Riina Kallikorm

Seasonal variance of 25-(OH) vitamin D in the general population of Estonia, a Northern European country

BackgroundVitamin D has a wide variety of physiological functions in the human body. There is increasing evidence that low serum levels of this vitamin have an important role in the pathogenesis of different skeletal and extra-skeletal diseases. Vitamin D deficiency and insufficiency is common at northern latitudes. There are few population-based studies in the northern European region looking at the issue in a wider age group. We aimed to measure Vitamin D level in the general population of Estonia (latitude 59°N), a North-European country where dairy products are not fortified with vitamin D.MethodsThe study subjects were a population-based random selection of 367 individuals (200 women and 167 men, mean age 48.9 ± 12.2 years, range 25–70 years) from the registers of general health care providers. 25-(OH) vitamin D (25(OH)D) level and parathyroid hormone (PTH) were measured in summer and in winter. Additionally age, sex, body mass index (BMI) and self-reported sunbathing habits were recorded.ResultsThe mean serum 25(OH)D concentration in winter was 43.7 ± 15 nmol/L and in summer 59.3 ± 18 nmol/L (p < 0.0001). In winter 73% of the subjects had 25(OH)D insufficiency (25(OH)D concentration below 50 nmol/L) and 8% had deficiency (25(OH)D below 25 nmol/L). The corresponding percentages in summer were 29% for insufficiency and less than 1% for deficiency. PTH reached a plateau at around 80 nmol/L. BMI and age were inversely associated with 25(OH)D, but lost significance when adjusted for sunbathing habits. A difference in the seasonal 25(OH)D amplitude between genders (p = 0.01) was revealed.ConclusionVitamin D insufficiency is highly prevalent throughout the year in a population without vitamin D dairy fortification living at the latitude of 59°N.

Body mass index determines sunbathing habits: implications on vitamin D levels.

Vitamin D is crucial for calcium and bone metabolism. Overweight people have been found to have lower levels of this vitamin. The aim of the paper was to test if sun exposure habits might differ according to weight and body fat per cent in a random population‐based sample, and have an impact on vitamin D levels. The analysis of 367 persons showed that, among other established factors, differences in sunbathing also explain the lower vitamin D levels in overweight and elderly individuals.

Inflammatory mediators and radiographic changes in temporomandibular joints of patients with rheumatoid arthritis

The aim of this study was to investigate the relation between the inflammatory mediators tumor necrosis factor alpha (TNF ! ) and serotonin (5-HT), the inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as rheumatoid factor (RF) and thrombocyte particle concentration (TPC) in blood versus temporomandibular joint (TMJ) radiographic changes in patients with clinical TMJ involvement by rheumatoid arthritis (RA). Twenty patients were included. Venous blood was collected for quantification of the mediators, markers, and TPC. The radiographic signs of erosion, flattening, sclerosis, subchondral pseudocyst, and osteophyte as well as radiographic grade were investigated with computed tomography. The median (IQR) plasma levels of TNF ! and 5-HT were 0 (13) r pg/mL and 13 (22) r nmol/L, respectively, while serum level of 5-HT was 1360 (874) nmol/L. ESR, CRP, and TPC were abnormally high in 53%, 25%, and 15% of the patients, respectively. The most frequent radiographic signs were sclerosis (75%), erosion (50%), and flattening (30%). Erosion was found to be associated with high TPC and flattening with high plasma level of TNF ! . In conclusion, patients with clinical TMJ involvement by RA show an association between high level of TPC and TNF ! in plasma versus radiographic signs of joint bone destruction.

Impact of temporomandibular joint pain on activities of daily living in patients with rheumatoid arthritis.

The aim of this study was to investigate the impact of temporomandibular joint (TMJ) pain on daily living in patients with rheumatoid arthritis (RA) involving the TMJ. Nineteen patients (17 F, 2 M) with a median (IQR) age of 44 (23) years were included. A scale for the influence of TMJ pain/discomfort on the activities of daily living was used. TMJ resting pain and pain upon maximum mouth opening according to a visual analog scale as well as pressure pain threshold and tenderness to digital palpation of the TMJ were assessed. Blood samples were collected to measure the level of acute phase proteins. Activities of daily living were influenced in all patients at different levels. The impact on daily living by TMJ pain/discomfort was greatest on the performance of physical exercises and jaw movements, while it was smallest on the performance of hobbies and eating. Pain during maximum mouth opening and tenderness to digital palpation were correlated to difficulties with several activities such as to yawn and open the mouth wide, while pressure pain threshold was correlated with difficulties during eating, which confirms that the pain was located in the TMJ. In conclusion, this study indicates that pain/discomfort from the TMJ in patients with RA has a significant negative impact on activities of daily living

Immediate effects of the serotonin antagonist granisetron on temporomandibular joint pain in patients with systemic inflammatory disorders.

The aim of this study was to investigate if the 5-HT3 antagonist granisetron reduces temporomandibular joint (TMJ) pain in patients with systemic inflammatory joint disorders. Sixteen patients with systemic inflammatory joint disease with pain localized over the TMJ region and tenderness to digital palpation of the TMJ were included. The current resting pain (VASRest) and the pain during maximum mouth opening (VAS(MVM)) of the TMJs were assessed with a 100 mm visual analogue scale. An electronic pressure algometer was used to estimate the pressure pain threshold (PPT) over the lateral aspect of the TMJ. Venous blood was collected for measurement of the plasma and serum levels of 5-HT, erythrocyte sedimentation rate, rheumatoid factor and C-reactive protein. The selective 5-HT3 receptor antagonist granisetron or saline were injected into the posterior part of the upper TMJ compartment in a randomized double-blind manner. The patients in the granisetron group had lower VASRest than the patients in the saline group after 10 min. In the granisetron group, VASRest was decreased after 10 min, while VAS(MVM) was decreased and PPT increased after 20 min. In the saline group, VAS(MVM) was decreased after 20 min. In conclusion, granisetron has an immediate, short-lasting and specific pain reducing effect in TMJ inflammatory arthritis. The 5-HT3 receptor may therefore be involved in the mediation of TMJ pain in systemic inflammatory joint disorders.

Progression of radiographic changes in the temporomandibular joints of patients with rheumatoid arthritis in relation to inflammatory markers and mediators in the blood

The aim of this study was to investigate longitudinal radiographic changes in the temporomandibular joint (TMJ) with clinical involvement of rheumatoid arthritis (RA) and its relation to the blood level of inflammatory mediators and markers. Sixteen patients were investigated by computed tomography on two occasions 25–46 months apart. The radiographs were assessed independently for changes in presence of erosions, sclerosis, flattening, osteophytes, and subchondral pseudocysts. The serum (S) or plasma (P) concentrations of C‐reactive protein (CRP), thrombocyte particle concentration, serotonin (S‐5‐HT and P‐5‐HT), tumor necrosis factor alpha, interleukin‐1 receptor antagonist, tumor necrosis factor soluble receptor type II, interleukin‐1 soluble receptor type II (P‐IL‐1sRII) and interleukin 6 as well as the erythrocyte sedimentation rate (ESR) were measured. The radiographic status showed no consistent or significant change during the observation period, but the individual variation was considerable. The radiographic signs of erosion and sclerosis varied most. Regression of erosions was associated with high S‐5‐HT and P‐IL‐1sRII, while progression of erosions was associated with high P‐5‐HT. Regression of sclerosis was associated with an increase in P‐5‐HT and high ESR. Progression of flattening was associated with high CRP. In conclusion, this study indicates that the progression of radiographic changes that occurs in the TMJ of patients with well‐controlled RA during a period of 25–46 months seems to be related to the blood levels of CRP, 5‐HT, and IL‐1sRII. However, only minor progression can be expected to occur, and with considerable individual variation.

Impact of molecularly defined hypolactasia, self-perceived milk intolerance and milk consumption on bone mineral density in a population sample in Northern Europe

Objective. Milk intake as a source of calcium is considered an important factor for bone mineral metabolism. Low lactase activity in adult-type hypolactasia (HL) and self-perceived lactose intolerance (LI) are the main limiting factors of milk intake. The aim of this study was to examine the relationship of HL, LI, individual milk consumption and bone mineral density in a population with high milk consumption and a prevalent vitamin D deficiency. Material and methods. A population-based study of 367 men and women aged 25–70 years was conducted in Estonia. HL was diagnosed by direct sequencing of the LCT gene, bone mineral density and body composition measured by dual energy X-ray absorptiometry (DXA). An original health questionnaire was used to collect data on milk and dairy consumption, self-perceived milk intolerance, supplement usage and fracture history. Results. Lactase genotype and phenotype had no effect on bone mineral density in this high milk consumption population with a prevalent vitamin D insufficiency. Milk consumption was a significant determinant of bone mineral density in Estonia. Self-perceived milk intolerance leads to self-imposed reductions in milk consumption, increases in bone turnover and an increased risk of fracture. Conclusions. Self-perceived milk-intolerance rather than HL influences milk consumption and has deleterious effects on bone metabolism.

Impact of a New Sarco-Osteopenia Definition on Health-related Quality of Life in a Population-Based Cohort in Northern Europe

Sarcopenia has been shown to be a marker of falling; therefore, combining osteopenia and sarcopenia could identify a frailer, higher-fracture-risk population. We aimed to define sarco-osteopenia (SOP) in a population-based healthy young sample using both muscle functional and quantitative parameters and assessing the impact of this definition on health-related quality of life. A population sample of 304 patients aged 25-70 yr was analyzed with a Lunar DPX-IQ dual-energy X-ray absorptiometry machine (GE Healthcare, Pollards Wood, UK), and their health-related quality of life was assessed with the Short-Form-36 (SF-36) questionnaire. SOP was defined as bone mineral density (BMD) -1 standard deviation (SD) and height-adjusted appendicular muscle mass -2 SD and/or grip strength -2 SD less than the mean values of 77 young individuals in the population sample (age: 25-39 yr). Our proposed SOP definition identifies 3-9% of the population older than 40 yr as sarco-osteopenic. These individuals also show markedly lower scores in the role-physical (p=0.01), vitality (p=0.03), and role-emotional (p=0.02) subscales of the SF-36 questionnaire. No difference in the quality of life was observed between osteopenic individuals and those with normal BMD. The new definition identifies a population with significant decrements in health-related quality of life.

Influence of serotonin on the analgesic effect of granisetron on temporomandibular joint arthritis

The influence of circulating serotonin (5-HT) on the effects of intra-articular administration of granisetron on temporomandibular joint (TMJ) pain was investigated in 11 patients with chronic polyarthritides. An analgesic effect superior to placebo has been shown previously. The change in TMJ movement pain intensity was negatively correlated to circulating 5-HT; that is, the higher the 5-HT before injection, the greater the reduction of pain intensity. The resting pain intensity reduction was not related to 5-HT. In conclusion, this study indicates a stronger short-term analgesic effect on TMJ movement pain by intra-articular administration of the 5-HT3 receptor antagonist granisetron in patients with high levels of circulating 5-HT.

Assistive devices, home adjustments and external help in rheumatoid arthritis

Purpose: To explain the determinants of adaptation with disease and self-management of patients with rheumatoid arthritis (RA) in Estonia, focusing on the use of assistive devices, home adjustments and the need for external help. Method: A random sample (n = 1259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, the costs of care, quality of life, use of assistive devices, home adjustments and the need for external help. Regression analysis was used to analyse the predictors of patient’s adaptation with disease and self-management. Results: Twenty-six percent of the respondents used assistive devices, 20% had made home adjustments and 37% needed external help. Disabilities and physical impairments predicted the use of assistive devices, home adjustments and the need for external help. The use of medical rehabilitation services predicted the less frequent use of assistive devices, while female gender and single status predicted a more expressed need for external help. Conclusions: Disability and physical impairment are the most important determinants of the use of various technical aids and home adjustments. These factors, along with the female gender and single status of the patient, predict help-dependence. Implications for Rehabilitation Rheumatoid arthritis (RA) is a chronic progressive disease that can lead to joint damage, resulting in chronic pain, loss of function and disability. To reduce the difficulties and to manage their everyday lives, RA patients often require personal care, home adjustments or need to use assistive devices. A study based on a representative sample of Estonian RA patients demonstrated that disability and physical impairment are the most important determinants of the use of various technical aids and home adjustments. In RA, the female gender and single status of the patient predict a more expressed need for external help.