OBJECTIVETo examine the association between diabetes, glycemic control, and risk of tuberculosis (TB).RESEARCH DESIGN AND METHODSWe conducted a population-based case-control study in Northern Denmark. Cases of active TB were all individuals with a first-time principal hospital diagnosis of TB between 1980 and 2008. Each case subject was matched with up to five population control subjects with similar age, sex, place and length of residence in Denmark, and country of emigration. We computed odds ratios (ORs) for a first-time TB diagnosis among people with and without diabetes using regression to control for other comorbidities, alcoholism, immunosuppressive medications, and socioeconomic markers.RESULTSWe identified 2,950 patients, including 156 diabetic individuals (5.3%), with active TB, and 14,274 population control subjects, of which 539 had diabetes (3.8%). The adjusted OR for active TB among subjects with diabetes was 1.18 (95% CI 0.96–1.45) compared with nondiabetic individuals. We found a similar risk increase from diabetes in the 843 (29%) TB case subjects who were immigrants; adjusted OR = 1.23 (95% CI 0.78–1.93). In a subset with laboratory data, diabetic individuals with an HbA1c <7.0, 7–7.9, and ≥8.0% had ORs of 0.91 (0.51–1.63), 1.05 (0.41–2.66), and 1.19 (CI 0.61–2.30), respectively, compared with individuals without diabetes.CONCLUSIONSIn the low TB–burden country of Denmark, the TB risk increase associated with diabetes is substantially lower than previously suggested. We found no evidence for any association between TB and dysglycemia.

Children with JIA had a substantially lower pain threshold even in areas usually unaffected by arthritis. Our findings suggest that JIA alters the pain perception and causes decreased pain threshold.

BackgroundPain is still a part of everyday living for several children with juvenile idiopathic arthritis (JIA) despite improvement in treatment. Psychological interventions may contribute to diminish pain complaints and improve well-being in children with JIA. Only few studies have investigated the efficacy of psychological therapy in children with arthritis and with mixed results.The aim of the study was to evaluate the feasibility and preliminary efficacy of a cognitive behavioral therapy group intervention for children with JIA and their parents.MethodsNineteen children with JIA and their parents were allocated to six sessions’ group cognitive-behavioral therapy (n = 9) or a waitlist control condition (n = 10). Results were measured from self-reported scales and one-week pain diaries. Clinical data was collected by a rheumatologist.ResultsThe participation rate was low; 33 % of the invited families participated. However, the participants rated the intervention’s credibility and satisfaction with the intervention as high. The dropout rate was low and attendance rate high. Increased quality of life and improvements in adaptive pain cognitions was reported in the intervention condition compared to the waitlist condition, whereas no differences were found for pain and functional disability. The disease activity increased in the treatment condition but not in the control condition.ConclusionsThe feasibility of this study seemed high with regards to the acceptability of the families participating in the intervention. However, the feasibility in general was challenged by implementation problems with a low participation rate. A reduction in pain after the intervention was not found even though pain management was the main target in the intervention. Preliminary analysis showed that although the severity of the disease status increased, an increase in quality of life, reduction in pain catastrophizing, and an improvement in adaptive pain cognitions (the beliefs in controlling pain and self-efficacy) were seen in the intervention condition. The study highlights the importance of considering the disease status when evaluating the efficacy of a psychological intervention in children with arthritis. Conclusions on the strength of the efficacy require further research in a large, randomized controlled trial.

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Background Only few studies have examined the efficacy of psychological treatment in children with juvenile idiopathic arthritis (JIA) (1;2). These studies found improvement in functional disability and reduced pain, but were hampered by few participants and lack of a control group. Since JIA impacts children’s psychosocial wellbeing (3;4) improvement of wellbeing should be a goal of psychological treatment as well as improvement in symptoms. Objectives To evaluate the outcome of a psychological treatment program for children with JIA on pain, functional disability, quality of life, and the psychological variables of anxiety, depression and worries about pain in children with JIA. Methods Eighteen children and their parents participated in a 6-session psychological group treatment program. Participants were randomly allocated into either a 3 month wait-list control condition or an immediately treatment condition stratified by child’s age and address, resulting in 2 treatment and 2 waitlist control groups. Results were measured by self-report scales and a 1-week pain diary completed pre- and post-treatment, and at 4- and 12 month follow-ups. Clinical data were continuously collected from the rheumatologist. Results After controlling for disease activity, no differences between the intervention group and the waitlist group were found for measures of pain and functional disability Compared to the waitlist group the intervention group reported increased quality of life and reduction on anxiety, worries, and depression. The differences did not reach statistical significance, but small to moderate effect sizes (partial η2between 0.005–0.10). Quality of life increased and anxiety and worries about pain decreased at each follow-up period. Reductions were non-significant but with small to moderate effect sizes (r between 0.12 -0.53). Conclusions When controlling for disease activity, the children’s symptoms (pain and functional disability) did not change after the treatment. But despite this the participating children experienced an increased quality of life and a reduction in anxiety, depression and worries about pain. There were no statistically significant differences, which could be due to the small sample size. However, the moderate effect sizes indicated a notable change in the variables before and after the treatment. References Walco GA, Varni JW, Ilowite NT. Cognitive-behavioral pain management in children with juvenile arthritis. Pediatrics 1992;89:1075-9. Lavigne JV, Ross CK, Berry SL, Hayford JR, Pachman LM. Evaluation of a psychological treatment package for treating pain in juvenile rheumatoid arthritis. Arthritis Care Res 1992;5(2):101. Schanberg LE, Anthony KK, Gil KM, Maurin EC. Daily pain and symptoms in children with polyarticular arthritis. Arthritis Rheum 2003 May;48(5):1390-7. Sällfors C, Hallberg LRM, Fasth A. Well-being in children with juvenile chronic arthritis. Clinical and Experimental Rheumatology 2004;22(1):125-30. Disclosure of Interest None Declared