Objective. Foot impairments are related to reduced mobility and participation restrictions in daily activities in patients with established rheumatoid arthritis (RA). The new biologic medications are effective and reduce disease activity, but not disability to the same extent. Foot impairments are assumed to be related to participation restrictions also in patients with early RA, diagnosed after the introduction of biologic medications. Knowledge of foot impairments needs to be explored further after the introduction of biologic disease-modifying antirheumatic drugs (bDMARDs). The aim of this study was to explore the patients' perspective of foot impairments related to early RA. Methods. The sample included 59 patients (ages 20-63 years) who were interviewed about participation dilemmas in daily life using the critical incident technique. The interviews were audio-recorded and transcribed. Data related to foot impairments were extracted and analyzed thematically. A research partner validated the analysis. Results. Patients with early RA described a variety of participation restrictions related to foot impairments: foot hindrances in domestic life, foot impairments influencing work, leisure activities restricted by one's feet, struggling to be mobile, and foot impairments as an early sign of rheumatic disease. Conclusion. There is a need to focus on foot impairments related to early RA, and for health care professionals to understand these signs. A suggestion for future research is to conduct a longitudinal followup of foot impairment related to medication, disease activity, and disability in patients diagnosed after the introduction of bDMARDs.

Background Pain, stiffness and deformity of the feet are related to reduced mobility and participation restrictions in daily activities in patients with established rheumatoid arthritis (RA). The new biological medications are effective and reduce disease activity, but not disability to the same extent. Foot problems are assumed to be related to participation restrictions also in patients with early RA, diagnosed after the introduction of biological medications, hindering for example physical activity. Hence, there is a need for more knowledge about foot problems in order to identify possible needs for rehabilitative interventions. Objectives To explore disability related to foot problems in women and men with early rheumatoid arthritis and its relation to participation in daily life. Methods 59 patients (58% women, 20–63 years) with early RA were interviewed about participation dilemmas in daily life related to RA, using Critical Incident Technique. The interviews were audio-recorded and transcribed. Data related to foot problems were extracted and analysed thematically. A research partner with RA validated the retrieved categories. The study was approved by the Regional Ethics Committee. Results More than 2/3 of the patients mentioned that they had participation restrictions related to foot problems. The analysis revealed 5 categories concerning foot problems and the relation to participation restrictions: 1) foot problems as an early indicator of the disease, 2) hindrance in managing the daily routine and house hold activities, 3) struggling to be mobile, 4) difficulties in doing a god job at work and 5) difficulties in participating in recreation and leisure activities. Both women and men shared many experiences, as difficulties to be physically active. Several women expressed difficulties to use the shoes they wanted. Being able to move on uneven ground in, for example, the forest was something that many men expressed as difficult. Conclusions Patients with early RA with access to effective medications and multi professional interventions based on their individual needs still experience a wide range of foot related disability in major life arenas as work, in the household and during leisure time. This indicates a need to pay attention also in today9s early RA patients to foot problems in the multi professional rehabilitation to prevent further disabilities and enable physical activity for men and women with RA. Disclosure of Interest None declared

Purpose This research analysed general pain intensity, hand pain at rest and hand pain during activity in women and men in early rheumatoid arhtritis (RA). Method Out of the 454 patients that were recruited into the Swedish early RA project TIRA the 373 patients (67% women) that remained at 12 months follow-up are reported here. Disease activity 28 joint score (DAS-28), disability (Health Assessment Questionnaire=HAQ) and pain (VAS) were recorded at inclusion and after 3 (M3), 6 (M6) and 12 (M12) months. General pain, hand pain during rest, hand pain during test of grip force as assessed by Grippit, prescribed disease-modifying anti-inflammatory drugs (DMARDs) and hand dominance were recorded. Results DAS-28 and HAQ scores were high at inclusion and improved thereafter in both women and men. There were no significant differences between sexes at inclusion but women had higher DAS-28 and HAQ at all follow-ups. Women were more often prescribed DMARDs than were men. In both women and men all pain types were significantly lower at follow-up compared to at inclusion and women reported higher pain than men at follow-ups. The pain types differed significantly from each other at inclusion into TIRA, general pain was highest and hand pain during rest was lowest. There were no significant differences in hand pain related to hand dominance or between right and left hands. Conclusions Disease activity, disability and pain were high at inclusion and reduced over the first year. Despite more DMARDs prescribed in women than in men, women were more affected than were men. General pain was highest and not surprisingly hand pain during active grip testing was higher than hand pain during rest that was lowest in both sexes. Although our cohort was well controlled, it was evident that hand pain remains a problem. This has implications for rehabilitation and suggests potential ongoing activity limitations that should continue to receive attention from a multi-professional team.Implications for RehabilitationGeneral pain and hand pain remain a problem in RA despite today's early intervention and effective disease control with new era biologics.The extent of hand pain evidenced in our work gives a more detailed and comprehensive account of pain status.Higher hand pain during active grip testing than that during rest indicates a potential relationship to ongoing activity limitation.Hand pain assessment can help guiding multi-professional interventions directed to reduce hand pain and thereby probably reduce activity limitations.

Background Disability is an important outcome in rheumatoid arthritis (RA). The Valued Life Activity scale (VLA) comprises a wide range of life activities deemed to be important by the individual, ranging from self-care to leisure activities. Thereby VLA takes the patients´ priorities into account and includes activities in which disability may occur early. Objectives Translation, cultural adaptation including linkage to the International Classification of Functioning, Disability and Health (ICF) and psychometric testing of the VLA scale in Swedish patients with RA. Methods The VLA, developed by Katz et al (1) was translated and culturally adapted to a Swedish version, the VLA-swe. As a part of this, both the VLA and VLA-swe were linked to the ICF according to linking rules (2). 737 RA patients(73% women)aged 18 - 80 (mean age 62 years) were recruited from the Swedish Rheumatology Quality Registry (SRQ). The average disease duration was 16 years. Data for disease activity (DAS28), activity limitations (HAQ) and life satisfaction (LiSat11) were registered and patients completed the VLA-swe. Internal consistency was assessed with Cronbach’s alpha and item statistics. To establish construct validity VLA-swe was correlated to DAS28, HAQ and LiSat11. Results The conceptual similarity between the VLA-swe and the original VLA was high when linked to the ICF: in 29 of the 33 items the ICF codes tallied exactly with each other and the remaining differed only slightly. Each of the 9 ICF activity/participation domains was represented in one or more items. The internal consistency was excellent for the VLA-swe (0.97) and alpha coefficients did not improve after omitting any of the 33 items. The correlations between the single items and the total VLA-swe score varied between r=0.57 and r=0.84. Scores of the VLA-swe correlated strongly with the HAQ (r=0.87), moderately with the LiSat11 (r=-0.61) and weakly with the DAS28 (r=0.38), as expected. Conclusions The VLA-swe is culturally adapted and validated, and addresses a broad range of ICF activity/participation domains. Since both the patients´ preferences and ICF concepts of disability are taken into account, it is a useful complement to traditional measures, such as the HAQ, which measure activity limitations only. References Katz P, Morris A, Yelin E. Prevalence and predictors of disability in valued life activities among individuals with rheumatoid arthritis. Ann Rheum Dis 2006;65:763e9. Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B, Stucki G. ICF linking rules: an update based on lessons learned. J Rehabil Med 2005;37:212-218. Disclosure of Interest None Declared

Psychological distress is a well-known complication in rheumatoid arthritis (RA), but knowledge regarding emotions and their relationship to participation restrictions is scarce. The objective of the study was to explore emotions related to participation restrictions by patients with early RA. In this study, 48 patients with early RA, aged 20–63 years, were interviewed about participation restrictions using the critical incident technique. Information from transcribed interviews was converted into dilemmas and linked to International Classification of Functioning, Disability, and Health (ICF) participation codes. The emotions described were condensed and categorized. Hopelessness and sadness were described when trying to perform daily activities such as getting up in the mornings and getting dressed, or not being able to perform duties at work. Sadness was experienced in relation to not being able to continue leisure activities or care for children. Examples of fear descriptions were found in relation to deteriorating health and fumble fear, which made the individual withdraw from activities as a result of mistrusting the body. Anger and irritation were described in relation to domestic and employed work but also in social relations where the individual felt unable to continue valued activities. Shame or embarrassment was described when participation restrictions became visible in public. Feelings of grief, aggressiveness, fear, and shame are emotions closely related to participation restrictions in everyday life in early RA. Emotions related to disability need to be addressed both in clinical settings in order to optimize rehabilitative multi-professional interventions and in research to achieve further knowledge.

Background Pain in Rheumatoid arthritis (RA) is more prevalent in women than men. Hand involvement in RA is associated with hand pain, low grip force and reduced grip ability. Hand pain related to hand activity and possible differences between sexes have not yet been reported in early RA. Objectives To analyze hand pain during activity, hand pain at rest and general pain during the first year of RA for women and men. Methods 454 patients were recruited into the Swedish early RA project “TIRA” during 2006-2009. The 373 patients (67 % women) that remained at 12 months follow up are reported here. Data for disease activity (DAS-28), general pain (VAS), hand pain during rest (VAS) and hand pain during activity (VAS) was registered at inclusion and at the follow-ups after 3 (M3), 6 (M6), and 12 (M12) months respectively. Hand pain during activity was related to test of grip force as measured by Grippitä. Prescribed disease-modifying anti-inflammatory drugs (DMARDs) and hand dominance was registered. Differences in mean values were analysed using ANOVA and differences in medication were analysed using chi-square tests. Results Women had slightly higher proportions of DMARDs than men throughout the study (84% to 93 % vs 75% to 92%) although the differences were significant only at M3 (p=.022; 85% vs 75%). Disease activity was high at inclusion (mean=5.12) and decreased significantly (p<.001) at M3 and M6, but not between M6 and M12. Women had higher DAS than men at all follow-ups but the difference were not significant. 86% reported right-hand dominance. Women reported higher overall pain than men (p=.007) and overall pain was higher at inclusion than at the follow-ups (p<.001). The paintypes were significantly different (p<.001), general pain was highest and hand pain at rest was lowest. A significant interaction between pain-type and follow-up (p<.001) showed that the three paintypes differed at each follow-up but for general pain and hand pain during activity at M3. There were no significant differences in hand pain between dominant and nondominant hand or between right and left hand. Conclusions Women had higher DAS and pain than men despite somewhat more women than men prescribed DMARD:s. Hand pain in activity was higher than pain during rest, strongly indicating that hand pain is closely related to performing hand activities in general in early RA. Disclosure of Interest None Declared

BACKGROUND:In patients in whom the height of the alveolar process is adequate but the crest is too narrow to host an implant, lateral augmentation is required. Such augmentations have mostly been performed using autogenous bone blocks secured to the buccal surface. An alternative to autogenous bone may be bovine hydroxyapatite (Bio-Oss, Geistlich Pharma AG, Wolhusen, Switzerland) or other bone substitutes.PURPOSE:The aim of this study was to evaluate the clinical and radiographic outcome of dental implants inserted after lateral augmentation of too narrow alveolar processes with a combination of bovine hydroxyapatite (Bio-Oss) and autogenous bone.METHODS:Thirty patients (14 males and 16 females) with a mean age of 41.6 years fulfilled the inclusion criteria. Twenty-nine augmentation sites with a total of 74 implants could be followed for 3 years.RESULTS:Three implants were lost; these were lost before loading (at the abutment operation). The survival rate was 95.9%. The mean marginal bone loss during the 3-year observation period was 0.3 +/- 0.2 mm.CONCLUSIONS:A 50/50 combination of Bio-Oss and autogenous bone chips stabilized with Tisseel (Baxter AG/Duo Quick AG, Vienna, Austria) was useful for lateral augmentation of the alveolar crest. Lateral grafts with Bio-Oss, autogenous bone, and Tisseel made it possible to achieve good implant stability and high implant survival results. The bone level changes adjacent to the implants were the same as in nongrafted cases.

Kanslor relaterade till delaktighet begransningar – erfarenheter fran patienter med reumatoid artrit,en kvalitativ intervjustudie

Kanslor relaterade till delaktighets begransningar vid reumatoid artrit. : En kvalitativ intervjustudie.