid = {26836286},
	keywords = {Arthroscopy, Biomechanics, Joint load, Knee adduction moment, Meniscectomy, Osteoarthritis},
	pages = {1153--1159},
}

OBJECTIVE: Patients undergoing arthroscopic partial meniscectomy (APM) are at increased risk of knee osteoarthritis (OA). Meniscal damage and/or surgery may alter knee joint loading to increase OA risk. We investigated changes in knee joint loading following medial APM surgery, compared with the contra-lateral leg. METHODS: We estimated indices of knee joint loading (external peak knee adduction moment (KAM), KAM impulse and peak knee flexion moment (KFM)) normalized to body size (i.e., body mass (BM) and height (HT)) using 3D gait analysis in 23 patients (17 men, mean (SD) 46.2 (6.4) years, BMI 25.8 (3.4) kg/m(2)) without radiographic knee OA before and 12 months after medial APM. Static alignment was assessed by radiography and self-reported outcomes by Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Peak KAM and KAM impulse increased in the APM leg compared to the contra-lateral leg from before to 12 months after surgery (change difference: 0.38 Nm/BM*HT% 95% CI 0.01 to 0.76 (P = 0.049) and 0.20 Nm*s/BM*HT% 95% CI 0.10 to 0.30 (P \textless 0.001)). Patients self-reported improvements on all KOOS subscales (KOOS pain improvement: 22.8 95% CI 14.5 to 31.0 (P \textless 0.01)). CONCLUSIONS: A relative increase in indices of medial compartment loading was observed in the leg undergoing APM compared with the contra-lateral leg from before to 12 months after surgery. This increase may contribute to the elevated risk of knee OA in these patients. Randomized trials including a non-surgical control group are needed to determine if changes in joint loading following APM are caused by surgery or by changes in symptoms.

@article{wetterholm_rate_2016,
	title = {The rate of joint replacement in osteoarthritis depends on the patient's socioeconomic status.},
	volume = {87},
	issn = {1745-3682 1745-3674},
	url = {http://dx.doi.org/10.3109/17453674.2016.1161451},
	doi = {10.3109/17453674.2016.1161451},
	abstract = {Background and purpose - Assessment of potential disparities in access to care is a vital part of achieving equity in health and healthcare. We have therefore studied the effect of socioeconomic status (SES) on the rates of knee and hip replacement due to osteoarthritis. Methods - This was a cohort study in Skane, Sweden. We included all residents aged {\textgreater}/= 35 years with consultations between 2004 and 2013 for hip or knee osteoarthritis. We retrieved individual information on income, education, and occupation and evaluated the rates of knee and hip replacement according to SES, with adjustment for age and sex. Professionals, legislators, senior officials, and managers, and individuals with the longest education, served as the reference group. Results - We followed 50,498 knee osteoarthritis patients (59\% women) and 20,882 hip osteoarthritis patients (58\% women). The mutually adjusted rate of knee replacement was lower in those with an elementary occupation (hazard ratio (HR) = 0.81, 95\% CI: 0.72-0.92), in craft workers and those with related trades (HR = 0.88, CI: 0.79-0.98), and in skilled  agricultural/fishery workers (HR = 0.83, CI: 0.72-0.96), but higher in the 2 least educated groups (HR = 1.2 in both). The rate of hip replacement was lower in those with an elementary occupation (HR = 0.77, 95\% CI: 0.68-0.87), in plant and machine operators/assemblers (HR = 0.83, CI: 0.75-0.93), and service workers/shop assistants (HR = 0.88, CI: 0.80-0.96). The rate of hip replacement was higher in the highest income group (HR = 1.1, 95\% CI: 1.0-1.2). Interpretation - There was a lower rate of joint replacement in osteoarthritis patients working in professions often associated with lower socioeconomic status, suggesting inequity in access to care. However, the results are not unanimous, as the rate of knee replacement was higher in the least educated groups.},
	language = {eng},
	number = {3},
	journal = {Acta orthopaedica},
	author = {Wetterholm, Malin and Turkiewicz, Aleksandra and Stigmar, Kjerstin and Hubertsson, Jenny and Englund, Martin},
	month = jun,
	year = {2016},
	pmid = {26982799},
	pmcid = {PMC4900082},
	pages = {245--251},
}

Background and purpose - Assessment of potential disparities in access to care is a vital part of achieving equity in health and healthcare. We have therefore studied the effect of socioeconomic status (SES) on the rates of knee and hip replacement due to osteoarthritis. Methods - This was a cohort study in Skane, Sweden. We included all residents aged \textgreater/= 35 years with consultations between 2004 and 2013 for hip or knee osteoarthritis. We retrieved individual information on income, education, and occupation and evaluated the rates of knee and hip replacement according to SES, with adjustment for age and sex. Professionals, legislators, senior officials, and managers, and individuals with the longest education, served as the reference group. Results - We followed 50,498 knee osteoarthritis patients (59% women) and 20,882 hip osteoarthritis patients (58% women). The mutually adjusted rate of knee replacement was lower in those with an elementary occupation (hazard ratio (HR) = 0.81, 95% CI: 0.72-0.92), in craft workers and those with related trades (HR = 0.88, CI: 0.79-0.98), and in skilled agricultural/fishery workers (HR = 0.83, CI: 0.72-0.96), but higher in the 2 least educated groups (HR = 1.2 in both). The rate of hip replacement was lower in those with an elementary occupation (HR = 0.77, 95% CI: 0.68-0.87), in plant and machine operators/assemblers (HR = 0.83, CI: 0.75-0.93), and service workers/shop assistants (HR = 0.88, CI: 0.80-0.96). The rate of hip replacement was higher in the highest income group (HR = 1.1, 95% CI: 1.0-1.2). Interpretation - There was a lower rate of joint replacement in osteoarthritis patients working in professions often associated with lower socioeconomic status, suggesting inequity in access to care. However, the results are not unanimous, as the rate of knee replacement was higher in the least educated groups.

@article{jordan_influences_2016,
	title = {Influences on the decision to use an osteoarthritis diagnosis in primary care: {A} cohort study with linked survey and electronic health record data.},
	volume = {24},
	issn = {1522-9653},
	shorttitle = {Influences on the decision to use an osteoarthritis diagnosis in primary care},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2015.12.015},
	doi = {10.1016/j.joca.2015.12.015},
	abstract = {OBJECTIVE: Clinicians may record patients presenting with osteoarthritis (OA) symptoms with joint pain rather than an OA diagnosis. This may have implications for OA research studies and patient care. The objective was to assess whether older adults recorded with joint pain are similar to those with a recorded OA diagnosis.
METHOD: A study of adults aged ≥50 years in eight United Kingdom general practices, with electronic health records linked to survey data. Patients with a recorded regional OA diagnosis were compared to those with a recorded joint pain symptom on socio-demographics, risk factors, body region, pain severity, prescribed analgesia, and potential differential diagnoses. A sub-group was compared on radiographic knee OA.
RESULTS: Thirteen thousand eight hundred and thirty-one survey responders consented to record review. One thousand four hundred and twenty-seven (10\%) received an OA (n = 616) or joint pain (n = 811) code with wide practice variation. Receiving an OA diagnosis was associated with age (75+ compared to 50-64 OR 3.25; 95\% Credible intervals (CrI) 2.36, 4.53), obesity (1.72; 1.22, 2.33), and pain interference (1.45; 1.09, 1.92). Analgesia management was similar. Radiographic OA was common in both groups. A quarter of those with a joint pain record received an OA diagnosis in the following 6 years.
CONCLUSION: Recording OA diagnoses are less common than recording a joint pain symptom and associated with risk factors and severity. OA studies in primary care need to consider joint pain symptoms to understand the burden and quality of care across the spectrum of OA. Patients recorded with joint pain may represent early cases of OA with need for early intervention.},
	language = {eng},
	number = {5},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Jordan, K. P. and Tan, V. and Edwards, J. J. and Chen, Y. and Englund, M. and Hubertsson, J. and Jöud, A. and Porcheret, M. and Turkiewicz, A. and Peat, G.},
	month = may,
	year = {2016},
	pmid = {26746149},
	pmcid = {PMC4850243},
	keywords = {Computerized patient medical records, Osteoarthritis, Primary health care},
	pages = {786--793},
}

OBJECTIVE: Clinicians may record patients presenting with osteoarthritis (OA) symptoms with joint pain rather than an OA diagnosis. This may have implications for OA research studies and patient care. The objective was to assess whether older adults recorded with joint pain are similar to those with a recorded OA diagnosis. METHOD: A study of adults aged ≥50 years in eight United Kingdom general practices, with electronic health records linked to survey data. Patients with a recorded regional OA diagnosis were compared to those with a recorded joint pain symptom on socio-demographics, risk factors, body region, pain severity, prescribed analgesia, and potential differential diagnoses. A sub-group was compared on radiographic knee OA. RESULTS: Thirteen thousand eight hundred and thirty-one survey responders consented to record review. One thousand four hundred and twenty-seven (10%) received an OA (n = 616) or joint pain (n = 811) code with wide practice variation. Receiving an OA diagnosis was associated with age (75+ compared to 50-64 OR 3.25; 95% Credible intervals (CrI) 2.36, 4.53), obesity (1.72; 1.22, 2.33), and pain interference (1.45; 1.09, 1.92). Analgesia management was similar. Radiographic OA was common in both groups. A quarter of those with a joint pain record received an OA diagnosis in the following 6 years. CONCLUSION: Recording OA diagnoses are less common than recording a joint pain symptom and associated with risk factors and severity. OA studies in primary care need to consider joint pain symptoms to understand the burden and quality of care across the spectrum of OA. Patients recorded with joint pain may represent early cases of OA with need for early intervention.

@article{sihvonen_mechanical_2016-1,
	title = {Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: {A} secondary analysis of a randomized trial.},
	volume = {164},
	issn = {1539-3704 0003-4819},
	url = {http://dx.doi.org/10.7326%2FM15-0899},
	doi = {10.7326/M15-0899},
	abstract = {BACKGROUND: Recent evidence shows that arthroscopic partial meniscectomy (APM) offers no benefit over conservative treatment of patients with a degenerative meniscus tear. However, patients who report mechanical symptoms (sensations of knee catching or locking) may benefit from APM. OBJECTIVE: To assess whether APM  improves mechanical symptoms better than sham surgery. DESIGN: Randomized, patient- and outcome assessor-blinded, sham surgery-controlled, multicenter trial. (ClinicalTrials.gov: NCT00549172). SETTING: 5 orthopedic clinics in Finland. PATIENTS: Adults (aged 35 to 65 years) with a degenerative medial meniscus tear and no knee osteoarthritis. INTERVENTION: APM or sham surgery. MEASUREMENTS: Patients' self-report of mechanical symptoms before surgery and at  2, 6, and 12 months after surgery. RESULTS: 70 patients were randomly assigned to APM, and 76 were assigned to sham surgery. Thirty-two patients (46\%) in the APM group and 37 (49\%) in the sham surgery group reported catching or locking before  surgery; the corresponding numbers at any follow-up were 34 (49\%) and 33 (43\%), with a risk difference of 0.03 (95\% CI, -0.06 to 0.12). In the subgroup of 69 patients with preoperative catching or locking, the risk difference was 0.07 (CI, -0.08 to 0.22). LIMITATION: Analyses were post hoc, and the results are only generalizable to knee catching and occasional locking because few patients reported other types of mechanical symptoms. CONCLUSION: Resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking. These findings question whether mechanical symptoms are caused by a degenerative meniscus tear and prompt caution in using patients' self-report of these symptoms as an indication for APM. PRIMARY FUNDING SOURCE: Academy of Finland.},
	language = {eng},
	number = {7},
	journal = {Annals of internal medicine},
	author = {Sihvonen, Raine and Englund, Martin and Turkiewicz, Aleksandra and Jarvinen, Teppo L. N.},
	month = apr,
	year = {2016},
	pmid = {26856620},
	keywords = {Adult, Aged, Arthroscopy/*methods, Double-Blind Method, Female, Humans, Male, Menisci, Tibial/*injuries/physiopathology/*surgery, Middle Aged, Treatment Outcome},
	pages = {449--455},
}

BACKGROUND: Recent evidence shows that arthroscopic partial meniscectomy (APM) offers no benefit over conservative treatment of patients with a degenerative meniscus tear. However, patients who report mechanical symptoms (sensations of knee catching or locking) may benefit from APM. OBJECTIVE: To assess whether APM improves mechanical symptoms better than sham surgery. DESIGN: Randomized, patient- and outcome assessor-blinded, sham surgery-controlled, multicenter trial. (ClinicalTrials.gov: NCT00549172). SETTING: 5 orthopedic clinics in Finland. PATIENTS: Adults (aged 35 to 65 years) with a degenerative medial meniscus tear and no knee osteoarthritis. INTERVENTION: APM or sham surgery. MEASUREMENTS: Patients' self-report of mechanical symptoms before surgery and at 2, 6, and 12 months after surgery. RESULTS: 70 patients were randomly assigned to APM, and 76 were assigned to sham surgery. Thirty-two patients (46%) in the APM group and 37 (49%) in the sham surgery group reported catching or locking before surgery; the corresponding numbers at any follow-up were 34 (49%) and 33 (43%), with a risk difference of 0.03 (95% CI, -0.06 to 0.12). In the subgroup of 69 patients with preoperative catching or locking, the risk difference was 0.07 (CI, -0.08 to 0.22). LIMITATION: Analyses were post hoc, and the results are only generalizable to knee catching and occasional locking because few patients reported other types of mechanical symptoms. CONCLUSION: Resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking. These findings question whether mechanical symptoms are caused by a degenerative meniscus tear and prompt caution in using patients' self-report of these symptoms as an indication for APM. PRIMARY FUNDING SOURCE: Academy of Finland.

@article{bergkvist_knee_2016,
	title = {Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find? {An} evaluation from southern {Sweden}.},
	volume = {87},
	issn = {1745-3682 1745-3674},
	url = {http://dx.doi.org/10.3109%2F17453674.2015.1055179},
	doi = {10.3109/17453674.2015.1055179},
	abstract = {BACKGROUND AND PURPOSE: Several randomized controlled trials have not shown any added benefit of arthroscopy over placebo surgery or physiotherapy in middle-aged patients with knee symptoms without trauma. We studied the characteristics of the knee arthroscopies performed in southern Sweden. PATIENTS AND METHODS: From the orthopedic surgical records from 2007-2009 in the Skane region of Sweden (with a  population of 1.2 million), we retrieved ICD-10 diagnostic codes and selected all 4,096 arthroscopies that were diagnosed peroperatively with code M23.2 (derangement of meniscus due to old tear or injury) or code M17 (knee osteoarthritis). We extracted information on cartilage and meniscus status at arthroscopy, and we also randomly sampled 502 of these patients from the regional archive of radiology and analyzed the preoperative prevalence of radiographic or  magnetic resonance imaging (MRI)-defined osteoarthritis. RESULTS: 2,165 (53\%) of  the 4,096 arthroscopies had the diagnostic code M23.2 or M17. In this subgroup, 1,375 cases (64\%) had typical findings consistent with degenerative meniscal tear (i.e. that correspond to a degenerative meniscal tear in at least a third of all  arthroscopies). Of the randomly sampled patients, the preoperative prevalence of  radiological knee osteoarthritis was 46\%. INTERPRETATION: There is a discrepancy  between evidence-based medicine treatment guidelines and clinical practice regarding the amount of knee arthroscopies performed in patients with symptoms of degenerative knee disease.},
	language = {eng},
	number = {1},
	journal = {Acta orthopaedica},
	author = {Bergkvist, Dan and Dahlberg, Leif E. and Neuman, Paul and Englund, Martin},
	month = feb,
	year = {2016},
	pmid = {26012547},
	pmcid = {PMC4940584},
	keywords = {Age Factors, Arthroscopy/*methods, Cartilage Diseases/pathology/radiography/surgery, Confidence Intervals, Databases, Factual, Female, Humans, Knee Injuries/pathology/*radiography/*surgery, Magnetic Resonance Imaging/methods, Male, Menisci, Tibial/*injuries/radiography/surgery, Osteoarthritis, Knee/parasitology/*radiography/*surgery, Preoperative Care/methods, Radiology/methods, Retrospective Studies, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Sex Factors, Sweden, Treatment Outcome},
	pages = {12--16},
}

BACKGROUND AND PURPOSE: Several randomized controlled trials have not shown any added benefit of arthroscopy over placebo surgery or physiotherapy in middle-aged patients with knee symptoms without trauma. We studied the characteristics of the knee arthroscopies performed in southern Sweden. PATIENTS AND METHODS: From the orthopedic surgical records from 2007-2009 in the Skane region of Sweden (with a population of 1.2 million), we retrieved ICD-10 diagnostic codes and selected all 4,096 arthroscopies that were diagnosed peroperatively with code M23.2 (derangement of meniscus due to old tear or injury) or code M17 (knee osteoarthritis). We extracted information on cartilage and meniscus status at arthroscopy, and we also randomly sampled 502 of these patients from the regional archive of radiology and analyzed the preoperative prevalence of radiographic or magnetic resonance imaging (MRI)-defined osteoarthritis. RESULTS: 2,165 (53%) of the 4,096 arthroscopies had the diagnostic code M23.2 or M17. In this subgroup, 1,375 cases (64%) had typical findings consistent with degenerative meniscal tear (i.e. that correspond to a degenerative meniscal tear in at least a third of all arthroscopies). Of the randomly sampled patients, the preoperative prevalence of radiological knee osteoarthritis was 46%. INTERPRETATION: There is a discrepancy between evidence-based medicine treatment guidelines and clinical practice regarding the amount of knee arthroscopies performed in patients with symptoms of degenerative knee disease.

@article{kumm_natural_2016,
	title = {Natural history of intrameniscal signal intensity on knee {MR} images: {Six} years of data from the osteoarthritis initiative.},
	volume = {278},
	copyright = {(c) RSNA, 2015},
	issn = {1527-1315 0033-8419},
	url = {http://dx.doi.org/10.1148%2Fradiol.2015142905},
	doi = {10.1148/radiol.2015142905},
	abstract = {PURPOSE: To assess the natural history of intrameniscal signal intensity on magnetic resonance (MR) images of the medial compartment. MATERIALS AND METHODS:  Both knees of 269 participants (55\% women, aged 45-55 years) in the Osteoarthritis Initiative without radiographic knee osteoarthritis (OA) and without medial meniscal tear at baseline were studied. One radiologist assessed},
	language = {eng},
	number = {1},
	journal = {Radiology},
	author = {Kumm, Jaanika and Roemer, Frank W. and Guermazi, Ali and Turkiewicz, Aleksandra and Englund, Martin},
	month = jan,
	year = {2016},
	pmid = {26172533},
	pmcid = {PMC4699496},
	keywords = {Female, Humans, Knee Injuries/*diagnosis/surgery, Longitudinal Studies, Magnetic Resonance Imaging/*methods, Male, Menisci, Tibial/*injuries/pathology/surgery, Middle Aged, Osteoarthritis, Knee/pathology, Reproducibility of Results},
	pages = {164--171},
}

PURPOSE: To assess the natural history of intrameniscal signal intensity on magnetic resonance (MR) images of the medial compartment. MATERIALS AND METHODS: Both knees of 269 participants (55% women, aged 45-55 years) in the Osteoarthritis Initiative without radiographic knee osteoarthritis (OA) and without medial meniscal tear at baseline were studied. One radiologist assessed

@article{kiadaliri_association_2016,
	title = {Association of knee pain and different definitions of knee osteoarthritis with health-related quality of life: {A} population-based cohort study in southern {Sweden}.},
	volume = {14},
	issn = {1477-7525 1477-7525},
	url = {http://dx.doi.org/10.1186%2Fs12955-016-0525-4},
	doi = {10.1186/s12955-016-0525-4},
	abstract = {BACKGROUND: While the impact of knee pain and knee osteoarthritis (OA) on health-related quality of life (HRQoL) has been investigated in the literature, there is a lack of knowledge on the impact of different definitions of OA on HRQoL. The main aim of this study was to measure and compare the impact of knee OA and its different definitions on HRQoL in the general population. METHODS: A random sample of 1300 participants from Malmo, Sweden with pain in one or both knees in the past 12 months with duration {\textgreater}/=4 weeks and 650 participants without were invited to clinical and radiographic knee examination. A total of 1527 individuals with a mean (SD) age 69.4 (7.2) participated and responded to both generic (EQ-5D-3L) and disease-specific (the Knee injury and Osteoarthritis Outcome Score) questionnaires. Knee pain was defined as pain during the last month during most of the days. Knee OA was defined radiographically (equivalent to Kellgren and Lawrence grade {\textgreater}/=2) and clinically according to the American College of Rheumatology (ACR) criteria. RESULTS: Of participants with either knee pain or knee OA or both, 7 \% reported no problem for the EQ-5D-3L attributes. The corresponding proportion among references (neither knee pain nor OA) was 42 \%. The participants with knee pain and OA had all HRQoL measures lower compared to those with knee pain but no OA. The ACR clinical definition of knee OA was associated with lower HRQoL than the definition based on radiographic knee OA (adjusted difference -0.08 in UK EQ-5D-3L index score). CONCLUSIONS: Applying different definitions of knee OA result in different levels of HRQoL and this is  mainly explained by the knee pain experience. These differences may lead to discrepant conclusions from cost-utility analyses.},
	language = {eng},
	number = {1},
	journal = {Health and quality of life outcomes},
	author = {Kiadaliri, Aliasghar A. and Lamm, Carl Johan and de Verdier, Maria Gerhardsson and Engstrom, Gunnar and Turkiewicz, Aleksandra and Lohmander, L. Stefan and Englund, Martin},
	year = {2016},
	pmid = {27565135},
	pmcid = {PMC5002211},
	keywords = {EQ-5D-3L, KOOS, Knee osteoarthritis, Knee pain, Quality of life, Sweden},
	pages = {121},
}

BACKGROUND: While the impact of knee pain and knee osteoarthritis (OA) on health-related quality of life (HRQoL) has been investigated in the literature, there is a lack of knowledge on the impact of different definitions of OA on HRQoL. The main aim of this study was to measure and compare the impact of knee OA and its different definitions on HRQoL in the general population. METHODS: A random sample of 1300 participants from Malmo, Sweden with pain in one or both knees in the past 12 months with duration \textgreater/=4 weeks and 650 participants without were invited to clinical and radiographic knee examination. A total of 1527 individuals with a mean (SD) age 69.4 (7.2) participated and responded to both generic (EQ-5D-3L) and disease-specific (the Knee injury and Osteoarthritis Outcome Score) questionnaires. Knee pain was defined as pain during the last month during most of the days. Knee OA was defined radiographically (equivalent to Kellgren and Lawrence grade \textgreater/=2) and clinically according to the American College of Rheumatology (ACR) criteria. RESULTS: Of participants with either knee pain or knee OA or both, 7 % reported no problem for the EQ-5D-3L attributes. The corresponding proportion among references (neither knee pain nor OA) was 42 %. The participants with knee pain and OA had all HRQoL measures lower compared to those with knee pain but no OA. The ACR clinical definition of knee OA was associated with lower HRQoL than the definition based on radiographic knee OA (adjusted difference -0.08 in UK EQ-5D-3L index score). CONCLUSIONS: Applying different definitions of knee OA result in different levels of HRQoL and this is mainly explained by the knee pain experience. These differences may lead to discrepant conclusions from cost-utility analyses.

@article{jerrhag_increasing_2016,
	title = {Increasing wrist fracture rates in children may have major implications for future adult fracture burden.},
	volume = {87},
	issn = {1745-3682 1745-3674},
	url = {http://dx.doi.org/10.3109/17453674.2016.1152855},
	doi = {10.3109/17453674.2016.1152855},
	abstract = {Background and purpose - Childhood fractures are associated with lower peak bone  mass (a determinant of osteoporosis in old age) and higher adult fracture risk. By examining time trends in childhood fracture epidemiology, it may be possible to estimate the vector of fragility fracture risk in the future. Patients and methods - By using official inpatient and outpatient data from the county of Skane in Sweden, 1999-2010, we ascertained distal forearm fractures in children aged {\textless}/= 16 years and estimated overall and age- and sex-specific rates and time  trends (over 2.8 million patient years) and compared the results to earlier estimations in the same region from 1950 onwards. Results - During the period},
	language = {eng},
	number = {3},
	journal = {Acta orthopaedica},
	author = {Jerrhag, Daniel and Englund, Martin and Petersson, Ingmar and Lempesis, Vasileios and Landin, Lennart and Karlsson, Magnus K. and Rosengren, Bjorn E.},
	month = jun,
	year = {2016},
	pmid = {26905618},
	pmcid = {PMC4900094},
	pages = {296--300},
}

Background and purpose - Childhood fractures are associated with lower peak bone mass (a determinant of osteoporosis in old age) and higher adult fracture risk. By examining time trends in childhood fracture epidemiology, it may be possible to estimate the vector of fragility fracture risk in the future. Patients and methods - By using official inpatient and outpatient data from the county of Skane in Sweden, 1999-2010, we ascertained distal forearm fractures in children aged \textless/= 16 years and estimated overall and age- and sex-specific rates and time trends (over 2.8 million patient years) and compared the results to earlier estimations in the same region from 1950 onwards. Results - During the period

@article{zhang_risk_2016,
	title = {Risk factors for meniscal body extrusion on {MRI} in subjects free of radiographic knee osteoarthritis: {Longitudinal} data from the {Osteoarthritis} {Initiative}.},
	volume = {24},
	issn = {1522-9653},
	shorttitle = {Risk factors for meniscal body extrusion on {MRI} in subjects free of radiographic knee osteoarthritis},
	url = {http://dx.doi.org/10.1016/j.joca.2015.12.003},
	doi = {10.1016/j.joca.2015.12.003},
	abstract = {OBJECTIVE: To determine risk factors associated with increased meniscal body extrusion on knee magnetic resonance (MR) images in subjects free of radiographic osteoarthritis (OA).
METHODS: We selected 340 subjects (aged 45-55 years, mean [SD] body mass index 26.7 [4.4], 51\% women) with Kellgren-Lawrence grade 0 in both knees and bilateral knee MR images available at the baseline, 24 months, 48 months, and 72 month exam from the Osteoarthritis Initiative (OAI). We assessed mid-coronal 3-T MR images from baseline through the 72-month exam. One observer measured widths of the tibia plateau and medial or lateral meniscal body extrusion for baseline and 72 months follow-up. Another observer assessed meniscal integrity at all four time points. We calculated an extrusion ratio ([meniscal body extrusion]/[tibia width] × 100) to account for knee size. We evaluated risk factors for increased meniscal body extrusion ratio from baseline to 72 months by a multivariable linear regression mixed model for medial and lateral compartment, respectively.
RESULTS: In the medial compartment female sex (β = 0.35; 95\% confidence interval [CI] 0.16-0.53), incident meniscal tear (β = 0.29; 95\% CI 0.22-0.55), and the baseline value of the extrusion ratio (β = 0.63; 95\% CI 0.56-0.70) were associated with increased extrusion ratio by 72 months. Results were similar for the lateral compartment.
CONCLUSIONS: Only female sex, incident meniscal tear, and higher baseline value of extrusion are risk factors for increased meniscal body extrusion in subjects free of radiographic OA. The results suggest that meniscal extrusion may contribute to and mediate the well-known increase in knee OA incidence in middle-aged women.},
	language = {eng},
	number = {5},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Zhang, F. and Kumm, J. and Svensson, F. and Turkiewicz, A. and Frobell, R. and Englund, M.},
	month = may,
	year = {2016},
	pmid = {26706701},
	keywords = {Knee, Magnetic resonance imaging, Meniscus, Osteoarthritis},
	pages = {801--806},
}

OBJECTIVE: To determine risk factors associated with increased meniscal body extrusion on knee magnetic resonance (MR) images in subjects free of radiographic osteoarthritis (OA). METHODS: We selected 340 subjects (aged 45-55 years, mean [SD] body mass index 26.7 [4.4], 51% women) with Kellgren-Lawrence grade 0 in both knees and bilateral knee MR images available at the baseline, 24 months, 48 months, and 72 month exam from the Osteoarthritis Initiative (OAI). We assessed mid-coronal 3-T MR images from baseline through the 72-month exam. One observer measured widths of the tibia plateau and medial or lateral meniscal body extrusion for baseline and 72 months follow-up. Another observer assessed meniscal integrity at all four time points. We calculated an extrusion ratio ([meniscal body extrusion]/[tibia width] × 100) to account for knee size. We evaluated risk factors for increased meniscal body extrusion ratio from baseline to 72 months by a multivariable linear regression mixed model for medial and lateral compartment, respectively. RESULTS: In the medial compartment female sex (β = 0.35; 95% confidence interval [CI] 0.16-0.53), incident meniscal tear (β = 0.29; 95% CI 0.22-0.55), and the baseline value of the extrusion ratio (β = 0.63; 95% CI 0.56-0.70) were associated with increased extrusion ratio by 72 months. Results were similar for the lateral compartment. CONCLUSIONS: Only female sex, incident meniscal tear, and higher baseline value of extrusion are risk factors for increased meniscal body extrusion in subjects free of radiographic OA. The results suggest that meniscal extrusion may contribute to and mediate the well-known increase in knee OA incidence in middle-aged women.

@article{paradowski_osteoarthritis_2016,
	title = {Osteoarthritis of the knee after meniscal resection: {Long} term radiographic evaluation of disease progression.},
	volume = {24},
	issn = {1522-9653},
	shorttitle = {Osteoarthritis of the knee after meniscal resection},
	url = {http://dx.doi.org/10.1016/j.joca.2015.12.002},
	doi = {10.1016/j.joca.2015.12.002},
	abstract = {OBJECTIVE: To determine prevalence, incidence and progression of radiographic knee osteoarthritis (OA) in a cohort of subjects with previous meniscectomy.
METHODS: We assessed 221 subjects (177 men and 44 women) with weight bearing knee radiography twice (assessment A and B) with a follow-up time ranging from 4 to 10 years. All subjects had undergone meniscectomy 15-22 years before assessment A. At assessment B the mean (SD) age was 60 (11) years. We assessed prevalence and incidence of OA, as well as progression of radiographic features over time. Radiographic OA was defined as approximating Kellgren and Lawrence grade 2 or worse.
RESULTS: At assessment A, we found tibiofemoral radiographic OA in 107 subjects' index knee (48\%) of which 41 subjects (38\%) had bilateral tibiofemoral OA. At assessment B, the corresponding figures were 151 (68\%) and 71 (32\%). At assessment A, we found patellofemoral OA in 32 subjects' index knee (14\%) of which 11 (34\%) had bilateral patellofemoral OA. At assessment B, the corresponding figures were 51 (23\%) and 19 (37\%). There was an increase of the sum of joint space narrowing (JSN) and osteophyte grades in the tibiofemoral joint of 144 subjects' index knee (64\%) and in the contralateral tibiofemoral joints of 79 subjects (36\%). The corresponding progression in the patellofemoral joint was observed in 66 index knees (30\%) and in 41 (19\%) contralateral knees.
CONCLUSIONS: Overall, some 20-30 years after meniscectomy nearly three out of four persons had developed radiographic tibiofemoral OA and one out of four had developed patellofemoral OA.},
	language = {eng},
	number = {5},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Paradowski, P. T. and Lohmander, L. S. and Englund, M.},
	month = may,
	year = {2016},
	pmid = {26706700},
	keywords = {Knee, Meniscectomy, Osteoarthritis, Prevalence, Progression, Radiography},
	pages = {794--800},
}

OBJECTIVE: To determine prevalence, incidence and progression of radiographic knee osteoarthritis (OA) in a cohort of subjects with previous meniscectomy. METHODS: We assessed 221 subjects (177 men and 44 women) with weight bearing knee radiography twice (assessment A and B) with a follow-up time ranging from 4 to 10 years. All subjects had undergone meniscectomy 15-22 years before assessment A. At assessment B the mean (SD) age was 60 (11) years. We assessed prevalence and incidence of OA, as well as progression of radiographic features over time. Radiographic OA was defined as approximating Kellgren and Lawrence grade 2 or worse. RESULTS: At assessment A, we found tibiofemoral radiographic OA in 107 subjects' index knee (48%) of which 41 subjects (38%) had bilateral tibiofemoral OA. At assessment B, the corresponding figures were 151 (68%) and 71 (32%). At assessment A, we found patellofemoral OA in 32 subjects' index knee (14%) of which 11 (34%) had bilateral patellofemoral OA. At assessment B, the corresponding figures were 51 (23%) and 19 (37%). There was an increase of the sum of joint space narrowing (JSN) and osteophyte grades in the tibiofemoral joint of 144 subjects' index knee (64%) and in the contralateral tibiofemoral joints of 79 subjects (36%). The corresponding progression in the patellofemoral joint was observed in 66 index knees (30%) and in 41 (19%) contralateral knees. CONCLUSIONS: Overall, some 20-30 years after meniscectomy nearly three out of four persons had developed radiographic tibiofemoral OA and one out of four had developed patellofemoral OA.

@article{kiadaliri_no_2016,
	title = {No economic benefit of early knee reconstruction over optional delayed reconstruction for {ACL} tears: {Registry} enriched randomised controlled trial data.},
	volume = {50},
	copyright = {Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/},
	issn = {1473-0480 0306-3674},
	url = {http://dx.doi.org/10.1136/bjsports-2015-095308},
	doi = {10.1136/bjsports-2015-095308},
	abstract = {BACKGROUND: To analyse 5-year cost-effectiveness of early versus optional delayed acute anterior cruciate ligament (ACL) reconstruction. METHODS: 121 young, active adults with acute ACL injury to a previously uninjured knee were randomised to early ACL reconstruction (n=62, within 10 weeks of injury) or optional delayed ACL reconstruction (n=59; 30 with ACL reconstruction within 6-55 months); all patients received similar structured rehabilitation. Real life data on health care utilisation and sick leave were obtained from regional and national registers. Costs and quality-adjusted life years (QALYs) were discounted at 3\%. Full-analysis set (based on study randomisation) and as-treated analysis (according to actual treatment over 5 years) principles were applied. RESULTS: Mean cost of early ACL reconstruction was euro4695 higher than optional delayed ACL reconstruction (p=0.19) and provided an additional 0.13 QALYs (p=0.11). Full-analysis set showed incremental net benefit of early versus optional delayed ACL reconstruction was not statistically significantly different from zero at any level. As-treated analysis showed that costs for rehabilitation alone were euro13 650 less than early ACL reconstruction (p{\textless}0.001). Results were robust to sensitivity analyses. CONCLUSIONS: In young active adults with acute ACL injury,  a strategy of early ACL reconstruction did not provide extra economic value over  a strategy of optional delayed ACL reconstruction over a 5-year period. Results from this and previous reports of the KANON-trial imply that early identification of individuals who would benefit from either early ACL reconstruction or rehabilitation alone might reduce resource consumption and decrease risk of unnecessary overtreatment. TRIAL REGISTRATION: ISRCTN84752559.},
	language = {eng},
	number = {9},
	journal = {British journal of sports medicine},
	author = {Kiadaliri, Aliasghar A. and Englund, Martin and Lohmander, L. Stefan and Carlsson, Katarina Steen and Frobell, Richard B.},
	month = may,
	year = {2016},
	pmid = {26935859},
	keywords = {Economics, Effectiveness, Knee ACL, Randomised controlled trial, Rehabilitation},
	pages = {558--563},
}

BACKGROUND: To analyse 5-year cost-effectiveness of early versus optional delayed acute anterior cruciate ligament (ACL) reconstruction. METHODS: 121 young, active adults with acute ACL injury to a previously uninjured knee were randomised to early ACL reconstruction (n=62, within 10 weeks of injury) or optional delayed ACL reconstruction (n=59; 30 with ACL reconstruction within 6-55 months); all patients received similar structured rehabilitation. Real life data on health care utilisation and sick leave were obtained from regional and national registers. Costs and quality-adjusted life years (QALYs) were discounted at 3%. Full-analysis set (based on study randomisation) and as-treated analysis (according to actual treatment over 5 years) principles were applied. RESULTS: Mean cost of early ACL reconstruction was euro4695 higher than optional delayed ACL reconstruction (p=0.19) and provided an additional 0.13 QALYs (p=0.11). Full-analysis set showed incremental net benefit of early versus optional delayed ACL reconstruction was not statistically significantly different from zero at any level. As-treated analysis showed that costs for rehabilitation alone were euro13 650 less than early ACL reconstruction (p\textless0.001). Results were robust to sensitivity analyses. CONCLUSIONS: In young active adults with acute ACL injury, a strategy of early ACL reconstruction did not provide extra economic value over a strategy of optional delayed ACL reconstruction over a 5-year period. Results from this and previous reports of the KANON-trial imply that early identification of individuals who would benefit from either early ACL reconstruction or rehabilitation alone might reduce resource consumption and decrease risk of unnecessary overtreatment. TRIAL REGISTRATION: ISRCTN84752559.

@article{englund_evidence_2016,
	title = {Evidence that meniscus damage may be a component of osteoarthritis: {The} {Framingham} study.},
	volume = {24},
	issn = {1522-9653},
	shorttitle = {Evidence that meniscus damage may be a component of osteoarthritis},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2015.08.005},
	doi = {10.1016/j.joca.2015.08.005},
	abstract = {OBJECTIVES: The etiology of degenerative meniscus tear is unclear but could be related to a generalized osteoarthritic disease process. We studied whether radiographic hand osteoarthritis (OA) is associated with meniscus damage.
METHODS: We examined 974 persons aged 50-90 years drawn via census tract data and random-digit dialing from Framingham, Massachusetts, United States. One reader assessed bilateral hand radiographs (30 joints) and another read frontal knee radiographs, all according to the Kellgren-Lawrence (KL) scale. A third reader assessed right knee 1.5-T magnetic resonance imaging (MRI) scans for meniscus damage. We calculated the prevalence of medial and/or lateral meniscus damage in those with one to two and three or more finger joints with radiographic OA (KL grade ≥2) compared to those without radiographic hand OA with adjustment for age, sex, and body mass index. We also evaluated the above association in persons without evidence of radiographic OA (KL grade 0) in their knee (n = 748).
RESULTS: The prevalence of meniscus damage in the knee of subjects with no, one to two, and three or more finger joints with OA was 24.9\%, 31.7\%, and 47.2\%, respectively. The adjusted prevalence ratio (PR) of having meniscus damage was significantly increased in those who had three or more finger joints with OA (1.40 [95\% confidence interval (CI) 1.11-1.77]). The estimate remained similar in persons without evidence of radiographic OA in their knee (PR, 1.42 [95\% CI 1.03-1.97]). The association was more robust for medial meniscus damage.
CONCLUSION: Results suggest a common non-age related etiologic pathway for both radiographic hand OA and meniscus damage.},
	language = {eng},
	number = {2},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Englund, M. and Haugen, I. K. and Guermazi, A. and Roemer, F. W. and Niu, J. and Neogi, T. and Aliabadi, P. and Felson, D. T.},
	month = feb,
	year = {2016},
	pmid = {26318660},
	pmcid = {PMC4724446},
	keywords = {Hand, Knee, Magnetic resonance imaging, Meniscus, Osteoarthritis, Radiography},
	pages = {270--273},
}

OBJECTIVES: The etiology of degenerative meniscus tear is unclear but could be related to a generalized osteoarthritic disease process. We studied whether radiographic hand osteoarthritis (OA) is associated with meniscus damage. METHODS: We examined 974 persons aged 50-90 years drawn via census tract data and random-digit dialing from Framingham, Massachusetts, United States. One reader assessed bilateral hand radiographs (30 joints) and another read frontal knee radiographs, all according to the Kellgren-Lawrence (KL) scale. A third reader assessed right knee 1.5-T magnetic resonance imaging (MRI) scans for meniscus damage. We calculated the prevalence of medial and/or lateral meniscus damage in those with one to two and three or more finger joints with radiographic OA (KL grade ≥2) compared to those without radiographic hand OA with adjustment for age, sex, and body mass index. We also evaluated the above association in persons without evidence of radiographic OA (KL grade 0) in their knee (n = 748). RESULTS: The prevalence of meniscus damage in the knee of subjects with no, one to two, and three or more finger joints with OA was 24.9%, 31.7%, and 47.2%, respectively. The adjusted prevalence ratio (PR) of having meniscus damage was significantly increased in those who had three or more finger joints with OA (1.40 [95% confidence interval (CI) 1.11-1.77]). The estimate remained similar in persons without evidence of radiographic OA in their knee (PR, 1.42 [95% CI 1.03-1.97]). The association was more robust for medial meniscus damage. CONCLUSION: Results suggest a common non-age related etiologic pathway for both radiographic hand OA and meniscus damage.

@article{kiadaliri_mortality_2016,
	title = {Mortality with musculoskeletal disorders as underlying cause in {Sweden} 1997-2013: {A} time trend aggregate level study.},
	volume = {17},
	issn = {1471-2474},
	shorttitle = {Mortality with musculoskeletal disorders as underlying cause in {Sweden} 1997-2013},
	url = {http://dx.doi.org/10.1186/s12891-016-1024-9},
	doi = {10.1186/s12891-016-1024-9},
	abstract = {The aim was to assess time trend of mortality with musculoskeletal disorders (MSD) as underlying cause of death in Sweden from 1997 to 2013.},
	urldate = {2017-01-09},
	journal = {BMC Musculoskeletal Disorders},
	author = {Kiadaliri, Aliasghar A. and Englund, Martin},
	year = {2016},
	keywords = {Mortality, Musculoskeletal disorders, Sweden, Temporal trend},
	pages = {163},
}

The aim was to assess time trend of mortality with musculoskeletal disorders (MSD) as underlying cause of death in Sweden from 1997 to 2013.

@article{kapetanovic_prevalence_2016,
	title = {Prevalence and incidence of gout in southern {Sweden} from the socioeconomic perspective.},
	volume = {2},
	url = {http://dx.doi.org/10.1136%2Frmdopen-2016-000326},
	doi = {10.1136/rmdopen-2016-000326},
	abstract = {OBJECTIVES: To estimate the prevalence and cumulative incidence of gout in southern Sweden with respect to socioeconomic status.
METHODS: Among residents of Skåne region in the year 2013 (total population 1.3 million), adult persons (age 18 years +) who between 1998 and 2013 received a diagnosis of gout (International Classification of Disease 10th Edition (ICD-10) code M10) by any physician were identified using the Skåne Healthcare Register. We calculated the point prevalence by end of 2013 and annual cumulative incidence in 2013 standardised to the whole Skåne population according to sex, individual information on occupation (white collar/blue collar), income (low/middle/high) and level of education (primary school/high school/university).
RESULTS: The crude 2013 point prevalence of gout and 2013 cumulative incidence (95\% CI) were 1.69\% (1.66\% to 1.71\%) and 24 cases per 10 000 persons (23-25), respectively. Compared to women, men had higher point prevalence (2.44\% (2.40\% to 2.49\%) vs 0.96\% (0.93\% to 0.98\%)) and higher annual cumulative incidence (33 cases per 10 000 (32-35)) versus 15 (14-16)). These figures increased with higher age but decreased with higher level of education, being the lowest in individuals with a university degree. Persons with middle income had highest point prevalence and cumulative incidence of gout, while those with white collar occupations had the lowest.
CONCLUSIONS: Gout is the most common inflammatory arthritis in southern Sweden with a prevalence of ∼1.7\% in the adult population. There is a socioeconomic gradient with more gout present in the lower level of education and with more manual labour.},
	language = {eng},
	number = {2},
	journal = {RMD open},
	author = {Kapetanovic, Meliha C. and Hameed, Mohaned and Turkiewicz, Aleksandra and Neogi, Tuhina and Saxne, Tore and Jacobsson, Lennart and Englund, Martin},
	year = {2016},
	pmid = {27933209},
	keywords = {Epidemiology, Gout, Outcomes research},
	pages = {e000326},
}

OBJECTIVES: To estimate the prevalence and cumulative incidence of gout in southern Sweden with respect to socioeconomic status. METHODS: Among residents of Skåne region in the year 2013 (total population 1.3 million), adult persons (age 18 years +) who between 1998 and 2013 received a diagnosis of gout (International Classification of Disease 10th Edition (ICD-10) code M10) by any physician were identified using the Skåne Healthcare Register. We calculated the point prevalence by end of 2013 and annual cumulative incidence in 2013 standardised to the whole Skåne population according to sex, individual information on occupation (white collar/blue collar), income (low/middle/high) and level of education (primary school/high school/university). RESULTS: The crude 2013 point prevalence of gout and 2013 cumulative incidence (95% CI) were 1.69% (1.66% to 1.71%) and 24 cases per 10 000 persons (23-25), respectively. Compared to women, men had higher point prevalence (2.44% (2.40% to 2.49%) vs 0.96% (0.93% to 0.98%)) and higher annual cumulative incidence (33 cases per 10 000 (32-35)) versus 15 (14-16)). These figures increased with higher age but decreased with higher level of education, being the lowest in individuals with a university degree. Persons with middle income had highest point prevalence and cumulative incidence of gout, while those with white collar occupations had the lowest. CONCLUSIONS: Gout is the most common inflammatory arthritis in southern Sweden with a prevalence of ∼1.7% in the adult population. There is a socioeconomic gradient with more gout present in the lower level of education and with more manual labour.

@article{nagel_association_2015,
	title = {The association between antibody levels before and after 7-valent pneumococcal conjugate vaccine immunization and subsequent pneumococcal infection in chronic arthritis patients.},
	volume = {17},
	issn = {1478-6362 1478-6354},
	url = {http://dx.doi.org/10.1186%2Fs13075-015-0636-z},
	doi = {10.1186/s13075-015-0636-z},
	abstract = {INTRODUCTION: The aim of present study is to inverstigate the association between antibody levels after vaccination with 7-valent pneumococcal conjugate vaccine (PCV7) and subsequent serious pneumococcal infections in rheumatoid arthritis (RA) and spondylarthropathy (SpA) patients. METHODS: A cohort of 497 patients (RA=248 and SpA=249) received a single dose of PCV7. At vaccination, patients were treated with methotrexate (MTX; n=85), anti-tumour necrosis factor (anti-TNF) + MTX (n=169), anti-TNF monotherapy (n=158) and non-steroidal anti-inflammatory drugs (NSAIDs)/analgesics (n=85). Antibody levels of serotypes  6B and 23B were analyzed before and 4 to 6 weeks after vaccination using standard enzyme-linked immunosorbent assay (ELISA). Serious pneumococcal infections (pneumonia/lower respiratory tract infection, meningitis, sepsis, septic arthritis) occurring within 4.5 years after vaccination were identified in the Skane Healthcare Register using the International Classification of Diseases, tenth revision (ICD-10) codes. The association between post-vaccination antibody  levels and protection against infections and determination of protective cutoff levels was explored using receiver operating characteristic (ROC) curves. Predictors of infection were studied using regression analyses. RESULTS: Eighteen infections were registered in 15 patients before vaccination and 27 infections in 23 patients after vaccination. Patients with serious infections after vaccination had significantly lower post-vaccination antibody titres for both 6B (P=0.04) and 23 F (P=0.04). Post-vaccination antibody levels of at least 1.29 mg/L and 1.01 mg/L for 6B and 23, respectively, were associated with better protection from serious infections. Higher age, concomitant prednisolone but not MTX or anti-TNF  were associated with such infections. CONCLUSIONS: Patients with more robust antibody responses after vaccination with pneumococcal conjugate vaccine were less likely to suffer from serious infections. High age and prednisolone at vaccination were associated with putative serious pneumococcal infections in this cohort. TRIAL REGISTRATION NUMBER: EudraCT EU 2007-006539-29 and NCT00828997 . Registered 23 January 2009.},
	language = {eng},
	journal = {Arthritis research \& therapy},
	author = {Nagel, Johanna and Geborek, Pierre and Saxne, Tore and Jonsson, Goran and Englund, Martin and Petersson, Ingemar F. and Nilsson, Jan-Ake and Truedsson, Lennart and Kapetanovic, Meliha C.},
	year = {2015},
	pmid = {25986458},
	pmcid = {PMC4436875},
	keywords = {Aged, Aged, 80 and over, Antibodies, Bacterial/*blood, Arthritis, Rheumatoid/blood/*complications/immunology, Chronic Disease, Enzyme-Linked Immunosorbent Assay, Female, Heptavalent Pneumococcal Conjugate Vaccine/*therapeutic use, Humans, Immunization/*methods, Immunologic Factors/therapeutic use, Male, Middle Aged, Pneumococcal Infections/complications/microbiology/*prevention \& control, Young Adult},
	pages = {124},
}

INTRODUCTION: The aim of present study is to inverstigate the association between antibody levels after vaccination with 7-valent pneumococcal conjugate vaccine (PCV7) and subsequent serious pneumococcal infections in rheumatoid arthritis (RA) and spondylarthropathy (SpA) patients. METHODS: A cohort of 497 patients (RA=248 and SpA=249) received a single dose of PCV7. At vaccination, patients were treated with methotrexate (MTX; n=85), anti-tumour necrosis factor (anti-TNF) + MTX (n=169), anti-TNF monotherapy (n=158) and non-steroidal anti-inflammatory drugs (NSAIDs)/analgesics (n=85). Antibody levels of serotypes 6B and 23B were analyzed before and 4 to 6 weeks after vaccination using standard enzyme-linked immunosorbent assay (ELISA). Serious pneumococcal infections (pneumonia/lower respiratory tract infection, meningitis, sepsis, septic arthritis) occurring within 4.5 years after vaccination were identified in the Skane Healthcare Register using the International Classification of Diseases, tenth revision (ICD-10) codes. The association between post-vaccination antibody levels and protection against infections and determination of protective cutoff levels was explored using receiver operating characteristic (ROC) curves. Predictors of infection were studied using regression analyses. RESULTS: Eighteen infections were registered in 15 patients before vaccination and 27 infections in 23 patients after vaccination. Patients with serious infections after vaccination had significantly lower post-vaccination antibody titres for both 6B (P=0.04) and 23 F (P=0.04). Post-vaccination antibody levels of at least 1.29 mg/L and 1.01 mg/L for 6B and 23, respectively, were associated with better protection from serious infections. Higher age, concomitant prednisolone but not MTX or anti-TNF were associated with such infections. CONCLUSIONS: Patients with more robust antibody responses after vaccination with pneumococcal conjugate vaccine were less likely to suffer from serious infections. High age and prednisolone at vaccination were associated with putative serious pneumococcal infections in this cohort. TRIAL REGISTRATION NUMBER: EudraCT EU 2007-006539-29 and NCT00828997 . Registered 23 January 2009.

@article{yamamoto_fragility_2015,
	title = {Fragility fractures in patients with rheumatoid arthritis and osteoarthritis compared with the general population.},
	volume = {42},
	issn = {0315-162X 0315-162X},
	url = {http://dx.doi.org/10.3899%2Fjrheum.150325},
	doi = {10.3899/jrheum.150325},
	abstract = {OBJECTIVE: To determine the rate ratios of hip and distal radius fractures in patients with rheumatoid arthritis (RA), hip osteoarthritis (OA), and knee OA. METHODS: Cohort study using healthcare data (1998-2012) covering the entire population of the Skane region of Sweden. RESULTS: We found an increased rate of  hip fracture in both female [standardized fracture rate ratio (SFR) 1.54, 95\% CI  1.40-1.70] and male patients with RA (SFR 1.81, 95\% CI 1.51-2.17). The hip fracture rate in female OA was reduced by 10-20\%, and trochanteric fracture tended to have a higher rate ratio compared with the cervical. CONCLUSION: The},
	language = {eng},
	number = {11},
	journal = {The Journal of rheumatology},
	author = {Yamamoto, Yuri and Turkiewicz, Aleksandra and Wingstrand, Hans and Englund, Martin},
	month = nov,
	year = {2015},
	pmid = {26428208},
	keywords = {Age Factors, Aged, Antirheumatic Agents/therapeutic use, Arthritis, Rheumatoid/*complications/diagnosis/drug therapy, Case-Control Studies, EPIDEMIOLOGY, FRACTURES, Female, Fractures, Spontaneous/epidemiology/*etiology/radiography, Hip Fractures/*epidemiology/*etiology/radiography, Humans, Incidence, Male, Middle Aged, OSTEOPOROSIS, Osteoarthritis, Osteoarthritis, Hip/complications/diagnosis/drug therapy, Osteoarthritis, Knee/complications/diagnosis/drug therapy, Osteoarthritis/*complications/diagnosis/drug therapy, Predictive Value of Tests, Prognosis, RHEUMATOID ARTHRITIS, Radius Fractures/epidemiology/*etiology/radiography, Reference Values, Registries, Retrospective Studies, Risk Assessment, Severity of Illness Index, Sex Factors, Sweden/epidemiology},
	pages = {2055--2058},
}

OBJECTIVE: To determine the rate ratios of hip and distal radius fractures in patients with rheumatoid arthritis (RA), hip osteoarthritis (OA), and knee OA. METHODS: Cohort study using healthcare data (1998-2012) covering the entire population of the Skane region of Sweden. RESULTS: We found an increased rate of hip fracture in both female [standardized fracture rate ratio (SFR) 1.54, 95% CI 1.40-1.70] and male patients with RA (SFR 1.81, 95% CI 1.51-2.17). The hip fracture rate in female OA was reduced by 10-20%, and trochanteric fracture tended to have a higher rate ratio compared with the cervical. CONCLUSION: The

@article{larsson_interleukin-6_2015,
	title = {Interleukin-6 and tumor necrosis factor alpha in synovial fluid are associated with progression of radiographic knee osteoarthritis in subjects with previous meniscectomy.},
	volume = {23},
	issn = {1522-9653},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2015.05.035},
	doi = {10.1016/j.joca.2015.05.035},
	abstract = {OBJECTIVE: To explore potential associations between proinflammatory cytokines in synovial fluid and progression of osteoarthritis (OA) in meniscectomized subjects.
DESIGN: We studied 132 subjects on average 18 years after meniscectomy, with a second examination 4-10 years later. We measured concentrations of interleukin (IL)-6, -8 and tumor necrosis factor (TNF)-α by multiplex immunoassay, graded radiographic features of tibiofemoral and patellofemoral OA according to the Osteoarthritis Research Society International (OARSI) atlas, scored patient-reported outcomes using the Knee Injury and Osteoarthritis Outcome Score (KOOS), and used logistic regression (adjusted for age, gender, body mass index, and time between examinations) for assessment of associations.
RESULTS: Higher first examination concentrations of IL-6 and TNF-α were associated with increased risk for subsequent osteophyte progression (odds ratios (OR); 95\% confidence intervals 1.05; 1.00-1.09 and 1.35; 1.03-1.75). Higher second examination concentrations of TNF-α were associated with having progressed in loss of joint space (OR 1.70; 1.15-2.52) or having worsened in the activity of daily living subscale of KOOS (OR 1.50; 1.07-2.09) in the preceding years. Subjects with increasing concentrations of IL-6 or TNF-α between examinations were five times more likely to have progressed in joint space narrowing between the same examinations, as compared to those with stable or decreasing concentrations (OR 5.17; 1.54-17.32 and 5.01; 1.32-18.92).
CONCLUSIONS: In subjects with previous meniscectomy, higher or over time increasing synovial fluid levels of IL-6 and TNF-α seems to be associated with increased risk for progression of radiographic OA.},
	language = {eng},
	number = {11},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Larsson, S. and Englund, M. and Struglics, A. and Lohmander, L. S.},
	month = nov,
	year = {2015},
	pmid = {26521736},
	keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Biomarkers, Child, Child, Preschool, Cytokines, Disease Progression, Female, Follow-Up Studies, Humans, Knee Injuries, Male, Menisci, Tibial, Meniscus injury, Middle Aged, Osteoarthritis, Osteoarthritis, Knee, Patient reported outcomes, Postoperative Period, Prognosis, Retrospective Studies, Synovial Fluid, Tumor Necrosis Factor-alpha, Young Adult},
	pages = {1906--1914},
}

OBJECTIVE: To explore potential associations between proinflammatory cytokines in synovial fluid and progression of osteoarthritis (OA) in meniscectomized subjects. DESIGN: We studied 132 subjects on average 18 years after meniscectomy, with a second examination 4-10 years later. We measured concentrations of interleukin (IL)-6, -8 and tumor necrosis factor (TNF)-α by multiplex immunoassay, graded radiographic features of tibiofemoral and patellofemoral OA according to the Osteoarthritis Research Society International (OARSI) atlas, scored patient-reported outcomes using the Knee Injury and Osteoarthritis Outcome Score (KOOS), and used logistic regression (adjusted for age, gender, body mass index, and time between examinations) for assessment of associations. RESULTS: Higher first examination concentrations of IL-6 and TNF-α were associated with increased risk for subsequent osteophyte progression (odds ratios (OR); 95% confidence intervals 1.05; 1.00-1.09 and 1.35; 1.03-1.75). Higher second examination concentrations of TNF-α were associated with having progressed in loss of joint space (OR 1.70; 1.15-2.52) or having worsened in the activity of daily living subscale of KOOS (OR 1.50; 1.07-2.09) in the preceding years. Subjects with increasing concentrations of IL-6 or TNF-α between examinations were five times more likely to have progressed in joint space narrowing between the same examinations, as compared to those with stable or decreasing concentrations (OR 5.17; 1.54-17.32 and 5.01; 1.32-18.92). CONCLUSIONS: In subjects with previous meniscectomy, higher or over time increasing synovial fluid levels of IL-6 and TNF-α seems to be associated with increased risk for progression of radiographic OA.

@article{kraus_call_2015,
	title = {Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use.},
	volume = {23},
	issn = {1522-9653},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2015.03.036},
	doi = {10.1016/j.joca.2015.03.036},
	abstract = {Osteoarthritis (OA) is a heterogeneous disorder. The goals of this review are (1) To stimulate use of standardized nomenclature for OA that could serve as building blocks for describing OA and defining OA phenotypes, in short to provide unifying disease concepts for a heterogeneous disorder; and (2) To stimulate establishment of ROAD (Risk of OA Development) and ROAP (Risk of OA Progression) tools analogous to the FRAX™ instrument for predicting risk of fracture in osteoporosis; and (3) To stimulate formulation of tools for identifying disease in its early preradiographic and/or molecular stages - REDI (Reliable Early Disease Identification). Consensus around more sensitive and specific diagnostic criteria for OA could spur development of disease modifying therapies for this entity that has proved so recalcitrant to date. We fully acknowledge that as we move forward, we expect to develop more sophisticated definitions, terminology and tools.},
	language = {eng},
	number = {8},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Kraus, V. B. and Blanco, F. J. and Englund, M. and Karsdal, M. A. and Lohmander, L. S.},
	month = aug,
	year = {2015},
	pmid = {25865392},
	pmcid = {PMC4516635},
	keywords = {Anatomy, Biomarkers, Clinical Trials as Topic, Criteria, Definition, Disease Progression, Health Promotion, Humans, Osteoarthritis, Osteoporotic Fractures, Patient Outcome Assessment, Physiology, Risk Assessment, Terminology as Topic},
	pages = {1233--1241},
}

Osteoarthritis (OA) is a heterogeneous disorder. The goals of this review are (1) To stimulate use of standardized nomenclature for OA that could serve as building blocks for describing OA and defining OA phenotypes, in short to provide unifying disease concepts for a heterogeneous disorder; and (2) To stimulate establishment of ROAD (Risk of OA Development) and ROAP (Risk of OA Progression) tools analogous to the FRAX™ instrument for predicting risk of fracture in osteoporosis; and (3) To stimulate formulation of tools for identifying disease in its early preradiographic and/or molecular stages - REDI (Reliable Early Disease Identification). Consensus around more sensitive and specific diagnostic criteria for OA could spur development of disease modifying therapies for this entity that has proved so recalcitrant to date. We fully acknowledge that as we move forward, we expect to develop more sophisticated definitions, terminology and tools.

@article{englund_replacing_2015,
	title = {Replacing the meniscus to prevent knee {OA} - {Fact} or fiction?},
	volume = {11},
	issn = {1759-4804 1759-4790},
	url = {http://dx.doi.org/10.1038%2Fnrrheum.2015.87},
	doi = {10.1038/nrrheum.2015.87},
	language = {eng},
	number = {8},
	journal = {Nature reviews. Rheumatology},
	author = {Englund, Martin},
	month = aug,
	year = {2015},
	pmid = {26100971},
	keywords = {Animals, Cartilage, Articular/*pathology/*radiography, Menisci, Tibial/*transplantation},
	pages = {448--449},
}

@article{turkiewicz_prevalence_2015,
	title = {Prevalence of knee pain and knee {OA} in southern {Sweden} and the proportion that seeks medical care.},
	volume = {54},
	copyright = {(c) The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.},
	issn = {1462-0332 1462-0324},
	url = {http://dx.doi.org/10.1093%2Frheumatology%2Fkeu409},
	doi = {10.1093/rheumatology/keu409},
	abstract = {OBJECTIVE: The aim of this study was to estimate the prevalence of frequent knee  pain in radiographic, symptomatic and clinically defined knee OA in middle-aged and elderly patients and the proportion that seeks medical care. METHODS: In 2007 a random sample of 10 000 56- to 84-year-old residents of Malmo, Sweden, were questioned about knee pain. We classified subjects reporting knee pain with a duration of at least 4 weeks as having frequent knee pain. A random sample of 1300 individuals with frequent knee pain and 650 without were invited for assessment by the ACR clinical knee OA criteria and for bilateral weight-bearing  knee radiography. We considered a Kellgren-Lawrence grade {\textgreater}/=2 as radiographic knee OA and that in combination with frequent knee pain as symptomatic knee OA. By linkage with the Skane Healthcare Register, we determined the proportion of subjects that had consulted for knee OA or pain. RESULTS: The 10 000 subjects had a mean age of 70 years (s.d. 7.6), a mean BMI of 27.1 kg/m(2) and 62\% were women. The prevalence of frequent knee pain was 25.1\% (95\% CI 24.1, 26.1), higher in women and similar across age groups. The prevalence of radiographic knee OA was 25.4\% while 15.4\% had either symptomatic or clinically defined knee OA. Of these, 68.9\% consulted a physician for knee OA or pain during 2004-11. CONCLUSION: Fifteen per cent of middle-aged or elderly individuals have knee OA and symptoms. About one in three of those do not consult a physician. Inefficient care of OA and self-coping may be an explanation.},
	language = {eng},
	number = {5},
	journal = {Rheumatology (Oxford, England)},
	author = {Turkiewicz, Aleksandra and Gerhardsson de Verdier, Maria and Engstrom, Gunnar and Nilsson, Peter M. and Mellstrom, Carl and Lohmander, L. Stefan and Englund, Martin},
	month = may,
	year = {2015},
	pmid = {25313145},
	keywords = {*Knee Joint/radiography, Adaptation, Psychological, Aged, Aged, 80 and over, Arthralgia/*epidemiology, Female, Humans, Knee osteoarthritis, Knee pain, Male, Middle Aged, Osteoarthritis, Knee/*epidemiology, Patient Acceptance of Health Care/*statistics \& numerical data, Patient Satisfaction/statistics \& numerical data, Prevalence, Retrospective Studies, Surveys and Questionnaires, Sweden/epidemiology, radiography},
	pages = {827--835},
}

OBJECTIVE: The aim of this study was to estimate the prevalence of frequent knee pain in radiographic, symptomatic and clinically defined knee OA in middle-aged and elderly patients and the proportion that seeks medical care. METHODS: In 2007 a random sample of 10 000 56- to 84-year-old residents of Malmo, Sweden, were questioned about knee pain. We classified subjects reporting knee pain with a duration of at least 4 weeks as having frequent knee pain. A random sample of 1300 individuals with frequent knee pain and 650 without were invited for assessment by the ACR clinical knee OA criteria and for bilateral weight-bearing knee radiography. We considered a Kellgren-Lawrence grade \textgreater/=2 as radiographic knee OA and that in combination with frequent knee pain as symptomatic knee OA. By linkage with the Skane Healthcare Register, we determined the proportion of subjects that had consulted for knee OA or pain. RESULTS: The 10 000 subjects had a mean age of 70 years (s.d. 7.6), a mean BMI of 27.1 kg/m(2) and 62% were women. The prevalence of frequent knee pain was 25.1% (95% CI 24.1, 26.1), higher in women and similar across age groups. The prevalence of radiographic knee OA was 25.4% while 15.4% had either symptomatic or clinically defined knee OA. Of these, 68.9% consulted a physician for knee OA or pain during 2004-11. CONCLUSION: Fifteen per cent of middle-aged or elderly individuals have knee OA and symptoms. About one in three of those do not consult a physician. Inefficient care of OA and self-coping may be an explanation.

@article{kraus_oarsi_2015,
	title = {{OARSI} {Clinical} {Trials} {Recommendations}: {Soluble} biomarker assessments in clinical trials in osteoarthritis.},
	volume = {23},
	issn = {1522-9653},
	shorttitle = {{OARSI} {Clinical} {Trials} {Recommendations}},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2015.03.002},
	doi = {10.1016/j.joca.2015.03.002},
	abstract = {The objective of this work was to describe requirements for inclusion of soluble biomarkers in osteoarthritis (OA) clinical trials and progress toward OA-related biomarker qualification. The Guidelines for Biomarkers Working Group, representing experts in the field of OA biomarker research from both academia and industry, convened to discuss issues related to soluble biomarkers and to make recommendations for their use in OA clinical trials based on current knowledge and anticipated benefits. This document summarizes current guidance on use of biomarkers in OA clinical trials and their utility at five stages, including preclinical development and phase I to phase IV trials. As demonstrated by this summary, biomarkers can provide value at all stages of therapeutics development. When resources permit, we recommend collection of biospecimens in all OA clinical trials for a wide variety of reasons but in particular, to determine whether biomarkers are useful in identifying those individuals most likely to receive clinically important benefits from an intervention; and to determine whether biomarkers are useful for identifying individuals at earlier stages of OA in order to institute treatment at a time more amenable to disease modification.},
	language = {eng},
	number = {5},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Kraus, V. B. and Blanco, F. J. and Englund, M. and Henrotin, Y. and Lohmander, L. S. and Losina, E. and Önnerfjord, P. and Persiani, S.},
	month = may,
	year = {2015},
	pmid = {25952342},
	pmcid = {PMC4430113},
	keywords = {Biomarkers, Clinical Trials as Topic, Clinical trials, Guidelines, Humans, Osteoarthritis, Practice Guidelines as Topic},
	pages = {686--697},
}

The objective of this work was to describe requirements for inclusion of soluble biomarkers in osteoarthritis (OA) clinical trials and progress toward OA-related biomarker qualification. The Guidelines for Biomarkers Working Group, representing experts in the field of OA biomarker research from both academia and industry, convened to discuss issues related to soluble biomarkers and to make recommendations for their use in OA clinical trials based on current knowledge and anticipated benefits. This document summarizes current guidance on use of biomarkers in OA clinical trials and their utility at five stages, including preclinical development and phase I to phase IV trials. As demonstrated by this summary, biomarkers can provide value at all stages of therapeutics development. When resources permit, we recommend collection of biospecimens in all OA clinical trials for a wide variety of reasons but in particular, to determine whether biomarkers are useful in identifying those individuals most likely to receive clinically important benefits from an intervention; and to determine whether biomarkers are useful for identifying individuals at earlier stages of OA in order to institute treatment at a time more amenable to disease modification.

@article{rosengren_21st-century_2015,
	title = {The 21st-century landscape of adult fractures: {Cohort} study of a complete adult regional population.},
	volume = {30},
	copyright = {(c) 2014 American Society for Bone and Mineral Research.},
	issn = {1523-4681 0884-0431},
	url = {http://dx.doi.org/10.1002%2Fjbmr.2370},
	doi = {10.1002/jbmr.2370},
	abstract = {Recent reports on adult fracture epidemiology have focused mainly on the hip in the elderly, in whom increasing rates lately have changed to a decline. New reports of the preponderance of nonhip fractures in health expenditure call for a wider scope. We therefore examined current overall and site-specific fracture epidemiology in adults. We ascertained all fractures diagnosed in inpatient and outpatient care in all men and women aged 20 years or older in Skane County, Sweden, from 1999 to 2010 (10 million person-years). For each fracture type, we estimated age-specific and sex-specific rates and evaluated potential time trends. We found 205,908 fractures yielding an overall fracture rate of 192 per 10,000 person-years. The age-standardized overall fracture rate increased by 1.2  per 10,000 and year (95\% confidence interval, 0.8 to 1.5), but time trends were different for different fracture types, age strata, and for men and women. For example, in both women and men aged {\textgreater}/=50 years the rates of proximal humerus fracture increased (0.6 and 0.2 per 10,000 and year, respectively) while hip fracture rates declined (-1.0 and -0.3 per 10,000/year, respectively). Overall age-specific number of fractures increased with age in women but was stable in men. The increasing overall fracture rate is a major concern in the context of a  growing and aging population. Effective and affordable preventive strategies and  treatments should be an urgent priority to meet the challenges, especially in older women in whom most fractures occur. Comprehensive current detailed data, as provided in this study, may serve as reference for projections and for cost calculations of fracture care in other settings before results of similar examinations are available there.},
	language = {eng},
	number = {3},
	journal = {Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research},
	author = {Rosengren, Bjorn E. and Karlsson, Magnus and Petersson, Ingemar and Englund, Martin},
	month = mar,
	year = {2015},
	pmid = {25280349},
	keywords = {Aged, Aged, 80 and over, Cohort Studies, EPIDEMIOLOGY, FRACTURE, Fractures, Bone/*epidemiology, History, 21st Century, Humans, Incidence, Middle Aged, OSTEOPOROSIS, SECULAR TRENDS, Sweden/epidemiology, Young Adult},
	pages = {535--542},
}

Recent reports on adult fracture epidemiology have focused mainly on the hip in the elderly, in whom increasing rates lately have changed to a decline. New reports of the preponderance of nonhip fractures in health expenditure call for a wider scope. We therefore examined current overall and site-specific fracture epidemiology in adults. We ascertained all fractures diagnosed in inpatient and outpatient care in all men and women aged 20 years or older in Skane County, Sweden, from 1999 to 2010 (10 million person-years). For each fracture type, we estimated age-specific and sex-specific rates and evaluated potential time trends. We found 205,908 fractures yielding an overall fracture rate of 192 per 10,000 person-years. The age-standardized overall fracture rate increased by 1.2 per 10,000 and year (95% confidence interval, 0.8 to 1.5), but time trends were different for different fracture types, age strata, and for men and women. For example, in both women and men aged \textgreater/=50 years the rates of proximal humerus fracture increased (0.6 and 0.2 per 10,000 and year, respectively) while hip fracture rates declined (-1.0 and -0.3 per 10,000/year, respectively). Overall age-specific number of fractures increased with age in women but was stable in men. The increasing overall fracture rate is a major concern in the context of a growing and aging population. Effective and affordable preventive strategies and treatments should be an urgent priority to meet the challenges, especially in older women in whom most fractures occur. Comprehensive current detailed data, as provided in this study, may serve as reference for projections and for cost calculations of fracture care in other settings before results of similar examinations are available there.

@article{atroshi_sickness_2015,
	title = {Sickness absence from work among persons with new physician-diagnosed carpal tunnel syndrome: {A} population-based matched-cohort study.},
	volume = {10},
	issn = {1932-6203 1932-6203},
	url = {http://dx.doi.org/10.1371%2Fjournal.pone.0119795},
	doi = {10.1371/journal.pone.0119795},
	abstract = {BACKGROUND: Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. METHODS: In Skane region in Sweden we identified all subjects, aged 17-57 years,  with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004-2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73\% women; mean age 43 years).  We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those  with carpal tunnel syndrome 2111 women (53\%) and 710 men (48\%) underwent surgery  within 24 months of diagnosis. We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery. RESULTS: Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort. A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12\% of the women (n = 492) and 11\% of the men (n = 170) and with surgery in 53\% (n = 1121) and 58\% (n = 408) of the surgically treated, respectively; median duration in conjunction with surgery was 35 days (IQR 27-45) for women and 41 days (IQR},
	language = {eng},
	number = {3},
	journal = {PloS one},
	author = {Atroshi, Isam and Zhou, Caddie and Joud, Anna and Petersson, Ingemar F. and Englund, Martin},
	year = {2015},
	pmid = {25803841},
	pmcid = {PMC4372214},
	keywords = {*Physicians, Adolescent, Adult, Carpal Tunnel Syndrome/*diagnosis/*epidemiology/surgery, Cohort Studies, Female, Humans, Male, Middle Aged, Sex Factors, Sick Leave/*statistics \& numerical data, Sweden/epidemiology, Young Adult},
	pages = {e0119795},
}

BACKGROUND: Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. METHODS: In Skane region in Sweden we identified all subjects, aged 17-57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004-2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 months of diagnosis. We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery. RESULTS: Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort. A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12% of the women (n = 492) and 11% of the men (n = 170) and with surgery in 53% (n = 1121) and 58% (n = 408) of the surgically treated, respectively; median duration in conjunction with surgery was 35 days (IQR 27-45) for women and 41 days (IQR

@article{nagel_risk_2015,
	title = {The risk of pneumococcal infections after immunization with pneumococcal conjugate vaccine compared to non-vaccinated inflammatory arthritis patients.},
	volume = {44},
	issn = {1502-7732},
	url = {http://dx.doi.org/10.3109%2F03009742.2014.984754},
	doi = {10.3109/03009742.2014.984754},
	abstract = {OBJECTIVES: To examine the risk of putative pneumococcal infections in adult arthritis patients on different anti-rheumatic drugs immunized with heptavalent pneumococcal conjugate vaccine (Prevenar 7; PCV7) and non-vaccinated individually matched arthritis patients.
METHOD: All individuals in a cohort of 505 patients with rheumatoid arthritis (RA) or spondylarthropathy (SpA) receiving different anti-rheumatic treatments were immunized with a single dose of PCV7 (exposed group). Of these, 497 patients (RA = 248; SpA = 249) were included. For each vaccinated patient, we identified four reference subjects (n = 1988) from the same geographic area, individually matched for age, gender, and diagnosis. These were considered unexposed to conjugated pneumococcal vaccination. The Skåne Healthcare Register (SHR) was searched for all individuals seeking health care for putative pneumococcal infections occurring 4 years before vaccination and up to 4.5 years after vaccination using ICD-10 diagnostic codes. The following infections were considered as serious cases: pneumonia, other lower respiratory infections, meningitis, sepsis, and septic arthritis. The relative risk (RR) of infection was calculated as the number of events after/number of events before vaccination. Ratios of relative risk (RRRs) were calculated between vaccinated and non-vaccinated groups of patients. A generalized estimating equation (GEE) was used to handle correlated data for several events in the same individual.
RESULTS: Although statistically non-significant, the point estimate of the RRR [0.55, 95\% confidence interval (CI) 0.25-1.22] suggested a reduced risk of serious pneumococcal infections in vaccinated patients compared to the unexposed group.
CONCLUSIONS: Vaccination with PCV7 tended to reduce the risk of putative serious pneumococcal infections by about 45\% compared to non-vaccinated patients in this observational cohort study.},
	language = {eng},
	number = {4},
	journal = {Scandinavian Journal of Rheumatology},
	author = {Nagel, J. and Geborek, P. and Saxne, T. and Jönsson, G. and Englund, M. and Petersson, I. F. and Nilsson, J.-Å and Kapetanovic, M. C.},
	year = {2015},
	pmid = {25656734},
	keywords = {Adult, Aged, Aged, 80 and over, Antirheumatic Agents, Arthritis, Rheumatoid, Case-Control Studies, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Pneumococcal Infections, Pneumococcal Vaccines, Risk Factors, Spondylarthropathies, Sweden, Vaccines, Conjugate},
	pages = {271--279},
}

OBJECTIVES: To examine the risk of putative pneumococcal infections in adult arthritis patients on different anti-rheumatic drugs immunized with heptavalent pneumococcal conjugate vaccine (Prevenar 7; PCV7) and non-vaccinated individually matched arthritis patients. METHOD: All individuals in a cohort of 505 patients with rheumatoid arthritis (RA) or spondylarthropathy (SpA) receiving different anti-rheumatic treatments were immunized with a single dose of PCV7 (exposed group). Of these, 497 patients (RA = 248; SpA = 249) were included. For each vaccinated patient, we identified four reference subjects (n = 1988) from the same geographic area, individually matched for age, gender, and diagnosis. These were considered unexposed to conjugated pneumococcal vaccination. The Skåne Healthcare Register (SHR) was searched for all individuals seeking health care for putative pneumococcal infections occurring 4 years before vaccination and up to 4.5 years after vaccination using ICD-10 diagnostic codes. The following infections were considered as serious cases: pneumonia, other lower respiratory infections, meningitis, sepsis, and septic arthritis. The relative risk (RR) of infection was calculated as the number of events after/number of events before vaccination. Ratios of relative risk (RRRs) were calculated between vaccinated and non-vaccinated groups of patients. A generalized estimating equation (GEE) was used to handle correlated data for several events in the same individual. RESULTS: Although statistically non-significant, the point estimate of the RRR [0.55, 95% confidence interval (CI) 0.25-1.22] suggested a reduced risk of serious pneumococcal infections in vaccinated patients compared to the unexposed group. CONCLUSIONS: Vaccination with PCV7 tended to reduce the risk of putative serious pneumococcal infections by about 45% compared to non-vaccinated patients in this observational cohort study.

@article{owman_association_2014,
	title = {Association between delayed gadolinium-enhanced {MRI} of cartilage ({dGEMRIC}) and joint space narrowing and osteophytes: {A} cohort study in patients with partial meniscectomy with 11 years of follow-up.},
	volume = {22},
	issn = {1522-9653},
	shorttitle = {Association between delayed gadolinium-enhanced {MRI} of cartilage ({dGEMRIC}) and joint space narrowing and osteophytes},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2014.02.929},
	doi = {10.1016/j.joca.2014.02.929},
	abstract = {OBJECTIVE: To examine the association between the relaxation time (T1Gd) of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and grade of tibiofemoral joint space narrowing (JSN) and osteophytosis 11 years later, in a cohort of meniscectomized patients.
DESIGN: Patients (n = 45) aged 35-50 who had undergone an arthroscopic partial medial meniscectomy 1-6 years earlier, due to degenerative meniscal tear, were examined using dGEMRIC. These patients had no cartilage changes defined as deep clefts or visible bone at the time of arthroscopy. Eleven years later (12-16 years after surgery) 34 of these subjects (76\%) were evaluated by weight-bearing knee radiography, and tibiofemoral joint changes were graded according to the Osteoarthritis Research Society International Atlas.
RESULTS: Lower T1Gd in the medial compartment was associated with higher grade of medial JSN (grade 0, 351 ms; grade 1, 386 ms; grade 2, 342 ms; grade 3, 259 ms [P for trend {\textless} 0.001]) and more osteophytosis (score 0, 371 ms; score 1, 389 ms; score 2, 354 ms; score 3, 289 ms; score 4, 265 ms; score 5, 275 ms [P for trend = 0.001]). Lower T1Gd in the lateral compartment was associated with higher grade of lateral JSN (grade 0, 436 ms; grade 1, 346 ms [P for trend = 0.026]).
CONCLUSION: The current study suggests that lower T1Gd measured with dGEMRIC of medial and lateral femoral cartilage is associated with higher grade of JSN 11 years later, and medially, also with more osteophytosis.},
	language = {eng},
	number = {10},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Owman, H. and Ericsson, Y. B. and Englund, M. and Tiderius, C. J. and Tjörnstrand, J. and Roos, E. M. and Dahlberg, L. E.},
	month = oct,
	year = {2014},
	pmid = {24583348},
	keywords = {Arthroscopy, Cartilage, Cartilage, Articular, Cohort Studies, Female, Follow-Up Studies, Gadolinium, Glycosaminoglycans, Humans, Knee, Knee Joint, Magnetic resonance imaging, Male, Menisci, Tibial, Middle Aged, Osteoarthritis, Osteoarthritis, Knee, Osteophyte, Risk Factors, dGEMRIC},
	pages = {1537--1541},
}

OBJECTIVE: To examine the association between the relaxation time (T1Gd) of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and grade of tibiofemoral joint space narrowing (JSN) and osteophytosis 11 years later, in a cohort of meniscectomized patients. DESIGN: Patients (n = 45) aged 35-50 who had undergone an arthroscopic partial medial meniscectomy 1-6 years earlier, due to degenerative meniscal tear, were examined using dGEMRIC. These patients had no cartilage changes defined as deep clefts or visible bone at the time of arthroscopy. Eleven years later (12-16 years after surgery) 34 of these subjects (76%) were evaluated by weight-bearing knee radiography, and tibiofemoral joint changes were graded according to the Osteoarthritis Research Society International Atlas. RESULTS: Lower T1Gd in the medial compartment was associated with higher grade of medial JSN (grade 0, 351 ms; grade 1, 386 ms; grade 2, 342 ms; grade 3, 259 ms [P for trend \textless 0.001]) and more osteophytosis (score 0, 371 ms; score 1, 389 ms; score 2, 354 ms; score 3, 289 ms; score 4, 265 ms; score 5, 275 ms [P for trend = 0.001]). Lower T1Gd in the lateral compartment was associated with higher grade of lateral JSN (grade 0, 436 ms; grade 1, 346 ms [P for trend = 0.026]). CONCLUSION: The current study suggests that lower T1Gd measured with dGEMRIC of medial and lateral femoral cartilage is associated with higher grade of JSN 11 years later, and medially, also with more osteophytosis.

@article{kijowski_imaging_2014,
	title = {Imaging following acute knee trauma.},
	volume = {22},
	issn = {1522-9653},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2014.06.024},
	doi = {10.1016/j.joca.2014.06.024},
	abstract = {Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.},
	language = {eng},
	number = {10},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Kijowski, R. and Roemer, F. and Englund, M. and Tiderius, C. J. and Swärd, P. and Frobell, R. B.},
	month = oct,
	year = {2014},
	pmid = {25278054},
	keywords = {Adult, Anterior Cruciate Ligament, Cartilage, Articular, Female, Humans, Imaging, Knee, Knee Injuries, Knee Joint, Ligament, Longitudinal Studies, Magnetic resonance imaging, Male, Menisci, Tibial, Meniscus, Osteoarthritis, Osteoarthritis, Knee, Post-traumatic, Tomography, X-Ray Computed, Young Adult},
	pages = {1429--1443},
}

Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.

@article{andreasson_prevalence_2014,
	title = {Prevalence and incidence of systemic sclerosis in southern {Sweden}: {Population}-based data with case ascertainment using the 1980 {ARA} criteria and the proposed {ACR}-{EULAR} classification criteria.},
	volume = {73},
	issn = {1468-2060},
	shorttitle = {Prevalence and incidence of systemic sclerosis in southern {Sweden}},
	url = {http://dx.doi.org/10.1136%2Fannrheumdis-2013-203618},
	doi = {10.1136/annrheumdis-2013-203618},
	abstract = {OBJECTIVES: To estimate the prevalence and incidence of systemic sclerosis (SSc) in southern Sweden.
METHODS: In Skåne, the southernmost region of Sweden (total population 1.2 million), healthcare provided is registered in the Skåne Healthcare Register. We identified all Skåne residents who had received an International Classification of Diseases 10 diagnosis of SSc (M34) or Raynaud's phenomenon (I73.0) between 1998 and 2010. Every single case was ascertained by review of medical records in reference to the 1980 American Rheumatism Association preliminary classification criteria for SSc and the proposed American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria presented at the ACR/Association of Rheumatology Health Professionals Annual Meeting 2012. We calculated the point prevalence by the end of 2010 by linkage with the population register to exclude deceased persons and we also estimated the mean annual cumulative incidence for 2006-2010.
RESULTS: Using the 1980 ARA criteria, the adult prevalence and annual incidence of SSc in the Skåne region were 235 and 14 per 1 million inhabitants respectively. Applying the proposed ACR-EULAR criteria, the corresponding figures were 305 and 19 per 1 million inhabitants. A majority (82\%) of the prevalent cases had the limited cutaneous SSc subtype.
CONCLUSIONS: The prevalence and incidence of SSc in southern Sweden, based on the 1980 ARA criteria, are higher than previously reported in northern Europe and do not support the concept of a north-south gradient of SSc occurrence in Europe. Application of the proposed ACR-EULAR classification criteria in this population results in about 30-40\% higher estimates of SSc prevalence and incidence compared to the 1980 ARA criteria.},
	language = {eng},
	number = {10},
	journal = {Annals of the Rheumatic Diseases},
	author = {Andréasson, K. and Saxne, T. and Bergknut, C. and Hesselstrand, R. and Englund, M.},
	month = oct,
	year = {2014},
	pmid = {23897770},
	keywords = {Adult, Age Distribution, Aged, Autoantibodies, Autoimmune Diseases, Epidemiology, Female, Humans, Incidence, Male, Middle Aged, Prevalence, Registries, Scleroderma, Systemic, Severity of Illness Index, Sex Distribution, Sweden, Systemic Sclerosis},
	pages = {1788--1792},
}

OBJECTIVES: To estimate the prevalence and incidence of systemic sclerosis (SSc) in southern Sweden. METHODS: In Skåne, the southernmost region of Sweden (total population 1.2 million), healthcare provided is registered in the Skåne Healthcare Register. We identified all Skåne residents who had received an International Classification of Diseases 10 diagnosis of SSc (M34) or Raynaud's phenomenon (I73.0) between 1998 and 2010. Every single case was ascertained by review of medical records in reference to the 1980 American Rheumatism Association preliminary classification criteria for SSc and the proposed American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria presented at the ACR/Association of Rheumatology Health Professionals Annual Meeting 2012. We calculated the point prevalence by the end of 2010 by linkage with the population register to exclude deceased persons and we also estimated the mean annual cumulative incidence for 2006-2010. RESULTS: Using the 1980 ARA criteria, the adult prevalence and annual incidence of SSc in the Skåne region were 235 and 14 per 1 million inhabitants respectively. Applying the proposed ACR-EULAR criteria, the corresponding figures were 305 and 19 per 1 million inhabitants. A majority (82%) of the prevalent cases had the limited cutaneous SSc subtype. CONCLUSIONS: The prevalence and incidence of SSc in southern Sweden, based on the 1980 ARA criteria, are higher than previously reported in northern Europe and do not support the concept of a north-south gradient of SSc occurrence in Europe. Application of the proposed ACR-EULAR classification criteria in this population results in about 30-40% higher estimates of SSc prevalence and incidence compared to the 1980 ARA criteria.

@article{joud_socioeconomic_2014,
	title = {Socioeconomic status and the risk for being diagnosed with spondyloarthritis and  chronic pain: {A} nested case-control study.},
	volume = {34},
	issn = {1437-160X 0172-8172},
	url = {http://dx.doi.org/10.1007%2Fs00296-014-3039-6},
	doi = {10.1007/s00296-014-3039-6},
	abstract = {Socioeconomic status could potentially impact on which type of rheumatic diagnosis a patient receives. We determined whether different socioeconomic status is a risk factor for being diagnosed with spondyloarthritis (SpA) or chronic pain. In a nested case-control study, we identified two sets of adult cases diagnosed with (i) SpA (n = 1,194) and (ii) chronic pain (n = 3,730) during},
	language = {eng},
	number = {9},
	journal = {Rheumatology international},
	author = {Joud, Anna and Petersson, Ingemar F. and Jordan, Kelvin P. and Lofvendahl, Sofia and Grahn, Birgitta and Englund, Martin},
	month = sep,
	year = {2014},
	pmid = {24825253},
	keywords = {*Socioeconomic Factors, Adult, Aged, Case-Control Studies, Chi-Square Distribution, Chronic Pain/*diagnosis/drug therapy/epidemiology, Educational Status, Employment, Female, Health Resources/utilization, Health Status, Humans, Income, Logistic Models, Male, Marital Status, Middle Aged, Odds Ratio, Residence Characteristics, Risk Factors, Spondylarthritis/*diagnosis/drug therapy/epidemiology, Sweden/epidemiology, Young Adult},
	pages = {1291--1298},
}

Socioeconomic status could potentially impact on which type of rheumatic diagnosis a patient receives. We determined whether different socioeconomic status is a risk factor for being diagnosed with spondyloarthritis (SpA) or chronic pain. In a nested case-control study, we identified two sets of adult cases diagnosed with (i) SpA (n = 1,194) and (ii) chronic pain (n = 3,730) during

@article{jarvinen_arthroscopy_2014,
	title = {Arthroscopy for degenerative knee - {A} difficult habit to break?},
	volume = {85},
	issn = {1745-3682 1745-3674},
	url = {http://dx.doi.org/10.3109%2F17453674.2014.922736},
	doi = {10.3109/17453674.2014.922736},
	language = {eng},
	number = {3},
	journal = {Acta orthopaedica},
	author = {Jarvinen, Teppo L. N. and Sihvonen, Raine and Englund, Martin},
	month = jun,
	year = {2014},
	pmid = {24847793},
	pmcid = {PMC4062784},
	keywords = {Arthralgia/*surgery, Arthroscopy/*trends, Female, Humans, Knee Joint/*surgery, Male, Menisci, Tibial/*surgery, Osteoarthritis, Knee/*surgery},
	pages = {215--217},
}

@article{turkiewicz_current_2014,
	title = {Current and future impact of osteoarthritis on health care: {A} population-based study with projections to year 2032.},
	volume = {22},
	issn = {1522-9653},
	shorttitle = {Current and future impact of osteoarthritis on health care},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2014.07.015},
	doi = {10.1016/j.joca.2014.07.015},
	abstract = {OBJECTIVE: To estimate the current and future (to year 2032) impact of osteoarthritis (OA) health care seeking.
METHOD: Population-based study with prospectively ascertained data from the Skåne Healthcare Register (SHR), Sweden, encompassing more than 15 million person-years of primary and specialist outpatient care and hospitalizations. We studied all Skåne region residents aged ≥45 by the end of 2012 (n = 531, 254) and determined the prevalence of doctor-diagnosed OA defined as the proportion of the prevalent population that had received a diagnosis of OA of the knee, hip, hand, or other locations except the spine between 1999 and 2012. We projected consultation prevalence of OA until year 2032 using Statistics Sweden's (SCB) projected age and sex structure and prevalence of overweight and obesity.
RESULTS: In 2012 the proportion of population aged ≥45 with any doctor-diagnosed OA was 26.6\% (95\% confidence interval (CI): 26.5-26.8) (men 22.4\%, women 30.5\%). The most common locations were knee (13.8\%), hip (5.8\%) and hand (3.1\%). Of the prevalent cases 26.8\% had OA in multiple joints. By the year 2032, the proportion of the population aged ≥45 with doctor-diagnosed OA is estimated to increase from 26.6\% to 29.5\% (any location), from 13.8\% to 15.7\% for the knee and 5.8-6.9\% for the hip.
CONCLUSION: In 2032, at least an additional 26,000 individuals per 1 million population aged ≥45 years are estimated to have consulted a physician for OA in a peripheral joint compared to 2012. These findings underscore the need to address modifiable risk factors and develop new effective OA treatments.},
	language = {eng},
	number = {11},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Turkiewicz, A. and Petersson, I. F. and Björk, J. and Hawker, G. and Dahlberg, L. E. and Lohmander, L. S. and Englund, M.},
	month = nov,
	year = {2014},
	pmid = {25084132},
	keywords = {Aged, Aged, 80 and over, Delivery of Health Care, Epidemiology, Female, Forecasting, Global Health, Humans, Knee osteoarthritis, Male, Middle Aged, Osteoarthritis, Population Surveillance, Prevalence, Prospective Studies, Risk Factors},
	pages = {1826--1832},
}

OBJECTIVE: To estimate the current and future (to year 2032) impact of osteoarthritis (OA) health care seeking. METHOD: Population-based study with prospectively ascertained data from the Skåne Healthcare Register (SHR), Sweden, encompassing more than 15 million person-years of primary and specialist outpatient care and hospitalizations. We studied all Skåne region residents aged ≥45 by the end of 2012 (n = 531, 254) and determined the prevalence of doctor-diagnosed OA defined as the proportion of the prevalent population that had received a diagnosis of OA of the knee, hip, hand, or other locations except the spine between 1999 and 2012. We projected consultation prevalence of OA until year 2032 using Statistics Sweden's (SCB) projected age and sex structure and prevalence of overweight and obesity. RESULTS: In 2012 the proportion of population aged ≥45 with any doctor-diagnosed OA was 26.6% (95% confidence interval (CI): 26.5-26.8) (men 22.4%, women 30.5%). The most common locations were knee (13.8%), hip (5.8%) and hand (3.1%). Of the prevalent cases 26.8% had OA in multiple joints. By the year 2032, the proportion of the population aged ≥45 with doctor-diagnosed OA is estimated to increase from 26.6% to 29.5% (any location), from 13.8% to 15.7% for the knee and 5.8-6.9% for the hip. CONCLUSION: In 2032, at least an additional 26,000 individuals per 1 million population aged ≥45 years are estimated to have consulted a physician for OA in a peripheral joint compared to 2012. These findings underscore the need to address modifiable risk factors and develop new effective OA treatments.

@article{guermazi_imaging_2014,
	title = {Imaging of non-osteochondral tissues in osteoarthritis.},
	volume = {22},
	issn = {1522-9653},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2014.05.001},
	doi = {10.1016/j.joca.2014.05.001},
	abstract = {OBJECTIVE: The aim of this review is to describe imaging techniques for evaluation of non-osteochondral structures such as the synovium, menisci in the knee, labrum in the hip, ligaments and muscles and to review the literature from recent clinical and epidemiological studies of OA.
METHODS: This is a non-systematic narrative review of published literature on imaging of non-osteochondral tissues in OA. PubMed and MEDLINE search for articles published up to 2014, using the keywords osteoarthritis, synovitis, meniscus, labrum, ligaments, plica, muscles, magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), scintigraphy, and positron emission tomography (PET).
RESULTS: Published literature showed imaging of non-osteochondral tissues in OA relies primarily on MRI and ultrasound. The use of semiquantitative and quantitative imaging biomarkers of non-osteochondral tissues in clinical and epidemiological OA studies is reported. We highlight studies that have compared both imaging methodologies directly, and those that have established a relationship between imaging biomarkers and clinical outcomes. We provide recommendations as to which imaging protocols should be used to assess disease-specific changes regarding synovium, meniscus in the knee, labrum in the hip, and ligaments, and highlight potential pitfalls in their usage.
CONCLUSION: MRI and ultrasound are currently the most useful imaging modalities for evaluation of non-osteochondral tissues in OA. MRI evaluation of any tissue needs to be performed using appropriate MR pulse sequences. Ultrasound may be particularly useful for evaluation of small joints of the hand. Nuclear medicine and CT play a limited role in imaging of non-osteochondral tissues in OA.},
	language = {eng},
	number = {10},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Guermazi, A. and Roemer, F. W. and Crema, M. D. and Englund, M. and Hayashi, D.},
	month = oct,
	year = {2014},
	pmid = {25278069},
	keywords = {Diagnostic Imaging, Humans, Ligaments, MRI, Magnetic resonance imaging, Menisci, Tibial, Meniscus, Muscle, Skeletal, Osteoarthritis, Osteoarthritis, Hip, Osteoarthritis, Knee, Positron-Emission Tomography, Radionuclide Imaging, Synovial Membrane, Synovitis, Tomography, X-Ray Computed, Ultrasound},
	pages = {1590--1605},
}

OBJECTIVE: The aim of this review is to describe imaging techniques for evaluation of non-osteochondral structures such as the synovium, menisci in the knee, labrum in the hip, ligaments and muscles and to review the literature from recent clinical and epidemiological studies of OA. METHODS: This is a non-systematic narrative review of published literature on imaging of non-osteochondral tissues in OA. PubMed and MEDLINE search for articles published up to 2014, using the keywords osteoarthritis, synovitis, meniscus, labrum, ligaments, plica, muscles, magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), scintigraphy, and positron emission tomography (PET). RESULTS: Published literature showed imaging of non-osteochondral tissues in OA relies primarily on MRI and ultrasound. The use of semiquantitative and quantitative imaging biomarkers of non-osteochondral tissues in clinical and epidemiological OA studies is reported. We highlight studies that have compared both imaging methodologies directly, and those that have established a relationship between imaging biomarkers and clinical outcomes. We provide recommendations as to which imaging protocols should be used to assess disease-specific changes regarding synovium, meniscus in the knee, labrum in the hip, and ligaments, and highlight potential pitfalls in their usage. CONCLUSION: MRI and ultrasound are currently the most useful imaging modalities for evaluation of non-osteochondral tissues in OA. MRI evaluation of any tissue needs to be performed using appropriate MR pulse sequences. Ultrasound may be particularly useful for evaluation of small joints of the hand. Nuclear medicine and CT play a limited role in imaging of non-osteochondral tissues in OA.

@article{moriatis_wolf_prevalence_2014,
	title = {Prevalence of doctor-diagnosed thumb carpometacarpal joint osteoarthritis: {An} analysis of {Swedish} health care.},
	volume = {66},
	issn = {2151-4658 2151-464X},
	url = {http://dx.doi.org/10.1002%2Facr.22250},
	doi = {10.1002/acr.22250},
	abstract = {OBJECTIVE: While the prevalence of radiographic thumb carpometacarpal (CMC1) osteoarthritis (OA) is well-described, little is known about clinically symptomatic disease presenting to physicians for care. We sought to determine the prevalence of doctor-diagnosed CMC1 OA. METHODS: Using health care data from Skane in southern Sweden (population 1.24 million), we identified all adults ages {\textgreater}20 years who consulted a physician at least once and received a diagnosis for CMC1 OA (International Classification of Diseases, Tenth Revision, code M18). Data from the 15-year period 1998-2012 were analyzed. Using cross-referencing with the Swedish population register to exclude subjects who were deceased or had relocated, we obtained point estimates of the proportion of the population consulting for CMC1 OA. RESULTS: The prevalence of doctor-diagnosed CMC1 OA in adults was estimated at 1.4\% (2.2\% in women and 0.62\% in men). The mean+/-SD age  in the prevalent CMC1 cohort (n=11,111) was 67.7+/-11.4 years; 78.5\% of diagnoses were in women. Prevalence peaked in women ages 70-74 years with an estimate of 5.3\% and in men ages 80-84 years with an estimate of 1.7\%. Age at initial diagnosis also differed, with women presenting between ages 60-69 years and men presenting between ages 70-79 years. CONCLUSION: The clinically important prevalence of CMC1 OA is 3 to 4 times higher in women than men. By the end of2012, more than 1 in 20 elderly women had consulted a physician for CMC1 OA over the last 15 years. The high prevalence of this subset of hand OA is a concern in an aging population.},
	language = {eng},
	number = {6},
	journal = {Arthritis care \& research},
	author = {Moriatis Wolf, Jennifer and Turkiewicz, Aleksandra and Atroshi, Isam and Englund, Martin},
	month = jun,
	year = {2014},
	pmid = {24339432},
	keywords = {*Physician's Role, Adult, Aged, Aged, 80 and over, Carpometacarpal Joints/*pathology, Cross-Sectional Studies, Delivery of Health Care/methods/*standards, Female, Humans, Male, Middle Aged, Osteoarthritis/*diagnosis/*epidemiology/therapy, Prevalence, Sweden/epidemiology, Thumb/*pathology, Young Adult},
	pages = {961--965},
}

OBJECTIVE: While the prevalence of radiographic thumb carpometacarpal (CMC1) osteoarthritis (OA) is well-described, little is known about clinically symptomatic disease presenting to physicians for care. We sought to determine the prevalence of doctor-diagnosed CMC1 OA. METHODS: Using health care data from Skane in southern Sweden (population 1.24 million), we identified all adults ages \textgreater20 years who consulted a physician at least once and received a diagnosis for CMC1 OA (International Classification of Diseases, Tenth Revision, code M18). Data from the 15-year period 1998-2012 were analyzed. Using cross-referencing with the Swedish population register to exclude subjects who were deceased or had relocated, we obtained point estimates of the proportion of the population consulting for CMC1 OA. RESULTS: The prevalence of doctor-diagnosed CMC1 OA in adults was estimated at 1.4% (2.2% in women and 0.62% in men). The mean+/-SD age in the prevalent CMC1 cohort (n=11,111) was 67.7+/-11.4 years; 78.5% of diagnoses were in women. Prevalence peaked in women ages 70-74 years with an estimate of 5.3% and in men ages 80-84 years with an estimate of 1.7%. Age at initial diagnosis also differed, with women presenting between ages 60-69 years and men presenting between ages 70-79 years. CONCLUSION: The clinically important prevalence of CMC1 OA is 3 to 4 times higher in women than men. By the end of2012, more than 1 in 20 elderly women had consulted a physician for CMC1 OA over the last 15 years. The high prevalence of this subset of hand OA is a concern in an aging population.

@article{neuman_knee_2014,
	title = {Knee cartilage assessment with {MRI} ({dGEMRIC}) and subjective knee function in {ACL} injured copers: {A} cohort study with a 20 year follow-up.},
	volume = {22},
	issn = {1522-9653},
	shorttitle = {Knee cartilage assessment with {MRI} ({dGEMRIC}) and subjective knee function in {ACL} injured copers},
	url = {http://dx.doi.org/10.1016%2Fj.joca.2013.10.006},
	doi = {10.1016/j.joca.2013.10.006},
	abstract = {OBJECTIVE: To assess knee cartilage quality and subjective knee function, 20 years after injury in anterior cruciate ligament (ACL) injured copers.
METHOD: We examined 32 knees using delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), 20 years after a complete ACL tear. Only subjects who had coped with the ACL injury without ACL reconstruction (ACLR), and who presented without radiographic signs of osteoarthritis (OA) at an earlier 16-year follow-up, were included in this study. The quality of the central weight-bearing parts of the medial and lateral femoral cartilage was estimated with dGEMRIC (T1Gd). These results were compared with corresponding results in 24 healthy individuals, and with the subjects' self-reported subjective knee function using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire.
RESULTS: The values of T1Gd in the medial and lateral femoral cartilage of the study group (mean (95\% CI)), were 404 (385-423) and 427 (399-455) ms, not statistically different from those of the healthy reference group (P = 0.065 and 0.31). The subjective knee function 20 years after the injury, according to the five domains of the KOOS score, was good, with a mean score of 90 ± 11. Values of T1Gd for the medial femoral cartilage were correlated with the KOOS subgroup QOL (P = 0.021, Pearson correlation).
CONCLUSIONS: Subjects who have managed to cope with their ACL injury for 20 years with sustained good subjective knee function also seem to have knee cartilage of good quality, with T1Gd values not very different from a healthy reference group.},
	language = {eng},
	number = {1},
	journal = {Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society},
	author = {Neuman, P. and Owman, H. and Müller, G. and Englund, M. and Tiderius, C. J. and Dahlberg, L. E.},
	month = jan,
	year = {2014},
	pmid = {24185106},
	keywords = {Adaptation, Psychological, Adult, Anterior Cruciate Ligament, Anterior cruciate ligament injury, Cartilage, Articular, Cohort Studies, Contrast Media, Female, Follow-Up Studies, Gadolinium DTPA, Humans, Knee, Knee Injuries, Knee Joint, MRI, Magnetic resonance imaging, Male, Meniscus injury, Middle Aged, Osteoarthritis, Prognosis, Recovery of Function, Self Report, dGEMRIC},
	pages = {84--90},
}

OBJECTIVE: To assess knee cartilage quality and subjective knee function, 20 years after injury in anterior cruciate ligament (ACL) injured copers. METHOD: We examined 32 knees using delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), 20 years after a complete ACL tear. Only subjects who had coped with the ACL injury without ACL reconstruction (ACLR), and who presented without radiographic signs of osteoarthritis (OA) at an earlier 16-year follow-up, were included in this study. The quality of the central weight-bearing parts of the medial and lateral femoral cartilage was estimated with dGEMRIC (T1Gd). These results were compared with corresponding results in 24 healthy individuals, and with the subjects' self-reported subjective knee function using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. RESULTS: The values of T1Gd in the medial and lateral femoral cartilage of the study group (mean (95% CI)), were 404 (385-423) and 427 (399-455) ms, not statistically different from those of the healthy reference group (P = 0.065 and 0.31). The subjective knee function 20 years after the injury, according to the five domains of the KOOS score, was good, with a mean score of 90 ± 11. Values of T1Gd for the medial femoral cartilage were correlated with the KOOS subgroup QOL (P = 0.021, Pearson correlation). CONCLUSIONS: Subjects who have managed to cope with their ACL injury for 20 years with sustained good subjective knee function also seem to have knee cartilage of good quality, with T1Gd values not very different from a healthy reference group.

@article{timpka_muscle_2014,
	title = {Muscle strength in adolescent men and risk of cardiovascular disease events and mortality in middle age: {A} prospective cohort study.},
	volume = {12},
	issn = {1741-7015 1741-7015},
	url = {http://dx.doi.org/10.1186%2F1741-7015-12-62},
	doi = {10.1186/1741-7015-12-62},
	abstract = {BACKGROUND: Ischemic heart disease and stroke are two severe types of cardiovascular disease (CVD), a major contributor to the global burden of disease. The preventive framework currently includes promotion of both adequate cardiorespiratory and muscular fitness. Although muscle fitness is established as an indicator of health, it is currently unknown whether muscle strength is associated with later CVD independently of cardiorespiratory fitness. METHODS: We studied 38,588 Swedish men who in 1969 to 1970 (typically aged 18 years) completed compulsory conscription. Using the mean standardized score of three isometric muscle strength tests performed at conscription (hand grip, elbow flexion and knee extension), we categorized the subjects into three groups with the 25th to 75th percentile defining the reference category. We followed the cohort until 2012 for diagnosed CVD events and mortality via national health care registers and the national cause of death register. To estimate hazard ratios (HR) for CVD events (coronary heart disease or stroke) and CVD mortality we used  Cox proportional hazard models adjusted for body mass index, smoking, alcohol consumption, cardiorespiratory fitness and socioeconomic status. RESULTS: Men with high muscle strength in adolescence had a decreased risk of later CVD events (HR 0.88, 95\% confidence interval 0.77 to 0.99), whereas we observed no increased risk in men with low muscle strength (0.99, 0.86 to 1.13). However, low muscle strength was associated with increased risk of CVD mortality during middle age (1.31, 1.02 to 1.67). CONCLUSIONS: Muscle strength in adolescent men is inversely associated with later CVD events and CVD mortality in middle age, independently of cardiorespiratory fitness and other important confounders. Thus, the role of muscle fitness in the prevention and pathogenesis of CVD warrants increased attention.},
	language = {eng},
	journal = {BMC medicine},
	author = {Timpka, Simon and Petersson, Ingemar F. and Zhou, Caddie and Englund, Martin},
	year = {2014},
	pmid = {24731728},
	pmcid = {PMC4006633},
	keywords = {Adolescent, Age Factors, Alcohol Drinking/adverse effects/mortality, Body Mass Index, Cardiovascular Diseases/*mortality/prevention \& control, Cardiovascular Physiological Phenomena, Cohort Studies, Coronary Disease/mortality, Hand Strength, Health Status, Humans, Male, Middle Aged, Muscle Strength/*physiology, Physical Fitness, Proportional Hazards Models, Prospective Studies, Respiratory Physiological Phenomena, Risk, Smoking/adverse effects/mortality, Social Class, Socioeconomic Factors, Stroke/mortality},
	pages = {62},
}

BACKGROUND: Ischemic heart disease and stroke are two severe types of cardiovascular disease (CVD), a major contributor to the global burden of disease. The preventive framework currently includes promotion of both adequate cardiorespiratory and muscular fitness. Although muscle fitness is established as an indicator of health, it is currently unknown whether muscle strength is associated with later CVD independently of cardiorespiratory fitness. METHODS: We studied 38,588 Swedish men who in 1969 to 1970 (typically aged 18 years) completed compulsory conscription. Using the mean standardized score of three isometric muscle strength tests performed at conscription (hand grip, elbow flexion and knee extension), we categorized the subjects into three groups with the 25th to 75th percentile defining the reference category. We followed the cohort until 2012 for diagnosed CVD events and mortality via national health care registers and the national cause of death register. To estimate hazard ratios (HR) for CVD events (coronary heart disease or stroke) and CVD mortality we used Cox proportional hazard models adjusted for body mass index, smoking, alcohol consumption, cardiorespiratory fitness and socioeconomic status. RESULTS: Men with high muscle strength in adolescence had a decreased risk of later CVD events (HR 0.88, 95% confidence interval 0.77 to 0.99), whereas we observed no increased risk in men with low muscle strength (0.99, 0.86 to 1.13). However, low muscle strength was associated with increased risk of CVD mortality during middle age (1.31, 1.02 to 1.67). CONCLUSIONS: Muscle strength in adolescent men is inversely associated with later CVD events and CVD mortality in middle age, independently of cardiorespiratory fitness and other important confounders. Thus, the role of muscle fitness in the prevention and pathogenesis of CVD warrants increased attention.

@article{meesters_risk_2014,
	title = {The risk for depression in patients with ankylosing spondylitis: {A} population-based cohort study.},
	volume = {16},
	issn = {1478-6362 1478-6354},
	url = {http://dx.doi.org/10.1186%2Fs13075-014-0418-z},
	doi = {10.1186/s13075-014-0418-z},
	abstract = {INTRODUCTION: Depression is frequent in ankylosing spondylitis (AS) patients. However, epidemiological data about the potential increase in risk are lacking. This study compares the rate of doctor-diagnosed depression in a well defined cohort of AS patients to the general population seeking care. METHODS: The Skane  Healthcare Register comprises healthcare data of each resident in Region Skane, Sweden (population 1.2 million), including ICD-10 diagnoses. Using physician coded consultation data from years 1999 to 2011, we calculated depression consultation rates for all AS patients. We obtained standardized depression-rate  ratios by dividing the observed depression rate in AS patients by the expected rate based on the corresponding age- and sex-specific rates of depression in the  general population seeking care. A ratio {\textgreater} 1 equals a higher rate of depression among AS patients. RESULTS: The AS cohort consisted of 1738 subjects (65\% men) with a mean age of 54 years. The reference population consisted of 967,012 subjects. During the 13-year observation period 10\% (n = 172) of the AS cohort had a doctor-diagnosed depression compared to 6\% (n = 105) to be expected. The standardized estimate of depression-rate ratio was 1.81 (95\% confidence interval  1.44 to 2.24) in women men and 1.49 (1.20 to 1.89) in men. CONCLUSIONS: The rate  of doctor-diagnosed depression is increased about 80\% in female and 50\% in male AS patients. Future challenges are to timely identify and treat the AS patients who suffer from depression.},
	language = {eng},
	number = {5},
	journal = {Arthritis research \& therapy},
	author = {Meesters, Jorit J. L. and Bremander, Ann and Bergman, Stefan and Petersson, Ingemar F. and Turkiewicz, Aleksandra and Englund, Martin},
	year = {2014},
	pmid = {25209603},
	pmcid = {PMC4180137},
	keywords = {Adult, Aged, Cohort Studies, Comorbidity, Depression/diagnosis/*epidemiology, Female, Humans, International Classification of Diseases, Male, Middle Aged, Population Surveillance/methods, Referral and Consultation/*statistics \& numerical data, Registries/*statistics \& numerical data, Risk Factors, Sex Factors, Spondylitis, Ankylosing/*epidemiology, Sweden/epidemiology},
	pages = {418},
}

INTRODUCTION: Depression is frequent in ankylosing spondylitis (AS) patients. However, epidemiological data about the potential increase in risk are lacking. This study compares the rate of doctor-diagnosed depression in a well defined cohort of AS patients to the general population seeking care. METHODS: The Skane Healthcare Register comprises healthcare data of each resident in Region Skane, Sweden (population 1.2 million), including ICD-10 diagnoses. Using physician coded consultation data from years 1999 to 2011, we calculated depression consultation rates for all AS patients. We obtained standardized depression-rate ratios by dividing the observed depression rate in AS patients by the expected rate based on the corresponding age- and sex-specific rates of depression in the general population seeking care. A ratio \textgreater 1 equals a higher rate of depression among AS patients. RESULTS: The AS cohort consisted of 1738 subjects (65% men) with a mean age of 54 years. The reference population consisted of 967,012 subjects. During the 13-year observation period 10% (n = 172) of the AS cohort had a doctor-diagnosed depression compared to 6% (n = 105) to be expected. The standardized estimate of depression-rate ratio was 1.81 (95% confidence interval 1.44 to 2.24) in women men and 1.49 (1.20 to 1.89) in men. CONCLUSIONS: The rate of doctor-diagnosed depression is increased about 80% in female and 50% in male AS patients. Future challenges are to timely identify and treat the AS patients who suffer from depression.

@article{bruns_meniscus_2014,
	title = {Meniscus body position and its change over four years in asymptomatic adults: {A} cohort study using data from the {Osteoarthritis} {Initiative} ({OAI}).},
	volume = {15},
	issn = {1471-2474 1471-2474},
	url = {http://dx.doi.org/10.1186%2F1471-2474-15-32},
	doi = {10.1186/1471-2474-15-32},
	abstract = {BACKGROUND: A high degree of meniscal body extrusion on knee magnetic resonance imaging has been shown to be strongly associated with development of knee osteoarthritis. However, very little is known about meniscal position in the asymptomatic knee and its natural history. Hence our objective was to study meniscal body position and its change over 4 years in asymptomatic adults. METHODS: Cohort study using data from the Osteoarthritis Initiative (OAI) involving four clinical sites in the United States (Baltimore, Maryland, Pawtucket, Rhode Island, Columbus, Ohio, and Pittsburgh, Pennsylvania). We studied both knees from 118 subjects (mean age 55 years, 61\% women, mean body mass index 24.4) from the OAI "non-exposed" reference cohort free of knee pain, radiographic knee osteoarthritis and risk factors for knee osteoarthritis at baseline. We assessed mid-coronal intermediate-weighted 3-Tesla magnetic resonance images from baseline and the 2- and 4-year follow-up visit. One observer measured tibia plateau, meniscal body width and meniscal body extrusion  in both compartments. We calculated meniscal overlap distance on the tibial plateau, \% coverage, and extrusion index compared to tibia width. Potential trends in position over the 4-year period were evaluated using a linear mixed-effects regression model. RESULTS: The mean (SD) values at baseline for medial meniscal body extrusion and overlap distance were 1.64 mm (0.92) and 10.1  mm (3.5), and coverage was 34.4\% (11.9). The corresponding values for the lateral compartment were 0.63 mm (0.73), 9.8 mm (2.4), and 31.0\% (7.7). Medial meniscus body extrusion index was greater in female knees (p = 0.03). There was slight increase in medial meniscal body extrusion over 4 years (0.040 mm/year [95\% CI: 0.019-0.062]). The other variables were relatively stable. CONCLUSIONS: In asymptomatic adults, the relative degree of meniscus body extrusion is more pronounced in female knees. Although a slight increase in extrusion over time was noted for the medial body, positions were relatively stable within subjects over  time.},
	language = {eng},
	journal = {BMC musculoskeletal disorders},
	author = {Bruns, Katharina and Svensson, Fredrik and Turkiewicz, Aleksandra and Wirth, Wolfgang and Guermazi, Ali and Eckstein, Felix and Englund, Martin},
	year = {2014},
	pmid = {24499033},
	pmcid = {PMC3924236},
	keywords = {*Magnetic Resonance Imaging, Aged, Asymptomatic Diseases, Female, Humans, Linear Models, Male, Menisci, Tibial/*pathology, Middle Aged, Osteoarthritis, Knee/*diagnosis/pathology, Sex Factors, Time Factors, United States},
	pages = {32},
}

BACKGROUND: A high degree of meniscal body extrusion on knee magnetic resonance imaging has been shown to be strongly associated with development of knee osteoarthritis. However, very little is known about meniscal position in the asymptomatic knee and its natural history. Hence our objective was to study meniscal body position and its change over 4 years in asymptomatic adults. METHODS: Cohort study using data from the Osteoarthritis Initiative (OAI) involving four clinical sites in the United States (Baltimore, Maryland, Pawtucket, Rhode Island, Columbus, Ohio, and Pittsburgh, Pennsylvania). We studied both knees from 118 subjects (mean age 55 years, 61% women, mean body mass index 24.4) from the OAI "non-exposed" reference cohort free of knee pain, radiographic knee osteoarthritis and risk factors for knee osteoarthritis at baseline. We assessed mid-coronal intermediate-weighted 3-Tesla magnetic resonance images from baseline and the 2- and 4-year follow-up visit. One observer measured tibia plateau, meniscal body width and meniscal body extrusion in both compartments. We calculated meniscal overlap distance on the tibial plateau, % coverage, and extrusion index compared to tibia width. Potential trends in position over the 4-year period were evaluated using a linear mixed-effects regression model. RESULTS: The mean (SD) values at baseline for medial meniscal body extrusion and overlap distance were 1.64 mm (0.92) and 10.1 mm (3.5), and coverage was 34.4% (11.9). The corresponding values for the lateral compartment were 0.63 mm (0.73), 9.8 mm (2.4), and 31.0% (7.7). Medial meniscus body extrusion index was greater in female knees (p = 0.03). There was slight increase in medial meniscal body extrusion over 4 years (0.040 mm/year [95% CI: 0.019-0.062]). The other variables were relatively stable. CONCLUSIONS: In asymptomatic adults, the relative degree of meniscus body extrusion is more pronounced in female knees. Although a slight increase in extrusion over time was noted for the medial body, positions were relatively stable within subjects over time.

@article{sward_soft_2014,
	title = {Soft tissue knee injury with concomitant osteochondral fracture is associated with higher degree of acute joint inflammation.},
	volume = {42},
	issn = {1552-3365 0363-5465},
	url = {http://dx.doi.org/10.1177%2F0363546514524924},
	doi = {10.1177/0363546514524924},
	abstract = {BACKGROUND: Osteochondral fractures are often seen on magnetic resonance imaging  (MRI) of acutely injured knees, but their existence has gained little interest because of a lack of knowledge of their relation to treatment options and outcome. It is not clear whether acute phase synovial fluid (SF) concentrations of cartilage and bone markers and proinflammatory cytokines are different between traumatically injured knees with or without osteochondral fracture. HYPOTHESIS: Acutely injured knees with an osteochondral fracture, particularly fractures with disrupted cortical bone, have higher concentrations of bone markers and cytokines than do knees without an osteochondral fracture. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Synovial fluid (hemarthrosis) was aspirated (median 1 day after injury) and 1.5-T MRI was performed (median 8 days after injury) in the acutely injured knee of 98 individuals (26\% women; mean age, 23 years). As visualized on MRI, 39\% knees had an osteochondral fracture with disrupted cortical bone, 30\% had an osteochondral fracture with intact cortical bone, and 32\% did not have an osteochondral fracture. Concentrations of sulfated  glycosaminoglycan, ARGS aggrecan, cartilage oligomeric matrix protein, osteocalcin, secreted protein acidic and rich in cysteine (SPARC), osteopontin and proinflammatory cytokines (interleukin [IL]-1beta, IL-6, IL-8, and tumor necrosis factor [TNF]-alpha) were analyzed. RESULTS: After adjusting for days between injury and SF aspiration, age at injury, and sex, knees with any osteochondral fracture (with or without disrupted cortical bone) had significantly higher SF concentrations of TNF-alpha (median [interquartile range  (IQR)] = 9 [7-12] pg/mL vs. 7 [5-14] pg/mL; P = .013), whereas knees with an osteochondral fracture with disrupted cortical bone had significantly higher SF concentrations (medians [IQRs]) of SPARC (492 [328-754] ng/mL vs. 407 [140-685] ng/mL; P = .030), IL-8 (278 [148-628] pg/mL vs. 138 [67-413] pg/mL; P = .028), and TNF-alpha (11 [7-15] pg/mL vs. 7 [5-14] pg/mL; P = .004) compared with knees  without an osteochondral fracture. CONCLUSION: In acutely injured knees with hemarthrosis, a concomitant osteochondral fracture with disrupted cortical bone is associated with a higher degree of joint inflammation.},
	language = {eng},
	number = {5},
	journal = {The American journal of sports medicine},
	author = {Sward, Per and Struglics, Andre and Englund, Martin and Roos, Harald P. and Frobell, Richard B.},
	month = may,
	year = {2014},
	pmid = {24664137},
	keywords = {Acute Disease, Adolescent, Adult, Arthritis/*metabolism, Biomarkers/metabolism, Cartilage Oligomeric Matrix Protein/metabolism, Cartilage, Articular/injuries, Cross-Sectional Studies, Female, Fractures, Bone/*complications/diagnosis, Fractures, Cartilage/*complications/diagnosis, Hemarthrosis/metabolism, Humans, Interleukin-8/metabolism, Knee Injuries/*complications/diagnosis, Magnetic Resonance Imaging, Male, Menisci, Tibial/injuries, Middle Aged, Osteoarthritis, Osteonectin/metabolism, Patellar Dislocation/complications/diagnosis, Posterior Cruciate Ligament/injuries, Soft Tissue Injuries/*complications/diagnosis, Suction, Synovial Fluid/*metabolism, Time Factors, Tumor Necrosis Factor-alpha/metabolism, Young Adult, anterior cruciate ligament, biomarkers, bone, cartilage, posttraumatic},
	pages = {1096--1102},
}

BACKGROUND: Osteochondral fractures are often seen on magnetic resonance imaging (MRI) of acutely injured knees, but their existence has gained little interest because of a lack of knowledge of their relation to treatment options and outcome. It is not clear whether acute phase synovial fluid (SF) concentrations of cartilage and bone markers and proinflammatory cytokines are different between traumatically injured knees with or without osteochondral fracture. HYPOTHESIS: Acutely injured knees with an osteochondral fracture, particularly fractures with disrupted cortical bone, have higher concentrations of bone markers and cytokines than do knees without an osteochondral fracture. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Synovial fluid (hemarthrosis) was aspirated (median 1 day after injury) and 1.5-T MRI was performed (median 8 days after injury) in the acutely injured knee of 98 individuals (26% women; mean age, 23 years). As visualized on MRI, 39% knees had an osteochondral fracture with disrupted cortical bone, 30% had an osteochondral fracture with intact cortical bone, and 32% did not have an osteochondral fracture. Concentrations of sulfated glycosaminoglycan, ARGS aggrecan, cartilage oligomeric matrix protein, osteocalcin, secreted protein acidic and rich in cysteine (SPARC), osteopontin and proinflammatory cytokines (interleukin [IL]-1beta, IL-6, IL-8, and tumor necrosis factor [TNF]-alpha) were analyzed. RESULTS: After adjusting for days between injury and SF aspiration, age at injury, and sex, knees with any osteochondral fracture (with or without disrupted cortical bone) had significantly higher SF concentrations of TNF-alpha (median [interquartile range (IQR)] = 9 [7-12] pg/mL vs. 7 [5-14] pg/mL; P = .013), whereas knees with an osteochondral fracture with disrupted cortical bone had significantly higher SF concentrations (medians [IQRs]) of SPARC (492 [328-754] ng/mL vs. 407 [140-685] ng/mL; P = .030), IL-8 (278 [148-628] pg/mL vs. 138 [67-413] pg/mL; P = .028), and TNF-alpha (11 [7-15] pg/mL vs. 7 [5-14] pg/mL; P = .004) compared with knees without an osteochondral fracture. CONCLUSION: In acutely injured knees with hemarthrosis, a concomitant osteochondral fracture with disrupted cortical bone is associated with a higher degree of joint inflammation.

@article{olofsson_predictors_2014,
	title = {Predictors of work disability during the first 3 years after diagnosis in a national rheumatoid arthritis inception cohort.},
	volume = {73},
	issn = {1468-2060 0003-4967},
	url = {http://dx.doi.org/10.1136%2Fannrheumdis-2012-202911},
	doi = {10.1136/annrheumdis-2012-202911},
	abstract = {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 ({\textless}/=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{\textless}0.001) and 18\% (p{\textless}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{\textless}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.},
	language = {eng},
	number = {5},
	journal = {Annals of the rheumatic diseases},
	author = {Olofsson, Tor and Petersson, Ingemar F. and Eriksson, Jonas K. and Englund, Martin and Simard, Julia F. and Nilsson, Jan-Ake and Geborek, Pierre and Jacobsson, Lennart T. H. and Askling, Johan and Neovius, Martin},
	month = may,
	year = {2014},
	pmid = {23520035},
	keywords = {*Arthritis, Rheumatoid, *Disability Evaluation, Adolescent, Adult, Cohort Studies, Disease Activity, EPIDEMIOLOGY, Early Rheumatoid Arthritis, Female, Humans, Male, Middle Aged, Outcomes research, Pensions, Sick Leave/*statistics \& numerical data, Sweden, Young Adult},
	pages = {845--853},
}

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 (\textless/=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\textless0.001) and 18% (p\textless0.001) 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\textless0.05). 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.

@article{jordan_international_2014,
	title = {International comparisons of the consultation prevalence of musculoskeletal conditions using population-based healthcare data from {England} and {Sweden}.},
	volume = {73},
	issn = {1468-2060 0003-4967},
	url = {http://dx.doi.org/10.1136%2Fannrheumdis-2012-202634},
	doi = {10.1136/annrheumdis-2012-202634},
	abstract = {OBJECTIVES: To assess the consultation prevalence of musculoskeletal (MSK) conditions as presented in different healthcare systems, and to determine the feasibility of comparing prevalence figures between nations. METHODS: The settings were an English regional database (Consultations in Primary Care Archive (CiPCA)) and the Swedish Skane County Health Care Register. Case definitions, data extraction and analysis procedures were harmonised. The number of people consulting per 10 000 registered population in primary care, and in primary or secondary care, in the year 2010 (annual consultation prevalence) were determined for doctor-diagnosed osteoarthritis (OA), rheumatoid arthritis (RA), low back pain, and spondyloarthritis including psoriatic arthritis and ankylosing spondylitis (AS). Seven-year period consultation prevalences were also determined. RESULTS: Combining primary and secondary care, annual consultation prevalences of any MSK condition (2143 vs 1610/10 000) and low back pain (587 vs  294/10 000) were higher in England than in Sweden, but higher for RA, spondyloarthritis and psoriatic arthritis in Sweden. Annual primary care prevalence figures for OA (176 vs 196/10 000), RA (25 vs 26/10 000), spondyloarthritis (both 8/10 000) and psoriatic arthritis (5 vs 3/10 000) were similar between England and Sweden. AS was rarely recorded in Swedish primary care. These patterns were also observed for 7-year period consultation prevalences. CONCLUSIONS: A rigorous methodological approach allowed feasible comparison of MSK consultation prevalence between England and Sweden. Differences in prevalence of inflammatory and unspecific pain conditions may be partially explained by known variations in healthcare systems and recording practice. Routine healthcare data offers potential for investigating variations in occurrence and outcome of MSK conditions between nations.},
	language = {eng},
	number = {1},
	journal = {Annals of the rheumatic diseases},
	author = {Jordan, Kelvin P. and Joud, Anna and Bergknut, Charlotte and Croft, Peter and Edwards, John J. and Peat, George and Petersson, Ingemar F. and Turkiewicz, Aleksandra and Wilkie, Ross and Englund, Martin},
	month = jan,
	year = {2014},
	pmid = {23345602},
	pmcid = {PMC3888586},
	keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Arthralgia/*epidemiology, Child, Child, Preschool, Cross-Cultural Comparison, Databases, Factual/statistics \& numerical data, EPIDEMIOLOGY, England/epidemiology, Female, Humans, Infant, Infant, Newborn, Low Back Pain, Male, Middle Aged, Morbidity, Musculoskeletal Diseases/*epidemiology, Osteoarthritis, Osteoarthritis/*epidemiology, Prevalence, Primary Health Care/*statistics \& numerical data, RHEUMATOID ARTHRITIS, Referral and Consultation/*statistics \& numerical data, Spondyloarthritis, Sweden/epidemiology, Young Adult},
	pages = {212--218},
}

OBJECTIVES: To assess the consultation prevalence of musculoskeletal (MSK) conditions as presented in different healthcare systems, and to determine the feasibility of comparing prevalence figures between nations. METHODS: The settings were an English regional database (Consultations in Primary Care Archive (CiPCA)) and the Swedish Skane County Health Care Register. Case definitions, data extraction and analysis procedures were harmonised. The number of people consulting per 10 000 registered population in primary care, and in primary or secondary care, in the year 2010 (annual consultation prevalence) were determined for doctor-diagnosed osteoarthritis (OA), rheumatoid arthritis (RA), low back pain, and spondyloarthritis including psoriatic arthritis and ankylosing spondylitis (AS). Seven-year period consultation prevalences were also determined. RESULTS: Combining primary and secondary care, annual consultation prevalences of any MSK condition (2143 vs 1610/10 000) and low back pain (587 vs 294/10 000) were higher in England than in Sweden, but higher for RA, spondyloarthritis and psoriatic arthritis in Sweden. Annual primary care prevalence figures for OA (176 vs 196/10 000), RA (25 vs 26/10 000), spondyloarthritis (both 8/10 000) and psoriatic arthritis (5 vs 3/10 000) were similar between England and Sweden. AS was rarely recorded in Swedish primary care. These patterns were also observed for 7-year period consultation prevalences. CONCLUSIONS: A rigorous methodological approach allowed feasible comparison of MSK consultation prevalence between England and Sweden. Differences in prevalence of inflammatory and unspecific pain conditions may be partially explained by known variations in healthcare systems and recording practice. Routine healthcare data offers potential for investigating variations in occurrence and outcome of MSK conditions between nations.

@article{peat_population-wide_2014,
	title = {Population-wide incidence estimates for soft tissue knee injuries presenting to healthcare in southern {Sweden}: {Data} from the {Skane} {Healthcare} {Register}.},
	volume = {16},
	issn = {1478-6362 1478-6354},
	url = {http://dx.doi.org/10.1186%2Far4678},
	doi = {10.1186/ar4678},
	abstract = {INTRODUCTION: Soft tissue knee injury is a well-established and potent risk factor for development of knee osteoarthritis. However, there is a paucity of epidemiological data from the general population. Our aim was to estimate the annual person-level incidence for a wide spectrum of clinically diagnosed soft tissue knee injuries, and their distribution by age, sex, and season. METHODS: In Sweden, in- and outpatient health care is registered using each individuals' unique personal identifier including International Classification of Diseases (ICD) 10 diagnostic code(s) as determined by physicians' clinical examination. For the calendar years 2004-2012, we studied the population in southern Sweden, Skane region (approx. 1.3 million). We identified residents who had at least one  visit to a physician with clinically diagnosed knee ligament, meniscal, or other  soft-tissue injury (S80.0, S83 and all subdiagnoses). We then calculated the mean annual incidence over the 9-year period. As a secondary objective, we investigated potential seasonal variation. RESULTS: The annual incidence for males and females was 766 (95\% CI: 742, 789) and 676 (649, 702) per 100,000 persons/year respectively. For males and females, the peak rate occurred in 15 to 19 year-olds (1698 per 100,000 men and 1464 per 100,000 women, respectively). In  women, rates were lowest in the 25 to 34 year-old age range before rising again between the ages of 35 and 49 years. We found substantial seasonal variation, greatest in men, with peaks in March-May and August-October. CONCLUSIONS: The incidence of clinically diagnosed soft-tissue knee injury peaks in adolescence and emerging adulthood. However, a range of knee injuries continue to occur across the adult lifespan including at ages when osteoarthritis is typically diagnosed and managed. The potential cumulative effect on osteoarthritis progression of these injuries may warrant further investigation.},
	language = {eng},
	number = {4},
	journal = {Arthritis research \& therapy},
	author = {Peat, George and Bergknut, Charlotte and Frobell, Richard and Joud, Anna and Englund, Martin},
	year = {2014},
	pmid = {25082600},
	pmcid = {PMC4262192},
	keywords = {Adolescent, Adult, Age Distribution, Female, Humans, Incidence, Knee Injuries/*epidemiology, Male, Middle Aged, Registries, Seasons, Sex Distribution, Soft Tissue Injuries/*epidemiology, Sweden/epidemiology, Young Adult},
	pages = {R162},
}

INTRODUCTION: Soft tissue knee injury is a well-established and potent risk factor for development of knee osteoarthritis. However, there is a paucity of epidemiological data from the general population. Our aim was to estimate the annual person-level incidence for a wide spectrum of clinically diagnosed soft tissue knee injuries, and their distribution by age, sex, and season. METHODS: In Sweden, in- and outpatient health care is registered using each individuals' unique personal identifier including International Classification of Diseases (ICD) 10 diagnostic code(s) as determined by physicians' clinical examination. For the calendar years 2004-2012, we studied the population in southern Sweden, Skane region (approx. 1.3 million). We identified residents who had at least one visit to a physician with clinically diagnosed knee ligament, meniscal, or other soft-tissue injury (S80.0, S83 and all subdiagnoses). We then calculated the mean annual incidence over the 9-year period. As a secondary objective, we investigated potential seasonal variation. RESULTS: The annual incidence for males and females was 766 (95% CI: 742, 789) and 676 (649, 702) per 100,000 persons/year respectively. For males and females, the peak rate occurred in 15 to 19 year-olds (1698 per 100,000 men and 1464 per 100,000 women, respectively). In women, rates were lowest in the 25 to 34 year-old age range before rising again between the ages of 35 and 49 years. We found substantial seasonal variation, greatest in men, with peaks in March-May and August-October. CONCLUSIONS: The incidence of clinically diagnosed soft-tissue knee injury peaks in adolescence and emerging adulthood. However, a range of knee injuries continue to occur across the adult lifespan including at ages when osteoarthritis is typically diagnosed and managed. The potential cumulative effect on osteoarthritis progression of these injuries may warrant further investigation.

@article{lofvendahl_validity_2014,
	title = {Validity of diagnostic codes and prevalence of physician-diagnosed psoriasis and  psoriatic arthritis in southern {Sweden} - {A} population-based register study.},
	volume = {9},
	issn = {1932-6203 1932-6203},
	url = {http://dx.doi.org/10.1371%2Fjournal.pone.0098024},
	doi = {10.1371/journal.pone.0098024},
	abstract = {OBJECTIVE: To validate diagnostic codes for psoriasis and psoriatic arthritis (PsA) and estimate physician-diagnosed prevalence of psoriasis and PsA in the Skane region, Sweden. METHODS: In the Skane Healthcare Register (SHR), all healthcare consultations are continuously collected for all inhabitants in the Skane region (population 1.2 million). During 2005-2010 we identified individuals with {\textgreater}/=1 physician-consultations consistent with psoriasis (ICD-10). Within this group we also identified those diagnosed with PsA. We performed a validation by reviewing medical records in 100 randomly selected cases for psoriasis and psoriasis with PsA, respectively. Further, we estimated the pre- and post-validation point prevalence by December 31, 2010. RESULTS: We identified 16  171 individuals (psoriasis alone: n = 13 185, psoriasis with PsA n = 2 986). The  proportion of ICD-10 codes that could be confirmed by review of medical records was 81\% for psoriasis and 63\% for psoriasis with PsA with highest percentage of confirmed codes for cases diagnosed {\textgreater}/=2 occasions in specialized care. For 19\% and 29\% of the cases respectively it was not possible to determine diagnosis due  to insufficient information. Thus, the positive predicted value (PPV) of one},
	language = {eng},
	number = {5},
	journal = {PloS one},
	author = {Lofvendahl, Sofia and Theander, Elke and Svensson, Ake and Carlsson, Katarina Steen and Englund, Martin and Petersson, Ingemar F.},
	year = {2014},
	pmid = {24875275},
	pmcid = {PMC4038520},
	keywords = {*International Classification of Diseases, Adult, Arthritis, Psoriatic/*diagnosis/*epidemiology, Female, Humans, Male, Middle Aged, Physicians, Population Surveillance, Prevalence, Psoriasis/*diagnosis/*epidemiology, Registries, Reproducibility of Results, Swede