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Biomedical subjects

K Aho

Publications and source records attributed to K Aho.

At least 73 records · Page 4Linked to original sources
PubMed1995

Prognostic value of quantitative measurement of rheumatoid factor in early rheumatoid arthritis.

The prognostic value of quantitative measurement of rheumatoid factor (RF) by immunoturbidimetry was evaluated in 78 patients with early rheumatoid arthritis (RA) during a 3-yr follow-up. After starting disease-modifying antirheumatic treatment, a significant improvement in conventional clinical and laboratory variables measuring disease activity was observed, while a steady increase was found in radiological progression. Initial RF levels correlated with radiologically determined joint damage up to 3 yr, whereas no correlation of other initially determined conventional variables of disease activity was found. High levels of RF at entry and persistent RF positivity during the follow-up were markers for destructive disease. Initial RF positivity alone was a sensitive predictor for later joint destruction, but quantitative measurement of the initial RF level and especially repeated measurements of RF seemed to add significantly to the prognostic value of RF in distinguishing between progressive and non-progressive disease in early RA.

Adult↗
PubMed1995

Parity and risk of rheumatoid arthritis in Finnish women.

Several recent case-control studies have suggested that nulliparity is a risk factor for rheumatoid arthritis (RA). We studied parity for its association with the incidence of RA in a cohort of adult Finnish women examined by the Mobile Clinic of the Social Insurance Institution in 1966-72. The 15,441 women were > or = 30 yr of age and had neither arthritis nor a history of it at the time of the baseline examination. They were followed up by examining records kept at the population register of the institution, to identify patients entitled to free anti-rheumatic medication. Up to late 1989, 269 women had developed RA. Of the incident cases, 176 were rheumatoid factor (RF)-positive. Compared with nulliparous women, the age-adjusted relative risks (95% confidence intervals) of parous women developing RF-positive RA, RF-negative RA or either type were 1.26 (0.82-1.92), 0.80 (0.48-1.32) and 1.06 (0.77-1.46), respectively. The number of childbirths presented an n-shaped relationship with the risk of RF-positive RA, but there were distinct differences between subpopulations. In female farmers the association was inverse, but in housewives and in other occupational groups (mainly employees) it was clearly positive. The results challenge the view that there is a causal relation between parity status and the development of RA.

Adult↗
PubMed1995

Rheumatoid factor, chronic arthritis and mortality.

OBJECTIVE: To investigate chronic arthritis and rheumatoid factor (RF) for their prediction of premature total and cardiovascular mortality. METHODS: In 1978-80, a representative population sample of 8000 Finns aged 30 or more was invited to participate in a comprehensive health examination; 90% complied. Arthritis was diagnosed on the basis of medical history, symptoms, and physical examination. Serum RF was determined by the sensitised sheep cell agglutination test. RESULTS: By the end of 1992 1597 of the subjects had died from all causes, including 876 deaths from cardiovascular diseases. When adjusted for age, gender and smoking, the relative risk of persons with RF positive arthritis dying from any cause was 1.61 (95% confidence interval (CI) 1.03 to 2.51); RF negative non-erosive arthritis was not associated with mortality (relative risk 1.03; 95% CI 0.72 to 1.49). In the absence of arthritis, 'false positive' RF titres > or = 128 predicted cardiovascular deaths with a relative risk of 1.74 (95% CI 1.06 to 2.86). CONCLUSION: Both RF positive arthritis and false positive RF reactions predict mortality, but through different disease patterns.

Adult↗
PubMed1995

Psychosocial and health status in stroke survivors after 14 years.

BACKGROUND AND PURPOSE: Most studies of long-term survival and assessment of health status in survivors of stroke are hospital based and are often based only on a relatively short follow-up. This study was aimed at evaluating survival of acute stroke after 14 years. We also assessed psychosocial and health status among the long-term stroke survivors. METHODS: This study is a follow-up of the Finnish part of the collaborative World Health Organization Stroke Study that took place during 1972 through 1974. All survivors were interviewed by telephone after being sent a structured questionnaire approximately 14 years after the initial stroke attack. Information on clinical history, socioeconomic situation, self-reported functional capacity, psychosomatic status, perceived mental status, and perceived health was collected. RESULTS: Of the 1241 persons who had been entered in the stroke register from 1972 through 1974, 241 (19.4%) were still alive after 14 years. Participation rate in the telephone interview was 83.4%. Over 80% of all stroke survivors lived at home or with relatives at the time of interview. Functional capacity was good in about two thirds of the stroke survivors. Only 10% to 15% of all respondents felt depressed. About half of both men and women aged 64 years or younger perceived their health as good, while only 25% of men aged 65 years or over did. CONCLUSIONS: Most stroke survivors did not need institutionalized care in the long term. Although a large proportion of them suffered from various somatic diseases, their functional capacity was found to be good.

Activities of Daily Living↗
PubMed1995

Mortality from cancer in patients with rheumatoid arthritis.

Data in nationwide Finnish registers were used to study the relationship between rheumatoid arthritis (RA) and site-specific cancers as a cause of death. The study included in all 1,666 subjects who had died in 1989 and who were entitled, under the nationwide sickness insurance scheme, to specially reimbursed medication because of RA. There were 277 deaths from malignancies. The proportion of such deaths in relation to all deaths declined with the duration of RA (p < 0.05). There was an excess of hematopoietic malignancies, particularly in males (p < 0.05). Deaths due to these malignancies, in relation to all cancer deaths, accumulated in long-lasting RA (p < 0.05). This suggests that hematopoietic malignancies arise as a complication of either RA or its treatment and to some degree argues against the notion of a shared etiological agent for these diseases.

Aged↗
PubMed1995

Rheumatoid factor and HLA antigens in wrist tenosynovitis and humeral epicondylitis.

A matched case-referent study was undertaken to assess whether rheumatoid factor (RF) is associated with repeating tenosynovitis or peritendinitis and whether HLA-B27 predisposes to epicondylitis. The study subjects consisted of 25 workers in manually strenuous jobs with a history of at least two episodes of tenosynovitis or peritendinitis in the wrist or forearm, or humeral epicondylitis, and their matched referents. The latex agglutination test was positive in seven of the 23 cases with tenosynovitis and in one of the referents (p = 0.03). The corresponding figures for IgM-RF by enzyme immunoassay were ten and two, respectively (p = 0.008). HLA-B27 antigen was found in five of the 13 workers with epicondylitis and in one worker with no such history (p = 0.13). It is possible that RF-positive repeating tenosynovitis represents an incomplete form of rheumatoid disease.

Case-Control Studies↗
PubMed1995

Antibodies against oxidised low-density lipoprotein in juvenile chronic arthritis.

Enhanced lipid peroxidation, reported to take place in rheumatoid joints and suggested to play a significant role in joint inflammation, led us to study the occurrence of antibodies against oxidised low-density lipoprotein (Ox-LDL Ab) in patients with juvenile chronic arthritis. Enzyme-linked immunosorbent assay was used to detect Ox-LDL Ab and antiphospholipid antibodies (aPL Ab) in sera from 84 patients and 91 controls. Elevated levels of Ox-LDL Ab were found in 14 patients (17%) as opposed to 4 controls (4%; p < 0.01). Similarly, 14 patients had an elevated aPL Ab level and a fairly good correlation between Ox-LDL Ab and aPL Ab (r = 0.52) existed in the patients. The increased frequency of elevated levels of Ox-LDL Ab may reflect lipid peroxidation occurring in rheumatoid joints but crossreactivity with aPL Ab for the induction of Ox-LDL Ab cannot be excluded.

Adolescent↗
PubMed1995

Cardiovascular mortality in women with rheumatoid arthritis.

OBJECTIVE: To investigate the relationship of deaths from cardiovascular causes in mortality of women with rheumatoid arthritis (RA). There is increasing evidence that subjects with RA have increased mortality from cardiovascular causes, but little is known of its determinants. METHODS: Our study included all women subjects in Finland who died during 1989 and who were entitled to reimbursement for medication for RA under the national health insurance plan. Demographic data on the Finnish population and health insurance statistics were used for computations. RESULTS: Half of the 1186 deaths of women were due to cardiovascular causes. The distribution of specific diagnoses within this disease group did not differ appreciably from that in the female population as a whole. However, there was a 34% excess of deaths due to cardiovascular causes. The median age at death in women with RA was 2.5 years lower than that in the whole population with deaths due to cardiovascular causes. CONCLUSION: Deaths due to cardiovascular causes constitute and important determinant in the surplus of mortality associated with RA in women.

Adolescent↗
PubMed1995

Death attributed to antirheumatic medication in a nationwide series of 1666 patients with rheumatoid arthritis who have died.

OBJECTIVE: Most drugs used in rheumatoid arthritis (RA) can have fatal side effects, but there are no good data on the frequency of such complications. Our study was designed to obtain information on deaths attributable to different antirheumatic drugs. METHODS: The role of antirheumatic medication as a cause of death was studied in 1666 subjects who died in Finland in 1989 and had been entitled under the nationwide sickness insurance scheme to receive specially reimbursed medication for RA. RESULTS: Forty-seven deaths were attributed to antirheumatic medication. Thirty deaths were attributed to the use of nonsteroidal antiinflammatory drugs (NSAID) (17 from peptic ulcer, 11 perforation or hemorrhage of the lower intestinal tract, one renal failure, and one bone marrow depression) and 11 deaths to the use of glucocorticoids (2 from perforations of the lower intestinal tract, 5 osteoporotic fractures, 3 septicemias after intraarticular injections and one adrenal insufficiency after abrupt discontinuation of treatment). There were 2 cases of fatal bone marrow depression attributed to methotrexate and 2 to sulfasalazine, one case of lymphoma induced by azathioprine and one hydroxychloroquine intoxication. In spite of widespread use of injectable gold in Finland, there were no deaths attributed to side effects of gold. CONCLUSION: The data emphasize the frequent occurrence of fatal side effects from NSAID and from glucocorticoids and the relative safety of treatment with gold.

Aged↗
PubMed1994

Antibody against oxidized low-density lipoprotein predicting myocardial infarction.

BACKGROUND: Oxidation of low-density lipoprotein is believed to be an important step in the pathogenesis of atherosclerosis. The purpose of the present study was to determine whether antibody against oxidized low-density lipoprotein, reported to be associated with the progression of carotid atherosclerosis, is predictive of cardiac death and nonfatal myocardial infarction. METHODS: Serum samples from 135 cases and their controls, drawn at entry from middle-aged dyslipidemic men participating in the Helsinki Heart Study, a 5-year coronary primary prevention trial with gemfibrozil, were tested for immunoglobulin G class antibodies against oxidized low-density lipoprotein by enzyme-linked immunosorbent assay. RESULTS: The mean antibody level, expressed in optical density units, was significantly higher in cases than in controls (0.412 vs 0.356, P = .002). After adjustment for age, smoking, blood pressure, and high-density lipoprotein cholesterol level, there was a 2.5-fold increased risk (95% confidence interval, 1.3 to 4.9) of a cardiac end point in the highest tertile of antibody level vs the lowest tertile (P = .005 for trend). CONCLUSIONS: Elevated levels of antibodies against oxidized low-density lipoprotein were predictive of myocardial infarction. The effect was independent of low-density lipoprotein cholesterol levels, and the joint effect was additive. Elevated antibody levels modified the effects of classic coronary risk factors.

Adult↗
PubMed1994

Marker antibodies of rheumatoid arthritis: diagnostic and pathogenetic implications.

Rheumatoid arthritis (RA) is associated with several autoantibodies specific enough to serve as diagnostic and prognostic markers. These include rheumatoid factor (RF), antikeratin antibody (AKA), antiperinuclear factor (APF), and anti-RA33. The first three, and possibly also anti-RA33, may precede the onset of clinical RA. The prevalence of positive test reactions depends on the period between taking the specimen and onset of disease; when the period is short, the prevalence is nearly the same as in established disease. Thus, RA has a long asymptomatic period with broadening immunological activity. The assays for AKA and APF (and possibly also for anti-RA33), compared with RF testing, yielded greater specificity rather than the ability to define any subgroup with particularly severe disease. Used together, the above marker antibodies may form a new and more enlightened basis for defining seropositive RA. It is commonly believed that genetically mediated immune response plays an important role in the initiation of RA. However, the role of the major histocompatibility complex antigens may be in modulation of the inflammatory reaction in a later phase.

Antibodies, Antinuclear↗
PubMed1994

Twin studies in rheumatic diseases.

Twin studies attract both clinicians and geneticists because of the value of the twin method in helping unravel the genetic predisposition to diseases and the role of environment in their causation. In the field of rheumatology, there are many case reports on twins concordant or discordant for diseases. Interesting as such reports may be, very few generalizations can be made from them. The concordance rate among monozygotic (MZ) twins indicates the maximum level of genetic contribution. Based on studies of systematically compiled twin series, the concordance rate is about 15% for rheumatoid arthritis; the rate is probably of the same order of magnitude for systemic lupus erythematosus (SLE). The fine specificity of antinuclear antibodies of MZ twins at least one of whom is affected by SLE is very similar, despite somatic generation of immune diversity. Up to now, twin studies have provided little information on the role of environmental factors in rheumatic diseases. A notable exception is a case-control study of MZ twins discordant for smoking that reinforced the role of smoking as a cause of lumbar intervertebral disc degeneration.

Arthritis, Rheumatoid↗
PubMed1994

Serum antioxidants and risk of rheumatoid arthritis.

OBJECTIVES: Oxygen free radicals have been implicated as mediators of tissue damage in patients with rheumatoid arthritis (RA). Thus it is possible that several micronutrients acting as antioxidants and free radical scavengers provide protection against RA. Serum alpha-tocopherol, beta-carotene, and selenium were studied for their associations with the risk of RA. METHODS: A case control study was nested within a Finnish cohort of 1419 adult men and women. During a median follow up of 20 years, 14 individuals initially free of arthritis developed RA. Two controls per each incident case were individually matched for sex, age, and municipality. Serum alpha-tocopherol, beta-carotene and selenium concentrations were measured from stored serum samples. An antioxidant index was calculated as the product of the molar concentrations of these three micronutrients. RESULTS: Elevated risks of RA were observed at low levels of alpha-tocopherol, beta-carotene and selenium, but none of the associations were statistically significant. A significant association, however, was observed with a low antioxidant index (p for trend = 0.03), the relative risk of RA between the lowest tertile and the higher tertiles of its distribution being 8.3 (95% confidence interval 1.0-71.0). CONCLUSIONS: The results of the present study are in line with the hypothesis that a low antioxidant level is a risk factor for RA.

Adult↗