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Sundbaum, Johanna
Publications (7 of 7) Show all publications
Sundbaum, J., Eriksson, N., Hallberg, P., Lehto, N., Wadelius, M. & Baecklund, E. (2019). Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long‐term follow‐up of predictors, surveillance, and outcome in clinical practice. International Journal of Rheumatic Diseases, 22(7), 1226-1232
Open this publication in new window or tab >>Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long‐term follow‐up of predictors, surveillance, and outcome in clinical practice
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2019 (English)In: International Journal of Rheumatic Diseases, E-ISSN 1756-185X, Vol. 22, no 7, p. 1226-1232Article in journal (Refereed) Published
Abstract [en]

Aim

To assess predictors of alanine aminotransferase (ALT) elevation in methotrexate (MTX) treated rheumatoid arthritis (RA) patients, and to describe the monitoring of liver enzymes, including handling and outcome of elevated ALT.

Methods

All RA patients starting MTX in January, 2005 to April, 2013 at a rheumatology clinic, (Uppsala University Hospital, Sweden) were identified from electronic medical records. Clinical and laboratory data were obtained from medical records, supplemented by telephone interviews. Predictors for ALT >1.5× over the upper limit of normal (ULN) were identified by multiple regression analysis.

Results

The study comprised 213 RA patients starting MTX. During a mean follow‐up of 4.3 years, 6288 ALT tests were performed; 7% of tests with ALT were >ULN. ALT >1.5× ULN was observed in 44 (21%) patients and the strongest predictor was a pre‐treatment elevation of ALT (adjusted odds ratio = 6.8, 95% CI 2.2‐20.5). Recurrent elevations occurred in 70% of patients who continued treatment, and the proportion was similar in those with and without interventions, for example MTX dose reduction (67% vs 73%, P = 0.43). Seven patients (3%) permanently stopped MTX due to ALT elevation, and two were eventually diagnosed with non‐alcoholic fatty liver disease. No patient developed hepatic failure.

Conclusion

Only a small number of ALT tests performed during MTX therapy in RA capture an elevation. A pre‐treatment elevation of ALT was the strongest predictor for early and recurrent ALT elevations during therapy. This study supports a more individualized approach to monitoring and handling of ALT elevations during MTX therapy in RA than recommended in current guidelines.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
liver toxicity, liver transaminases, methotrexate, non‐alcoholic fatty liver disease, rheumatoid arthritis
National Category
Other Health Sciences Other Physics Topics
Research subject
Health Science; Applied Physics
Identifiers
urn:nbn:se:ltu:diva-73727 (URN)10.1111/1756-185X.13576 (DOI)000476560400008 ()31012257 (PubMedID)
Note

Validerad;2019;Nivå 2;2019-08-19 (johcin)

Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-08-19Bibliographically approved
Söderberg, A., Sundbaum, J. & Engström, Å. (2017). Nursing students' reflections after meetings with patients and their relatives enacted by professional actors: Being touched and feeling emphaty. Issues in Mental Health Nursing, 38(2), 139-144
Open this publication in new window or tab >>Nursing students' reflections after meetings with patients and their relatives enacted by professional actors: Being touched and feeling emphaty
2017 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 38, no 2, p. 139-144Article in journal (Refereed) Published
Abstract [en]

When professional actors have been used in mental health simulations with nursing students, the experiencehas been regarded as a meaningful contribution to their education and described as a safe way ofexperiencing challenging situations that can occur in clinical settings. The aim was to study nursing students’reflections aftermeetings with nursing patients and their relatives, as enacted by professional actors,in psychiatric/elderly care. The design was a qualitative descriptive research approach. Gibbs’s (1988) reflectivecycle was the basis for the questions thatwere asked.Written reflections with 60 nursing studentswereanalysed using qualitative thematic content analysis. The analysis produced the theme “being touched andfeeling empathy,”with four categories: “becoming aware of what knowledge and skills are needed,” “wantingto dowell and to have the right answer,”“daring to get close and being present,”and “knowledge comesalive.” Simulation with real people who act as patients or relatives in vulnerable situations creates feelingsof empathy. To talk with them, experience eye contact, and see how they react on touch makes nursingstudents feel they have experienced closeness and their knowledge has become alive

Place, publisher, year, edition, pages
Taylor & Francis, 2017
National Category
Other Health Sciences Nursing
Research subject
Health Science; Nursing
Identifiers
urn:nbn:se:ltu:diva-59953 (URN)10.1080/01612840.2016.1251517 (DOI)000395131000006 ()28215111 (PubMedID)2-s2.0-85013301827 (Scopus ID)
Note

Validerad; 2017; Nivå 2; 2017-02-21 (andbra)

Available from: 2016-10-26 Created: 2016-10-26 Last updated: 2018-11-15Bibliographically approved
Söderberg, A., Sundbaum, J. & Engström, Å. (2016). Nursing students' perceptions of learning through complex meetings with standard psychatric patients (ed.). Paper presented at Annual Scientific Conference of the European Association for Psychosomatic Medicine : 16/06/2016 - 18/06/2016. Paper presented at Annual Scientific Conference of the European Association for Psychosomatic Medicine : 16/06/2016 - 18/06/2016.
Open this publication in new window or tab >>Nursing students' perceptions of learning through complex meetings with standard psychatric patients
2016 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Other Health Sciences Nursing
Research subject
Health Science; Nursing
Identifiers
urn:nbn:se:ltu:diva-31725 (URN)5fb830be-9683-44a8-b79c-36249458d730 (Local ID)5fb830be-9683-44a8-b79c-36249458d730 (Archive number)5fb830be-9683-44a8-b79c-36249458d730 (OAI)
Conference
Annual Scientific Conference of the European Association for Psychosomatic Medicine : 16/06/2016 - 18/06/2016
Note
Godkänd; 2016; 20160620 (andbra)Available from: 2016-09-30 Created: 2016-09-30 Last updated: 2017-11-25Bibliographically approved
Sundbaum, J., Back, J., Lehto, N., Vikman, I. & Baecklund, E. (2014). Kontrollprovtagning vid metotrexatebehandling av RA patienter: Erfarenheter från en reumatologklinik (ed.). Paper presented at Reumadagarna i Örebro : 01/04/2014 - 04/04/2014. Paper presented at Reumadagarna i Örebro : 01/04/2014 - 04/04/2014.
Open this publication in new window or tab >>Kontrollprovtagning vid metotrexatebehandling av RA patienter: Erfarenheter från en reumatologklinik
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2014 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Other Health Sciences Physiotherapy
Research subject
Health Science; Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-30806 (URN)4c2491f1-7683-4e6e-ac48-a84fbc19f6ae (Local ID)4c2491f1-7683-4e6e-ac48-a84fbc19f6ae (Archive number)4c2491f1-7683-4e6e-ac48-a84fbc19f6ae (OAI)
Conference
Reumadagarna i Örebro : 01/04/2014 - 04/04/2014
Note
Godkänd; 2014; 20140415 (nikle)Available from: 2016-09-30 Created: 2016-09-30 Last updated: 2018-04-24Bibliographically approved
Sundbaum, J., Berglund, V., Back, J., Lehto, N., Vikman, I., Rollman, O. & Baecklund, E. (2014). Methotrexate in rheumatoid arthritis and psoriasis/psoriatic arthritis: a comparative study of hepatotoxicity (ed.). Paper presented at . Scandinavian Journal of Rheumatology, 43, 29
Open this publication in new window or tab >>Methotrexate in rheumatoid arthritis and psoriasis/psoriatic arthritis: a comparative study of hepatotoxicity
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2014 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 43, p. 29-Article in journal, Meeting abstract (Refereed) Published
National Category
Other Health Sciences Physiotherapy
Research subject
Health Science; Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-27293 (URN)0b3b91af-d0b9-4287-a549-6d7ba6f6db77 (Local ID)0b3b91af-d0b9-4287-a549-6d7ba6f6db77 (Archive number)0b3b91af-d0b9-4287-a549-6d7ba6f6db77 (OAI)
Note
Godkänd; 2014; 20141016 (johsod)Available from: 2016-09-30 Created: 2016-09-30 Last updated: 2018-04-24Bibliographically approved
Sundbaum, J. (2012). Hepatitis B: is the risk increased in patients with rheumatois arthritis? (ed.). Paper presented at Annual European Congress of Rheumatology : 06/06/2012 - 09/06/2012. Paper presented at Annual European Congress of Rheumatology : 06/06/2012 - 09/06/2012.
Open this publication in new window or tab >>Hepatitis B: is the risk increased in patients with rheumatois arthritis?
2012 (English)Conference paper, Oral presentation only (Refereed)
National Category
Other Health Sciences
Research subject
Health Science
Identifiers
urn:nbn:se:ltu:diva-38977 (URN)d8b97427-7aca-490f-ae69-8e92f710f935 (Local ID)d8b97427-7aca-490f-ae69-8e92f710f935 (Archive number)d8b97427-7aca-490f-ae69-8e92f710f935 (OAI)
Conference
Annual European Congress of Rheumatology : 06/06/2012 - 09/06/2012
Note
Godkänd; 2012; 20131206 (andbra)Available from: 2016-10-03 Created: 2016-10-03 Last updated: 2017-11-25Bibliographically approved
Sundbaum, J., Arkema, E., Feltelius, N., Baecklund, E. & Askling, J. (2011). Hepatit B infektion hos patienter behandlade med biologiska läkemedel för reumatisk sjukdom: svenska fall 1999-2011 (ed.). Paper presented at Medicinska riksstämman : 30/11/2011 - 02/12/2011. Paper presented at Medicinska riksstämman : 30/11/2011 - 02/12/2011.
Open this publication in new window or tab >>Hepatit B infektion hos patienter behandlade med biologiska läkemedel för reumatisk sjukdom: svenska fall 1999-2011
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2011 (Swedish)Conference paper, Oral presentation only (Refereed)
National Category
Other Health Sciences
Research subject
Health Science
Identifiers
urn:nbn:se:ltu:diva-31814 (URN)61c06a96-558a-448c-9ccb-dca0b128d48e (Local ID)61c06a96-558a-448c-9ccb-dca0b128d48e (Archive number)61c06a96-558a-448c-9ccb-dca0b128d48e (OAI)
Conference
Medicinska riksstämman : 30/11/2011 - 02/12/2011
Note
Godkänd; 2011; 20131206 (andbra)Available from: 2016-09-30 Created: 2016-09-30 Last updated: 2017-11-25Bibliographically approved
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