Retinal arteriolar oxygen saturation is stable in healthy individuals, while there is a significant decrease in venular oxygen saturation with age in males and a similar trend in females. AV difference increases significantly with age for both sexes. Our study provided normative data for spectrophotometric retinal oximetry in the Caucasian population.

Retinal vessel oxygen saturation measurements are repeatable with a small standard deviation. When oximetry results are compared between time points or eyes, the imaging must be standardized and similar parts of the images analyzed.

INNGANGURÍ þessari grein höfum við leitast við að taka saman nýjustu upplýs-ingar og rannsóknir um þvagsýrugigt og vonumst til að efnið nýt-ist vel í klínískri vinnu laekna á Íslandi. Gerður er greinarmunur á haekkun þvagsýru í blóði og þvagsýrugigt þótt óneitanlega séu þessir þaettir nátengdir.Þvagsýrugigt er algengasti sjúkdómurinn sem veldur liðbólg-um og hefur möguleika á laekningu. Án meðferðar getur þvag-sýrugigt valdið bráðum og langvinnum liðbólgum, eyðileggingu á liðum og langvinnum verkjavanda. Margir sjúkdómar geta tengst þvagsýrugigt og ástandið getur valdið mikilli skerðingu á lífsgaeðum.1 Faraldsfraeðilegar rannsóknir benda til þess að þvag-sýrugigt sé vanmeðhöndluð og því hefur verið kallað eftir skýrum leiðbeiningum um viðeigandi greiningaraðferðir og meðferð. 2Þvagsýrugigt er allt að fjórfalt algengari meðal karla en kvenna og fer algengi sjúkdómsins vaxandi á heimsvísu.3,4 Á Vesturlönd-um er algengi frá 0,9-2,5% í Evrópu og 4% í Bandaríkjunum, og yfir 7% hjá sjúklingum yfir 65 ára. 5,6 Nýjar rannsóknir hafa komið fram á síðustu árum um tengsl haekkaðrar þvagsýru og þvagsýrugigtar við efnaskiptavillu, hjarta-og aeðasjúkdóma og aukna dánartíðni.2 Því hefur þótt rík ástaeða til að endurskoða evrópskar og bandarískar leiðbeiningar um forvarnir og meðferð þessara þátta. MEINMYNDUN Haekkun á þvagsýru og þvagsýrugigtÞvagsýrugigt er afleiðing haekkaðrar þvagsýru í blóði sem getur leitt til mónósódíum úrat (MSÚ) kristallaútfellinga, innan og/eða utan liða. Alþjóðleg viðmiðunargildi þvagsýruhaekkunar í blóði eru >400µmol/L fyrir karla en >350µmol/L fyrir konur.7,8 Á ÍslandiÞvagsýrugigt er liðbólgusjúkdómur sem í flestum tilfellum er laeknanlegur en algengi hans á heimsvísu fer vaxandi. Án meðferðar getur sjúkdómur-inn valdið varanlegum liðskemmdum en þrátt fyrir það benda rannsóknir til að vanmeðhöndlun sjúkdómsins sé mikil. Tengsl við lífsstílssjúkdóma á borð við efnaskiptavillu eru ótvíraeð en sjúkdómurinn getur einnig verið fylgikvilli lífshaettulegra sjúkdóma og meðferðar við þeim. Nú liggja fyrir nýlegar leiðbeiningar frá Bandaríkjunum og Evrópu varðandi greiningu og meðferð þvagsýrugigtar, baeði við bráðum liðbólgum sem og langtíma-meðferð. Aukin áhersla er lögð á meðferð til að fyrirbyggja sjúkdóminn, baeði með lífsstílsbreytingum og lyfjameðferð. Mikil áhersla er lögð á að fraeða sjúklinga um sjúkdóminn og tilvist góðra meðferðarúrraeða, hvernig skal bregðast við bráðri liðbólgu og mikilvaegi þess að laekka styrk þvag-sýru í blóði. Þegar sjúklingur greinist með þvagsýrugigt aetti að skima fyrir fylgisjúkdómum. Það er mikilvaegt að setja meðferðarmarkmið þvag-sýrulaekkunar og fylgja þeim með eftirfylgd yfir langan tíma, því þannig er haegt að koma þvagsýrugigt í varanlegt sjúkdómshlé. Þvagsýrugigt -laeknanleg liðbólgaGuðrún Arna Jóhannsdóttir *1 laeknir, Ólafur Pálsson *1 laeknir, Helgi Jónsson 2,4 laeknir, Björn Guðbjörnsson 3,4 laeknir eru viðmiðunargildin fyrir karla >480µmol/L og fyrir konur >50 ára eru þau >400µmol/L (samkvaemt handbók klínískrar lífefna-fraeðideildar á Landspítala) sem ef ti...

ObjectivesTo determine in a retrospective cohort whether patients with psoriatic arthritis (PsA) who would not have fulfilled the inclusion criteria for randomised controlled trials (RCTs) for the TNF inhibitor (TNFi) chosen for their treatment (excl) have similar benefits and drug survival as those patients who would have (incl).MethodsAll patients with rheumatic disorders who are treated with biological disease-modifying antirheumatic drugs in Iceland are registered in ICEBIO. On 1 February 2016, 329 individuals with PsA were registered in ICEBIO, of whom 231 had data available for their first start of TNFi and could be evaluated according to the inclusion criteria of the respective RCTs. Disease activity was collected at baseline using Visual Analogue Scale (pain, fatigue and global (patient and physician) assessments), swollen joint count (SJC) and tender joint count (TJC), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) and Health Assessment Questionnaire (HAQ). Treatment response was measured at 6 and 18 months according to American College of Rheumatology response criteria, DAS28-CRP and Disease Activity Score in Psoriatic Arthritis for 28 joints. Drug survival rate was also analysed.ResultsThe demographics of these two groups were similar at baseline, although the incl group had higher SJC (5.5 vs 3.8) and subsequently higher DAS28-CRP (4.6 vs 4.2). While a larger change in disease activity was observed in the incl group with respect to HAQ and SJC, both groups had similar disease activity at follow-up. Drug survival was similar in both groups.ConclusionsPatients with PsA who would not have fulfilled the inclusion criteria in RCTs reach similar disease activity scores at follow-up of 6 and 18 months and have similar drug survival as those patients who would have been included in RCTs.

Background:TNFα-inhibitor (TNFi) therapy is effective in controlling several rheumatic diseases and has been shown to reduce pain in patients with arthritis. Opioids are often prescribed for chronic pain, a common issue in inflammatory joint disease.Objectives:To explore the impact of the initiation of TNFi therapy as a first-line biologic disease-modifying anti-rheumatic drug (DMARD) on the prescription rates of opioids in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and undifferentiated arthritis (UA) in Iceland.Methods:All patients receiving biologic DMARD therapy for rheumatic diseases in Iceland are registered in a nationwide database (ICEBIO). The Icelandic Directorate of Health operates a Prescription Medicines Register that includes over 90% of all drug prescriptions in Iceland. The study group included patients with RA, PsA, AS, and UA registered in ICEBIO and for each of them five randomly selected comparators from the general population matched on age, sex, and calendar time. On February 1st2016 we extracted data on all filled opioid analgesic prescriptions two years before and two years after the date of TNFi initiation.Results:Data from 359 RA, 217 AS, 251 PsA and 113 UA patients and 4700 comparators were collected. In total, 75% of patients compared to 43% of comparators received ≥1 opiate prescription during the study period. The proportion of patients using opioids (regardless of dose) two years prior to TNFi initiation was 41%, increasing to 49% the following year. After TNFi initiation the proportion returned to 40% (Figure 1). Despite this, the mean yearly opiate dose used by the patients followed a rising trajectory throughout the study period (Figure 2). In total, patients were prescribed nearly 6 times more opioids than the comparators, corresponding to a bootstrapped mean (95% CI) dose of 818 (601-1073) mg MED per patient and year compared to 139 (111-171) mg for comparators.Figure 1.Percental distributions of opioid analgesic use by dose (according to dispensed prescriptions) among patients with inflammatory arthritis (A) and matched comparators (B). All doses are oral morphine equivalent dose (MED) in milligrams.Figure 2.Bootstrapped mean oral morphine equivalent dose per person per year for patients with inflammatory arthritis (above) and age and sex matched comparators (below). Box edges represent 25-75thpercentiles and whiskers 95% confidence intervals.Conclusion:Three out of four patients with inflammatory arthritis in Iceland use opioid analgesics in the two years prior to and/or after the initiation of TNFi therapy and the mean doses were significantly higher than in matched comparators. The proportion of patients receiving opioids increased before TNFi therapy and then decreased again to the previous level. The initiation of the first-line TNFi did not reduce opioid consumption by dose at the group level. On the contrary, there was a trend towards increasing doses over time in both patients and comparators, possibly reflecting the development of opiate tolerance.Table 1.Baseline demographic data. Mean ± SD unless specified. * defined from diagnosis to baselAll patientsRheumatoid arthritisPsoriatic arthritisAnkylosing spondylitisUndifferentiated arthritisTotal n (%)940 (100)359 (38)251 (27)217 (23)113 (12)Age (years)49 ± 1453 ± 1449 ± 1343 ± 1344 ± 15Disease duration (years)*7.8 ± 8.58.2 ± 8.27.4 ± 7.88.3 ± 10.26.3 ± 6.6Female58%73%59%34%52%Disclosure of Interests:Olafur Palsson: None declared, Thorvardur Love: None declared, Johan K Wallman Consultant of: Consultant for AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma., Meliha C Kapetanovic: None declared, Petur S Gunnarsson: None declared, Björn Gudbjornsson Speakers bureau: Novartis and Amgen