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  1. Article ; Online: Prevention vs treatment of rheumatoid arthritis.

    Klareskog, Lars / Alfredsson, Lars

    Immunotherapy advances

    2023  Volume 3, Issue 1, Page(s) ltad016

    Abstract: Whether a yet chronic and not curable disease like rheumatoid arthritis (RA) can be subject to prevention or whether available resources should be focused on treatment is a classical dilemma. Similar to the case in most other chronic diseases, the focus ... ...

    Abstract Whether a yet chronic and not curable disease like rheumatoid arthritis (RA) can be subject to prevention or whether available resources should be focused on treatment is a classical dilemma. Similar to the case in most other chronic diseases, the focus in research as well as in clinical practice has been on the treatment of established diseases, resulting in drugs that are efficient in eliminating most joint damage but not able to cure the disease or stop needs for continuous treatment of the disease. Less effort has been spent on identifying and implementing ways to prevent the disease. We argue in this review that knowledge concerning the longitudinal evolvement of the major, 'seropositive' subset of RA has now come to a stage where prevention should be a large part of the research agenda and that we should prepare for prevention as part of clinical practice in RA. We describe briefly the knowledge basis for broad public health-based prevention as well as for a 'precision prevention' strategy. In the latter, individuals at high risk for RA will be identified, monitored, and ultimately provided with advice on how to change lifestyle/environment or be given treatment with drugs able to delay and ultimately stop the development of RA. Whether this potential of precision prevention for RA will change the broader clinical practice will depend on whether specific and long-lasting interference with disease-inducing immunity, ultimately 'tolerance therapy', will become a reality.
    Language English
    Publishing date 2023-08-29
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2732-4303
    ISSN (online) 2732-4303
    DOI 10.1093/immadv/ltad016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Association between sun exposure habits and disease progression in multiple sclerosis.

    Wu, Jing / Olsson, Tomas / Alfredsson, Lars / Hedström, Anna Karin

    European journal of neurology

    2024  Volume 31, Issue 6, Page(s) e16269

    Abstract: Background and purpose: Higher latitude has been associated with increased occurrence of multiple sclerosis (MS) and with more severe disease. The aim was to study the impact of sun exposure habits on MS disease progression and health-related quality of ...

    Abstract Background and purpose: Higher latitude has been associated with increased occurrence of multiple sclerosis (MS) and with more severe disease. The aim was to study the impact of sun exposure habits on MS disease progression and health-related quality of life.
    Methods: Patients from a population-based case-control study were categorized based on sun exposure habits at diagnosis and were followed up to 15 years post-diagnosis through the Swedish MS registry (n = 3314) with regard to changes in Expanded Disability Status Scale (EDSS). Linear mixed models were used to analyse long-term changes, while Cox regression models, with 95% confidence intervals, were used to investigate outcomes, including 24-week confirmed diasability worsening, EDSS3, EDSS4, and physical worsening as measured by the physical component of the Multiple Sclerosis Impact Scale 29.
    Results: Compared to average sun exposure (median value), low exposure to sunlight was associated with faster EDSS progression, increased risk of confirmed disability worsening (hazard ratio [HR] 1.48, 95% CI 1.21-1.81), increased risk of reaching EDSS 3 (HR 1.35, 95% CI 1.02-1.79), EDSS 4 (HR 1.47, 95% CI 1.01-2.20) and self-reported physical worsening (HR 1.27, 95% CI 1.00-1.62). Significant trends revealed a lower risk of unfavourable outcomes with increasing sun exposure.
    Conclusions: Very low levels of sun exposure are associated with worse disease progression and health-related quality of life in patients with MS.
    MeSH term(s) Humans ; Disease Progression ; Male ; Female ; Sunlight ; Adult ; Multiple Sclerosis/epidemiology ; Middle Aged ; Case-Control Studies ; Sweden/epidemiology ; Registries ; Quality of Life ; Habits ; Disability Evaluation
    Language English
    Publishing date 2024-03-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1280785-0
    ISSN 1468-1331 ; 1351-5101 ; 1471-0552
    ISSN (online) 1468-1331
    ISSN 1351-5101 ; 1471-0552
    DOI 10.1111/ene.16269
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Inverse association between Mediterranean diet and risk of multiple sclerosis.

    Alfredsson, Lars / Olsson, Tomas / Hedström, Anna Karin

    Multiple sclerosis (Houndmills, Basingstoke, England)

    2023  Volume 29, Issue 9, Page(s) 1118–1125

    Abstract: Objective: There is some evidence implicating diet in the development of inflammatory diseases. We aimed to study the influence of dietary habits on the risk of developing multiple sclerosis (MS).: Methods: We used a population-based case-control ... ...

    Abstract Objective: There is some evidence implicating diet in the development of inflammatory diseases. We aimed to study the influence of dietary habits on the risk of developing multiple sclerosis (MS).
    Methods: We used a population-based case-control study recruiting incident cases of MS (1953 cases, 3557 controls). Subjects with different dietary habits 5 years prior to MS diagnosis were compared regarding MS risk by calculating odds ratios (OR) with 95% confidence intervals (CI) using logistic regression models. Adjustment was made for a large number of environmental and lifestyle habits, including ancestry, smoking, alcohol consumption, body mass index, physical activity, and sun exposure habits.
    Results: Mediterranean diet was associated with lower risk of developing MS (adjusted OR = 0.54, 95% CI: 0.34-0.86,
    Conclusions: Mediterranean diet may exert a protective influence regarding the risk of subsequently developing MS compared with Western-style diet.
    MeSH term(s) Humans ; Multiple Sclerosis/epidemiology ; Multiple Sclerosis/etiology ; Multiple Sclerosis/prevention & control ; Diet, Mediterranean ; Risk Factors ; Case-Control Studies ; Diet ; Alcohol Drinking
    Language English
    Publishing date 2023-06-27
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1290669-4
    ISSN 1477-0970 ; 1352-4585
    ISSN (online) 1477-0970
    ISSN 1352-4585
    DOI 10.1177/13524585231181841
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Reply.

    Alfredsson, Lars / Klareskog, Lars / Hedström, Anna Karin

    Arthritis & rheumatology (Hoboken, N.J.)

    2023  Volume 76, Issue 4, Page(s) 660–661

    Language English
    Publishing date 2023-12-18
    Publishing country United States
    Document type Letter
    ZDB-ID 2756371-6
    ISSN 2326-5205 ; 2326-5191
    ISSN (online) 2326-5205
    ISSN 2326-5191
    DOI 10.1002/art.42762
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  5. Article ; Online: Influence of Smoking on Disease Activity and Quality of Life in Patients With Rheumatoid Arthritis: Results From a Swedish Case-Control Study With Longitudinal Follow-Up.

    Alfredsson, Lars / Klareskog, Lars / Hedström, Anna Karin

    Arthritis care & research

    2023  Volume 75, Issue 6, Page(s) 1269–1277

    Abstract: Objective: Inconclusive findings have been reported regarding the influence of smoking on disease outcomes in established rheumatoid arthritis (RA). This study was undertaken to investigate the influence of smoking habits on disease activity and health- ... ...

    Abstract Objective: Inconclusive findings have been reported regarding the influence of smoking on disease outcomes in established rheumatoid arthritis (RA). This study was undertaken to investigate the influence of smoking habits on disease activity and health-related quality of life (HRQoL) in RA patients.
    Methods: Patients with newly diagnosed RA (n = 1,531) from the population-based case-control Epidemiological Investigation of Rheumatoid Arthritis study were followed up for up to 3 years after recruitment. Using logistic regression models, the risks of unfavorable outcomes in patients with different smoking habits were compared using self-reported swollen and tender joint counts, the Short Form 36 health survey, the Health Assessment Questionnaire, and the Hospital Anxiety and Depression Scale by calculating odds ratios with 95% confidence intervals.
    Results: At 1-year and 3-year follow-up, current smokers reported higher disease activity and lower HRQoL life compared to non-smokers, regarding both physical and mental aspects. Patients who stopped smoking within 1-year post-baseline had less disease activity measured as swollen joint counts at 1-year follow-up compared to those who continued smoking. Patients who stopped smoking after the 1-year follow-up had higher disease activity and lower HRQoL at baseline than smokers who did not quit, and late smoking cessation was not associated with more favorable outcomes compared to continued smoking.
    Conclusion: Current smoking is associated with increased disease activity and lower HRQoL among RA patients. Smoking cessation within the first year after baseline appears to have a favorable effect on disease activity.
    MeSH term(s) Humans ; Quality of Life ; Follow-Up Studies ; Case-Control Studies ; Sweden/epidemiology ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/epidemiology ; Smoking/adverse effects ; Smoking/epidemiology
    Language English
    Publishing date 2023-01-16
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.25026
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Disease Activity and Health-Related Quality of Life Among Patients With Rheumatoid Arthritis With Different Alcohol Consumption Habits.

    Alfredsson, Lars / Klareskog, Lars / Hedström, Anna Karin

    Arthritis & rheumatology (Hoboken, N.J.)

    2023  Volume 75, Issue 6, Page(s) 872–878

    Abstract: Objective: Multiple studies have found a relationship between alcohol consumption and disease activity in rheumatoid arthritis (RA), although reverse causation has been suggested to explain the association. We aimed to study the relationship between ... ...

    Abstract Objective: Multiple studies have found a relationship between alcohol consumption and disease activity in rheumatoid arthritis (RA), although reverse causation has been suggested to explain the association. We aimed to study the relationship between alcohol consumption and disease activity, disease progression, and health-related quality of life in patients with RA.
    Methods: We followed up 1,228 patients with newly diagnosed RA from a population-based case-control study, Epidemiological Investigation of Rheumatoid Arthritis (EIRA). Drinkers and non-drinkers were compared to evaluate risk of unfavorable outcomes regarding disease activity and health-related quality of life. Odds ratios with 95% confidence intervals were calculated using logistic regression models.
    Results: Non-drinkers at baseline had higher disease activity and estimated their pain as more severe compared to drinkers. At 1 year of follow-up, non-drinkers reported higher swollen and tender joint counts and experienced more pain and fatigue, lower global health scores, and lower health-related quality of life. The inverse relationship between alcohol consumption and RA-specific outcomes was also observed when comparing drinkers and non-drinkers who had not changed their alcohol consumption habits at or after the year of disease onset. Those who stopped drinking postbaseline experienced higher disease activity, more pain, and lower health-related quality of life at 1 year of follow-up, compared to drinkers, although there was no difference in disease activity at baseline between drinkers who continued versus discontinued drinking. Our findings argue against bias due to reverse causation.
    Conclusion: Alcohol consumption was associated with lower disease activity and higher health-related quality of life in RA patients in a dose-dependent manner.
    MeSH term(s) Humans ; Quality of Life ; Alcohol Drinking/epidemiology ; Case-Control Studies ; Arthritis, Rheumatoid/epidemiology ; Arthritis, Rheumatoid/etiology ; Pain/epidemiology ; Habits
    Language English
    Publishing date 2023-04-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2756371-6
    ISSN 2326-5205 ; 2326-5191
    ISSN (online) 2326-5205
    ISSN 2326-5191
    DOI 10.1002/art.42442
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  7. Article ; Online: Reply.

    Alfredsson, Lars / Klareskog, Lars / Hedström, Anna Karin

    Arthritis & rheumatology (Hoboken, N.J.)

    2023  Volume 76, Issue 3, Page(s) 487–488

    Language English
    Publishing date 2023-10-26
    Publishing country United States
    Document type Letter
    ZDB-ID 2756371-6
    ISSN 2326-5205 ; 2326-5191
    ISSN (online) 2326-5205
    ISSN 2326-5191
    DOI 10.1002/art.42719
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  8. Article ; Online: Head trauma results in manyfold increased risk of multiple sclerosis in genetically susceptible individuals.

    Johansson, Eva / Alfredsson, Lars / Strid, Pernilla / Kockum, Ingrid / Olsson, Tomas / Hedström, Anna Karin

    Journal of neurology, neurosurgery, and psychiatry

    2024  Volume 95, Issue 6, Page(s) 554–560

    Abstract: Background: Large register-based studies have reported an association between head trauma and increased risk of multiple sclerosis (MS). We aimed to investigate possible interactions between head trauma and MS-associated HLA genes in relation to MS risk. ...

    Abstract Background: Large register-based studies have reported an association between head trauma and increased risk of multiple sclerosis (MS). We aimed to investigate possible interactions between head trauma and MS-associated HLA genes in relation to MS risk.
    Methods: We used a Swedish population-based case-control study (2807 incident cases, 5950 matched controls with HLA genotypes available for 2057 cases, 2887 controls). Subjects with and without a history of self-reported head trauma were compared regarding MS risk, by calculating ORs with 95% CIs using logistic regression models. Additive interaction between head trauma,
    Results: A history of head trauma was associated with a 30% increased risk of subsequently developing MS (OR 1.34, 95% CI 1.17 to 1.53), with a trend showing increased risk of MS with increasing number of head impacts (p=0.03). We observed synergistic effects between recent head trauma and
    Conclusions: Our findings align with previous observations of a dose-dependent association between head trauma and increased risk of MS and add a novel aspect of this association by revealing synergistic effects between recent head trauma and MS-associated HLA genes.
    MeSH term(s) Humans ; Multiple Sclerosis/genetics ; Multiple Sclerosis/epidemiology ; Female ; Male ; Case-Control Studies ; HLA-DRB1 Chains/genetics ; Genetic Predisposition to Disease/genetics ; Craniocerebral Trauma/epidemiology ; Adult ; Sweden/epidemiology ; Middle Aged ; Genotype ; Risk Factors ; HLA-A2 Antigen/genetics ; Young Adult ; Aged
    Language English
    Publishing date 2024-05-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 3087-9
    ISSN 1468-330X ; 0022-3050
    ISSN (online) 1468-330X
    ISSN 0022-3050
    DOI 10.1136/jnnp-2023-332643
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  9. Article ; Online: Insufficient sleep during adolescence and risk of multiple sclerosis: results from a Swedish case-control study.

    Åkerstedt, Torbjörn / Olsson, Tomas / Alfredsson, Lars / Hedström, Anna Karin

    Journal of neurology, neurosurgery, and psychiatry

    2023  Volume 94, Issue 5, Page(s) 331–336

    Abstract: Background: Shift work, which often results in sleep deprivation and circadian desynchrony, has been associated with increased risk of multiple sclerosis (MS). We aimed at studying the impact of sleep duration, circadian disruption and sleep quality on ... ...

    Abstract Background: Shift work, which often results in sleep deprivation and circadian desynchrony, has been associated with increased risk of multiple sclerosis (MS). We aimed at studying the impact of sleep duration, circadian disruption and sleep quality on MS risk.
    Methods: We used a Swedish population-based case-control study (2075 cases, 3164 controls). Aspects of sleep were associated with MS risk by calculating OR with 95% CIs using logistic regression models.
    Results: Compared with sleeping 7-9 hours/night during adolescence, short sleep (<7 hours/night) was associated with increased risk of developing MS (OR 1.4, 95% OR 1.1-1.7). Similarly, subjective low sleep quality during adolescence increased the risk of subsequently developing MS (OR 1.5, 95% CI 1.3 to 1.9), whereas phase shift did not significantly influence the risk. Our findings remained similar when those who worked shifts were excluded.
    Conclusions: Insufficient sleep and low sleep quality during adolescence seem to increase the risk of subsequently developing MS. Sufficient restorative sleep at young age, needed for adequate immune functioning, may be a preventive factor against MS.
    MeSH term(s) Humans ; Adolescent ; Sleep Deprivation/complications ; Sleep Deprivation/epidemiology ; Multiple Sclerosis/epidemiology ; Case-Control Studies ; Sweden/epidemiology ; Sleep
    Language English
    Publishing date 2023-01-23
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3087-9
    ISSN 1468-330X ; 0022-3050
    ISSN (online) 1468-330X
    ISSN 0022-3050
    DOI 10.1136/jnnp-2022-330123
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  10. Article ; Online: Observed associations between indicators of socioeconomic status and risk of multiple sclerosis in Sweden are explained by a few lifestyle-related factors.

    Alfredsson, Lars / Hillert, Jan / Olsson, Tomas / Hedström, Anna Karin

    European journal of neurology

    2023  Volume 30, Issue 4, Page(s) 1001–1013

    Abstract: Background and purpose: The association between socioeconomic status (SES) and the risk of multiple sclerosis (MS) is unclear. The aim was to study whether a potential association between indicators of SES and MS risk in Sweden is explained by lifestyle/ ...

    Abstract Background and purpose: The association between socioeconomic status (SES) and the risk of multiple sclerosis (MS) is unclear. The aim was to study whether a potential association between indicators of SES and MS risk in Sweden is explained by lifestyle/environmental factors.
    Methods: Using the Swedish MS registry and the Swedish patient registries, a register study was performed comprising all cases diagnosed with MS in Sweden between 1990 and 2018 (N = 24,729) and five randomly selected controls per case, matched by year and age at disease onset, sex and residential area at disease onset. Data from two matched case-control studies combined comprising data on environment/lifestyle factors (7193 cases, 9609 controls, inclusion period 2005-2018) were also utilized. For all participants, information regarding ancestry, formal education (available 1990-2018) and family income (available 1998-2018) was retrieved from the National Board of Health and Welfare.
    Results: The registry study revealed no association between education and MS risk, whereas an income exceeding the upper quartile was associated with lower MS risk compared to having an income in the lowest quartile (odds ratio 0.86, 95% confidence interval 0.82-0.90). These findings were replicated in the crude analyses of the case-control study. However, after adjustment for confounding, no association was observed between income and risk of MS.
    Conclusions: Education and income were not associated with occurrence of MS after adjustment for a few lifestyle-related factors (smoking, alcohol consumption, body mass index and sun exposure habits), indicating that SES has no influence on MS risk besides its association with these lifestyle factors in the Swedish context.
    MeSH term(s) Humans ; Multiple Sclerosis/epidemiology ; Sweden/epidemiology ; Case-Control Studies ; Social Class ; Life Style ; Registries ; Socioeconomic Factors ; Risk Factors
    Language English
    Publishing date 2023-02-08
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1280785-0
    ISSN 1468-1331 ; 1351-5101 ; 1471-0552
    ISSN (online) 1468-1331
    ISSN 1351-5101 ; 1471-0552
    DOI 10.1111/ene.15705
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