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Biomedical subjects

K Aho

Publications and source records attributed to K Aho.

At least 37 records · Page 2Linked to original sources
PubMed2000

Coffee consumption, rheumatoid factor, and the risk of rheumatoid arthritis.

BACKGROUND: Recent epidemiological studies have suggested that smoking is a risk factor for rheumatoid factor (RF) positive rheumatoid arthritis (RA). Being overweight, high serum cholesterol, and dietary factors have in some studies been found to be associated with the risk of RA. No attention, however, has been paid to coffee consumption as a risk determinant, though it is a shared covariate of the alleged risk factors. OBJECTIVES: This study aimed at examining coffee consumption for its associations with RF positivity and with the risk of RA. METHODS: Coffee consumption was studied, firstly, for its association with RF (sensitised sheep cell agglutination titre >/=128) in a cross sectional survey of 6809 subjects with no clinical arthritis, and secondly, for its prediction of RA in a cohort of 18 981 men and women who had neither arthritis nor a history of it at the baseline examination in 1973-76. Up to late 1989, 126 subjects of the cohort study had developed RA, of whom, 89 were positive for RF by the time of diagnosis. RESULTS: In the cross sectional survey the number of cups of coffee drunk daily was directly proportional to the prevalence of RF positivity. Adjusted for age and sex this association was significant (p value for linear trend, 0.008), but after further adjustment for smoking the linear trend declined below significance (p=0.06). In the cohort study there was an association between coffee consumption and the risk of RF positive RA that was not due to age, sex, level of education, smoking, alcohol intake, body mass index, or serum cholesterol. After adjustment for these potential confounders the users of four or more cups a day still had a relative risk of 2.20 (95% confidence interval 1.13 to 4.27) for developing RF positive RA compared with those drinking less. Coffee consumption did not predict the development of RF negative RA. CONCLUSION: Coffee consumption may be a risk factor for RA, possibly through mechanisms contributing to the production of RF. This hypothesis remains to be tested in further studies.

Adult↗
PubMed2000

Decreased severity of brain infarct can in part explain the decreasing case fatality rate of stroke.

BACKGROUND AND PURPOSE: Case fatality rates for stroke has declined in most Western industrialized countries during recent decades. One possible explanation for this is a decrease in the severity of stroke symptoms. We therefore sought evidence for a change in stroke severity and its relationship with case fatality rates. METHODS: We compared the severity of symptoms among first-ever stroke patients in 2 population-based prospective stroke registers maintained during 1972 to 1973 and 1989 to 1991 in Finland. Patients who were evaluated by study assistants or the investigator during the first week after the onset of symptoms were included in the study, and their severity of symptoms was assessed with the use of comparable scales modified from the Scandinavian Stroke Scale. RESULTS: A total of 244 and 594 patients were registered, and a portion of them (155 [63.5%] and 360 [60.6%]) were included in the analyses in the registers for Espoo-Kauniainen from 1972 to 1973 and for 4 separate districts in Finland from 1989 to 1991, respectively. The death rates during the first week among those who were not included did not differ between the registers. The severity of symptoms decreased significantly between the registers in both patients with brain infarct or intracerebral hemorrhage but not in those with subarachnoid hemorrhage. The severity of symptoms was an independent factor of case fatality at 1 month. CONCLUSIONS: The severity of symptoms of brain infarcts has decreased and can in part explain the decreased case fatality rate of stroke in Finland. However, the change in patients with intracerebral hemorrhage may be overestimated due to undiagnosed intracerebral hemorrhages in the first register resulting from the lack of brain CT.

Aged↗
PubMed2000

Incidence of chronic inflammatory joint diseases in Finland in 1995.

OBJECTIVE: To investigate trends in the incidence of chronic inflammatory joint diseases. METHODS: Subjects entitled to receive drug reimbursement for chronic inflammatory joint diseases in 5/21 central hospital districts (population base about 1 million adults) in Finland during 1995 were studied. The mean age at disease onset was compared with figures from 1975, 1980, 1985, and 1990. Incidence rates were compared with those from 1980, 1985, and 1990. RESULTS: A total of 710 subjects were entitled to drug reimbursement for chronic inflammatory joint disease that had started at the age of 16 or over. The total incidence was 65/100,000 (95% confidence interval 60.7-70.4); the figures for rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and undifferentiated chronic poly/oligoarthritis were 34, 6, 7, and 13/100,000, respectively. In RA, the mean age at diagnosis was 59.0 years and was the same in rheumatoid factor (RF) positive and RF negative disease. The mean age at diagnosis had increased by 8.8 years from 1975 to 1995 (p<0.001). A 14% decline was evident in the incidence of RA in 1990 and 1995 compared with the earlier years (p = 0.013). In the younger age groups (35-54 years), the incidence declined by 50% compared with the year 1980. The incidence of spondyloarthropathies remained similar during 1980-95. CONCLUSION: Continuous monitoring of sickness insurance data provides information on the epidemiology of inflammatory joint diseases that will be useful in assessing demand for and supply of health services.

Adult↗
PubMed2000

Serum C-reactive protein does not predict rheumatoid arthritis.

OBJECTIVE: Clinical rheumatoid arthritis (RA) is preceded by an immunological process. Our objective was to investigate C-reactive protein (CRP) for its prediction of RA. METHODS: A case-control study was nested within a Finnish cohort of 19,072 adults who had no arthritis and no history of the disease at the baseline examination conducted between 1973 and 1977. By late 1989, 124 had developed RA. Three controls for each incident case were individually matched for sex, age, and municipality. The CRP concentration was measured by a sensitive ELISA. RESULTS: No difference was noted in serum CRP levels between cases and controls. The odds ratios (95% confidence intervals) of RA in the quintiles of CRP were 1.0, 0.89 (0.45-1.76), 1.11 (0.59-2.08), 0.99 (0.51-1.91), and 0.95 (0.49-1.87). Similarly, there was no difference when the data were analyzed in strata of sex, age, rheumatoid factor (RF) status at baseline, and length of time from taking the specimens to the onset of clinical disease. CONCLUSION: Pre-rheumatoid immunological process as reflected in RF production is not associated with any marked inflammation or tissue injury heightening CRP.

Adult↗
PubMed2000

Antifilaggrin antibodies within "normal" range predict rheumatoid arthritis in a linear fashion.

OBJECTIVE: Increasing attention has been paid to the significance of antifilaggrin antibodies (AFA) in rheumatoid arthritis (RA). We studied the prediction of RA by AFA in serum specimens from the period prior to the onset of clinical RA. METHODS: A case-control study was nested within a Finnish cohort of 19.072 adults who had neither arthritis nor a history of it at the baseline examination during 1973-77. Pre-illness serum specimens for the assay of AFA by ELISA, using filaggrin purified from human skin as the antigen, were available from 124 of the 126 patients who had developed RA by late 1989. Of the incident cases 89 were positive for rheumatoid factor (RF). Three controls per each incident case were individually matched for sex, age, and municipality. RESULTS: Pre-illness serum AFA level was found to be directly proportional to the risk of RF positive RA. The odds ratio (95% confidence interval) in the highest quintile compared to the lowest quintile was 5.4 (2.2-13.6). In the subgroup of subjects positive for RF at baseline the figure was 24 (4.0-140). AFA did not predict the development of RF negative RA. A close association of the same order of magnitude between RF and AFA was noted in the pre-illness sera and in the control sera. CONCLUSION: AFA still within the "normal" range predicts RA in a linear fashion. AFA and RF are associated markers of the rheumatoid immunological process.

Adult↗
PubMed1999

Serum testosterone and sex hormone-binding globulin concentrations and the risk of prostate carcinoma: a longitudinal study.

BACKGROUND: It has been hypothesized that high androgen levels are determinants of prostate carcinoma. METHODS: Serum concentrations of testosterone, sex hormone-binding globulin (SHBG), and androstenedione were analyzed to determine their role as predictors of prostate carcinoma in a longitudinal, population-based, nested case-control study. The serum concentrations of testosterone, SHBG, and androstenedione were determined from serum samples collected by the Finnish Mobile Clinic Health Examination Survey between 1968-1972 and stored at -20 degrees C. During a follow-up period of 24 years, a total of 166 prostate carcinoma cases occurred among men who originally were cancer free. Two controls (matched for age and municipality) were chosen. RESULTS: There was no association between serum testosterone, SHBG, or androstenedione concentrations and the occurrence of subsequent prostate carcinoma in the total study population or in subgroups determined based on age or body mass index. The association was not strengthened by simultaneous adjustment for the hormonal variables. CONCLUSIONS: The results of the current study do not appear to corroborate the hypothesis that serum testosterone, SHBG, or androstenedione are determinants of the subsequent occurrence of prostate carcinoma.

Aged↗
PubMed1999

Antifilaggrin antibodies in recent-onset arthritis.

We evaluated the sensitivity and prognostic value of an enzyme-linked immunosorbent assay (ELISA) for the measurement of antifilaggrin antibodies (AFA), using filaggrin purified from human skin as an antigen. The AFA test was applied to a series of 306 patients with various recent-onset inflammatory joint diseases. The results were compared to those of the conventional immunofluorescence tests for antikeratin antibody (AKA) and antiperinuclear factor (APF) and of the rheumatoid factor (RF) tests from a previous study. There was a very good agreement between the results of the tests for APF and AFA (kappa-value 0.79 in patients with peripheral poly/oligoarthritis). The agreement between the tests for AKA and AFA was significant but less pronounced (kappa-value 0.50). The AFA test detected 10/22 of the RF-negative erosive cases, particularly those with a large number of erosive joints. Thus, the test for AFA supplements RF in the prediction of erosiveness.

Adult↗
PubMed1999

Work disability in an inception cohort of patients with seropositive rheumatoid arthritis: a 20 year study.

OBJECTIVE: Information from successive inception cohorts is needed to monitor the long-term prognosis of rheumatoid arthritis (RA) and the effect of treatment on it. We studied work disability and its association with the Health Assessment Questionnaire (HAQ) index and the Larsen score of radiographic damage. METHODS: Work disability was recorded at onset and at 1, 3, 8, 15 and 20 yr from entry among 103 patients with recent-onset (<6 months) seropositive RA. RESULTS: Work disability due to RA was already 31% [95% confidence interval (CI) 21-40] after 1 yr among patients of working age. It increased gradually and the cumulative rate reached 80% (95% CI 70-89) by the 20 yr check-up. The mean HAQ index was 0.96 at the 20 yr check-up and the mean Larsen score 45% of the maximum value. CONCLUSION: The data serve as a basis of comparison for later cohort studies.

Adolescent↗
PubMed1999

Amyloidosis in a nationwide series of 1666 subjects with rheumatoid arthritis who died during 1989 in Finland.

OBJECTIVES: Virtually all studies dealing with the occurrence of amyloidosis in subjects with rheumatoid arthritis (RA) have been based on selected series collected from university clinics. The purpose of the study was to obtain information on the true prevalence of amyloidosis and the role of amyloidosis as a cause of death. METHODS: The study included all 1666 subjects (480 men and 1186 women) who had died in 1989 and had been entitled under the national sickness insurance scheme to receive specially reimbursed medication for RA. RESULTS: Amyloidosis was regarded as an immediate cause or an intervening antecedent cause of death in 64 cases (3.8%) and as a contributory cause of death in 33 cases (2%), corresponding to a prevalence of 5.8%. Amyloidosis had been diagnosed during life in 89 instances and was detected at autopsy in eight instances. Twenty-three (4.8%) of the subjects were men and 74 (6.2%) were women (P = 0.25). Compared with the remaining subjects in the study series, the lifespan of the subjects with amyloidosis was shortened by 7.7 yr. CONCLUSIONS: The prevalence of amyloidosis was lower than apparent from most earlier studies. Monitoring information derived from the Finnish sickness insurance system is a useful way of following trends in the occurrence of amyloidosis complicating RA.

Adult↗
PubMed1998

Prediction of myocardial infarction in dyslipidemic men by elevated levels of immunoglobulin classes A, E, and G, but not M.

BACKGROUND: Immune mechanisms have been suggested to play an important role in the development of coronary atherosclerosis and its thrombotic complications. We evaluated the predictive value of the levels of various serum immunoglobulin classes in middle-aged men at increased risk of myocardial infarction. METHODS: Using nested case-control design and logistic regression analysis, we estimated the association between serum immunoglobulins and the risk of coronary end points (nonfatal or fatal myocardial infarction or sudden cardiac death) in dyslipidemic men (levels of non-high-density lipoprotein cholesterol >5.2 mmol/L [>201 mg/dL]) participating in the Helsinki Heart Study. The cases consisted of 135 subjects in whom a coronary end point occurred during the 5-year observation period of the study, and the controls were 135 subjects who did not suffer coronary end points during this period. Levels of IgA, IgE, IgG, and IgM were determined in serum samples collected at study entry. RESULTS: Levels of IgA, IgE, and IgG, but not IgM, were significantly higher in cases than in controls. After adjustment for other risk factors, such as age, smoking, and blood pressure, the risk of coronary disease showed a significant relation to the levels of IgA, IgE, and IgG. The risk in the highest quartile of each distribution as compared with the lowest quartile was 2.2-fold for IgA (95% confidence interval, 1.0-4.5), 2.8-fold for IgE (1.3-5.9), and 2.8-fold for IgG (1.3-5.9). Hypertriglyceridemia and a low level of high-density lipoprotein cholesterol were associated with increased risk of a coronary end point only if the levels of IgA, IgE, or IgG were also elevated. CONCLUSION: Elevated levels of IgA, IgE, and IgG are associated with myocardial infarction and cardiac death in men with dyslipidemia. The present data suggest that, for dyslipidemia to cause coronary atherothrombosis, an immune response reflected by elevated levels of these immunoglobulin classes is an important determinant.

Adult↗
PubMed1998

HLA B27: a prognostic factor in juvenile chronic arthritis.

This study was performed to assess the frequency of HLA B27 in patients with juvenile chronic arthritis (JCA) of varying severity and outcome by studying three patient categories: those in whom cytostatic treatment with azathioprine had been started, those with secondary amyloidosis, and those with arthroplasty of the knee or hip joints. In the first category the frequency of the HLA B27 allele was compared between those who had attained remission and those who had not. In the second and third categories the rate at which amyloidosis developed and the timing for the need of arthroplasty, were compared for HLA B27-positive and -negative patients. A control group consisted of 37 patients with uncomplicated seronegative polyarthritis. Ten of the 37 patients in the control group (27%) were HLA B27 positive as opposed to 84 out of 190 (44%) in the three study groups. Of the 101 patients treated with azathioprine, two out of 15 in remission were HLA B27 positive, whereas as many as 41 out of 86 with still active disease were HLA B27 positive (p = 0.013). Of the secondary amyloidosis patients, 29 out of 51 carried HLA B27. The HLA B27-positive patients contracted amyloidosis on average 5.9 (median 6.7) years earlier than the HLA B27-negative patients (p = 0.038). Of the arthroplasty patients, 39 out of 91 carried HLA B27. The HLA B27-positive patients underwent arthroplasty on average 2.9 (median 3.5) years earlier than the HLA B27-negative patients (p = 0.050). We conclude that HLA B27-positive cases are accumulated among the most severe cases of JCA.

Adolescent↗
PubMed1998

Epidemiology of rheumatoid arthritis in Finland.

OBJECTIVES: To review the work pertaining to rheumatoid arthritis (RA) morbidity in Finland and to compare the data with that available from other countries. METHODS: Extensive investigations in Finland of the epidemiology of RA, based on nationwide registers designed primarily for administrative purposes and on extensive population studies, frequently in combination. RESULTS: According to several surveys with somewhat different study designs, the prevalence of clinically significant RA is about 0.8% of the adult Finnish population. Five national health interviews from a 30-year period have revealed figures about 50% higher, but with no clear change in prevalence. The incidence of clinically significant RA is about 40 per 100,000 of the adult population, which is in accordance with the prevalence figures. The mean age at diagnosis increased by 7.6 years from 1975 to 1990. Between 1978 and 1980, 5.8% of the severe disability in the adult Finnish population was attributable to RA. Some evidence suggests that severe disability resulting from RA diminished during the 1980s, possibly because of joint replacement surgery. CONCLUSIONS: Monitoring sickness insurance statistics is a useful means of following the epidemiology of RA.

Adult↗
PubMed1998

High prevalence of rheumatoid factor in community-based series of patients with rheumatoid arthritis meeting the new (1987) ARA criteria: RF-negative non-erosive rheumatoid arthritis is very rare.

The aim of the study was to assess the prevalence of rheumatoid factor (RF) in a community-based rheumatoid arthritis (RA) series. The subjects of the series represented prevalent RA cases in the Kuusamo community in Northern Finland with 13,000 adult inhabitants. The patients were selected from the official Finnish data registers and from among the subjects who had consulted the local general practitioners due to rheumatic complaints in the recent years, using the American Rheumatism Association (ARA) 1987 classification criteria for inclusion. For this study, ninety-five out of the 103 RA patients so found were RF-tested by immunoturbidimetry. At the time of the study. 71 (75%) of the 95 cases were RF positive, 83 (87%) being 'ever' positive (in one case the early RF status was unclear). Our result contrasts with the much lower prevalence figures (25-60%) obtained from the earlier cross-sectional population-based RA studies, which have used the ARA 1958 definite RA as the inclusion criterion of the subjects. All the eleven patients with RF-negative RA had erosive joint disease. The RF-negative RA patients had a significantly lower frequency of HLA-DR4 (18%) than the RF-positive ones (58%), p < 0.05. We found a high frequency of RF among prevalent community-based RA cases meeting the ARA criteria. According to our results, RF-negative non-erosive RA is very rare among cases selected with the above methods.

Adult↗
PubMed1998

Increased incidence of alcohol-related deaths from accidents and violence in subjects with ankylosing spondylitis.

Subjects with ankylosing spondylitis (AS) have an increased incidence of deaths from accidents and violence, which is due in part, but perhaps not entirely, to the vulnerability of the affected spine to fractures. The present study covered all the 71 subjects (58 men and 13 women) who had died in Finland in 1989 and who were entitled under the nationwide sickness insurance scheme to receive specially reimbursed medication for AS. The death certificates of an earlier cohort study dealing with mortality in AS were also re-examined. Sixteen subjects (14 men and two women) in the 1989 mortality series had died of accidents and violence. Nine of the deaths (three accidents, two suicides and four alcohol poisonings) were alcohol related. The relative risk of such deaths in subjects with AS compared to the Finnish population as a whole was 2.64 (95% confidence interval 1.44-4.84). In the cohort study, 16 deaths had been due to accidents and violence, the expected number being 11.4. Eight of the 16 deaths had been alcohol related. Uncontrolled use of alcohol is an important determinant in the surplus of deaths from accidents and violence in Finnish patients with AS.

Accidents↗
PubMed1998

Serum androgen-anabolic hormones and the risk of rheumatoid arthritis.

OBJECTIVE: It has been hypothesised, mainly on the basis of indirect evidence, that low serum concentrations of androgen-anabolic hormones would play a causal part in the aetiology of rheumatoid arthritis (RA). METHODS: A case-control study was nested with a Finnish cohort of 19,072 adults who had neither arthritis nor a history of it at the baseline examination during 1973-1977. Pre-illness serum specimens for the assay of testosterone and dehydroepiandrosterone sulphate (DHEAS) were available from 116 cases who had developed RA by late 1989. Three controls per each incident case were individually matched for sex, age, and municipality. RESULTS: The mean testosterone concentration was 1.4 nmol/l in those 84 women who developed RA and 1.4 nmol/l in their controls; the corresponding figures for DHEAS were 5.2 mumol/l and 5.5 mumol/l, respectively. Mean testosterone concentration in the 32 male cases was 26.1 nmol/l and 26.4 nmol/l in their controls; the corresponding figures for DHEAS were 11.2 mumol/l and 10.1 mumol/l, respectively. Analysis by subgroups (rheumatoid factor positive and negative disease, pre-menopausal and postmenopausal women) and by hormone distributions showed no differences. CONCLUSION: The findings are not in line with the contention that low concentrations of testosterone and DHEAS play a part in the aetiology of RA.

Adult↗