Socioeconomic factors and physical activity in relation to cardiovascular disease and death. A 12 year follow up of participants in a population study of women in Gothenburg, Sweden.

In a prospective population study of middle aged women socioeconomic factors and physical activity as initially reported were related to the 12 year incidence of ischaemic heart disease and to total mortality. There was a significant age specific correlation between low socioeconomic status according to the husband's occupation and myocardial infarction. No such association was seen between the socioeconomic status of the women themselves and myocardial infarction. Women with a low educational level had a significantly increased age specific incidence of angina pectoris. There was no significant correlation between marital status or number of children and incidence of ischaemic heart disease or overall mortality. Women who initially reported low physical activity at work during the last year had a significantly increased age specific 12 year incidence of stroke and death, as did those who reported low physical activity during leisure hours in whom the incidence of myocardial infarction and electrocardiographic changes indicating ischaemic heart disease were also increased. Multivariate analyses showed that the association between low educational level and incidence of angina pectoris was independent of socioeconomic group, smoking habits, systolic blood pressure, indices of obesity, serum triglycerides, and serum cholesterol. Similarly, low physical activity during leisure hours seemed to be an independent risk factor for stroke, and low physical activity at work was an independent risk factor for overall mortality.     

Adipose tissue distribution and female carcinomas. A 12-year follow-up of participants in the population study of women in Gothenburg, Sweden

A longitudinal population study of 1462 women, aged 38-60 years, was carried out in Gothenburg, Sweden, in 1968-69. In univariate analysis anthropometric variables indicating centrally localized adipose tissue (waist circumference, the ratio of waist to hip circumference and the subscapular skinfold) showed significant age-standardized positive associations with the occurrence (prevalence + incidence data) of endometrial carcinoma. Incidence data suggested that measurements of centrally localized adipose tissue might be of predictive value for this malignancy as well as for ovarian carcinoma. In contrast, measurements of generalized obesity (body weight or body mass index) or peripherally localized adipose tissue (triceps skinfold) showed no associations to these malignancies. No relationship was observed between the anthropometric variables studied and breast carcinoma. The association observed between endometrial and ovarian carcinomas with central adipose tissue did, however, not remain in multivariate analysis when generalized obesity was taken into account. Centrally localized adipose tissue is known to be associated with endocrine abberations including irregular ovulation and menstruation, re-emphasizing the importance of endocrine factors for the pathogenesis of endometrial and ovarian carcinomas. No positive association was found between development of the carcinomas and initial measurements of blood glucose, serum lipids or blood pressure, found to be elevated in cross-sectional studies. An increase in these variables therefore probably are parallel phenomena rather than predictors. The women with endometrial or breast carcinomas smoked more than the remaining women. Although the number of end-points observed was limited these results suggest that measurements of adipose tissue distribution might be a valuable addition to the predictors of endometrial and ovarian carcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)     

A 12 year follow up study in the general population on prognostic factors of cartilage loss in osteoarthritis of the knee.

The natural history and prognostic factors of cartilage loss in osteoarthritis of the knee were studied in subjects from a general population survey on rheumatic diseases in 1975-8. Baseline data were collected by questionnaire, physical examination, and weightbearing anteroposterior knee radiographs. Follow up of the subjects aged 46-68 years with radiological osteoarthritis grade 2-4 (Kellgren) took place in 1988-9. Cartilage loss was assessed by two observers who scored the change in joint space width between two radiographs. Thirty four per cent had cartilage loss. Prognostic factors and adjusted odds ratios (ORs) (95% confidence intervals) were: body mass index OR = 11.1 (3.3 to 37.3) fourth v first quartile; body weight OR = 7.9 (2.6 to 24.0) third v first tertile; age OR = 3.8 (1.1 to 13.4) > 60 v < or = 49 years; Heberden's nodes OR = 6.0 (1.5 to 23.1); clinical diagnosis of generalised osteoarthritis OR = 3.3 (1.3 to 8.3); and previous bow legs or knock knees OR = 5.1 (1.1 to 23.1). The relation of age with cartilage loss was also confounded by the presence of Heberden's nodes or a diagnosis of generalised osteoarthritis. There was no statistically significant relation for gender, meniscectomy, injury, uric acid concentration, chondrocalcinosis, smoking, and occupation related factors, except possibly standing.     

Prognosis for women with different symptoms and signs suggesting ischaemic heart disease--a 12-year follow-up. The population study of women in Gothenburg, Sweden

A longitudinal population study of a total of 1462 women aged 38-60 was carried out in 1968-69 in Gothenburg, Sweden. The women have been re-studied in 1974-75 and 1980-81. The incidences of myocardial infarction during the following 12-year period were: three of 29 women with a history of angina pectoris (10%), four of 23 women with initial ECG changes at rest (17%) and one of 30 with ECG changes during work (3%). In addition, all women of similar age in Gothenburg with myocardial infarction during the years 1968-70 have been followed-up with respect to mortality, and in all there were 47 women who were alive on arrival at hospital. The figures for the 12-year overall mortality in the population study were: three women with angina pectoris (10%), four women with ECG changes at rest (17%) and three women with ECG changes during work (10%) and in the series of women with myocardial infarction 21 of 47 (45%). It seemed that the mortality among women with a history of angina pectoris or ECG changes at rest or during exercise indicating ischaemic heart disease was only slightly increased, if at all, compared to other women in the population, while having had a myocardial infarction significantly increased the mortality risk.     

Adiposity and adipose tissue distribution in relation to incidence of diabetes in women: results from a prospective population study in Gothenburg, Sweden

The results refer to a 12-year longitudinal population study of women in Gothenburg, Sweden. Correlations were studied between initial adipose tissue amount and adipose tissue distribution on the one hand and incidence of diabetes and change in serum blood glucose concentration on the other. Body mass index, sum of two skinfolds and waist-to-hip circumference ratio were significantly associated with incidence of diabetes. The waist-to-hip ratio was also positively associated with an increase of serum glucose concentration in the fasting state during the followup period. The significant correlations remained in multivariate analysis and were independent of age, initial smoking habits, systolic blood pressure, intake of antihypertensive drugs and serum cholesterol, triglyceride and glucose concentrations. The correlations between the separate anthropometric variables and incidence of diabetes remained when the other anthropometric variables were considered as background factors. The distribution of fat to the abdominal region as well as the total amount of fat per se seem to be important risk factors for diabetes and the effect of one of these factors seems to add to the other.     

Diabetes incidence in users and non-users of antihypertensive drugs in relation to serum insulin, glucose tolerance and degree of adiposity: a 12-year prospective population study of women in Gothenburg, Sweden.

As part of a prospective population study in Gothenburg, Sweden, women aged 50 years were subjected to an intravenous glucose tolerance test on entry to the study and followed up for 12 years. Manifest diabetes was the only end-point registered in this part of the study. Of 352 initially non-diabetic women, 17 (4.8%) subjects developed diabetes, with a fourfold increased risk in women taking antihypertensive drugs (diuretics or beta-blockers, or both) compared with women who were not taking such medication. The increased risk was observed independently of initially measured glucose metabolism variables and degree of adiposity, although the incidences were higher overall if the use of antihypertensive drugs was combined with fasting hyperinsulinaemia and adiposity. This study provides further evidence to support the view that diuretics and beta-blockers are precipitators of type 2 diabetes mellitus.     

Lewis phenotypes, leisure time physical activity, and risk of ischaemic heart disease: an 11 year follow up in the Copenhagen male study

OBJECTIVE—To test the hypothesis that the predictive value for risk of fatal ischaemic heart disease associated with Lewis phenotypes depends on the level of leisure time physical activity.
DESIGN—Prospective study controlling for alcohol, tobacco, serum cotinine, blood pressure, body mass index, serum lipids, work related physical activity, and social class.
SETTING—The Copenhagen male study, Denmark.
SUBJECTS—2826 white men aged 53-75 years without overt cardiovascular disease; 266 (9.4%) had the Le(a−b−) phenotype.
MAIN OUTCOME MEASURE—Incidence of death from ischaemic heart disease during 11 years.
RESULTS—107 men died of ischaemic heart disease. Among men with a low level of leisure time physical activity (⩽ 4 hours/week moderate or ⩽ 2 hours/week more vigorous activity), being Le(a−b−) was associated with an increased risk of having a fatal ischaemic heart disease event compared with men with other Lewis phenotypes (relative risk (RR) 2.7, 95% confidence interval (CI) 1.4 to 5.2; p < 0.01). Among men with a high level of leisure time physical activity, the RR associated with being Le(a−b−) was 1.3 (95% CI 0.5 to 3.1; NS). Compared with all other alternatives tested, being Le(a−b−) and having a low level of leisure time physical activity was associated with an RR of 3.2 (95% CI 1.7 to 5.8; p < 0.001). As a point estimate and adjusted for confounding variables, among men with low leisure time physical activity the attributable risk associated with Le(a−b−) was 12%—that is, assuming that all sedentary men had phenotypes other than Le(a−b−), 12% of all fatal ischaemic heart disease events would not have occurred. The corresponding point estimate among those more active was 2%.
CONCLUSIONS—The excess risk of fatal ischaemic heart disease in middle aged and elderly men with the Le(a−b−) phenotype is strongly modified by leisure time physical activity. Public health and clinical implications may be important in populations with a predominantly sedentary lifestyle and in a high proportion of men with the Le(a−b−) phenotype.


     

Mortality in participants and non-participants of a multifactorial prevention study of cardiovascular diseases: a 28 year follow up of the Helsinki Businessmen Study.

OBJECTIVE--To investigate pretrial risk factors and long term mortality (1964-1992) in participants and non-participants of a multifactorial primary prevention trial. DESIGN--A prospective study among 3313 initially healthy businessmen. During the 1960s (1964 onwards), 3490 healthy male business executives born between 1919 and 1934 participated in voluntary health checks at the Institute of Occupational Health in Helsinki. From that period cardiovascular disease (CVD) risk factors were available in 3313 men. In the beginning of the 1970s these men were invited to join a multifactorial primary prevention trial of CVD. Six groups were formed: (I) healthy participants in a high risk intervention group (n = 612), and (II) their randomised control group (n = 610); (III) a non-participant low risk group (n = 593); (IV) an excluded group with signs of CVD (n = 563); (V) a refused group (n = 867); and (VI) dead (n = 68). Groups I and II participated in the five year prevention trial which started in 1974. Other groups were followed up through registers, with no personal contact. MEASUREMENTS--Cardiovascular risk factors during the 1960s. Mortality follow up using national registers up to 31 December, 1992. MAIN RESULTS--Baseline risk factors were lowest in the low risk group, highest in the excluded group, intermediate and comparable in other groups. Eighteen-year (1974-1992) mortality (per 1000) was 79.3, 106.6, 155.2, 179.9, and 259.3 in the low risk, control, intervention, refused, and excluded groups, respectively (P < 0.001). In the whole population of 3313 men, the 28-year (1964-1992) total (n = 577) and coronary deaths (n = 199) were significantly predicted by smoking, blood pressure, and cholesterol; cancer deaths (n = 163) by smoking only; and violent deaths (n = 83) by none of the risk factors. One-hour postload glucose was significantly associated with total mortality in the intervention group only. When the intervention and control groups were included in the same model, the effect of group on total mortality tended to be dependent on the 1 h blood glucose value (P = 0.06 for the group by 1 h glucose interaction term). CONCLUSION--The traditional risk factors (smoking, blood pressure, and cholesterol) are significantly associated with 28-year mortality in this high social class population with previous health education. Conversely, a "clustering" of low risk factors predicted low total, coronary, and cancer mortality. The findings on 1 h blood glucose suggest that factors related to glucose tolerance explain in part the excess mortality in the intervention group compared with the control group.     

Incidence and prevalence of thyroid disease in elderly women: results from the longitudinal population study of elderly people in Gothenburg, Sweden

The incidence and prevalence of thyroid dysfunction were estimated in a longitudinal study of a representative sample of elderly women at ages 70, 75, 79 and 81. Thyroid-stimulating-hormone concentrations were measured in frozen samples obtained at the ages of 70 and 75 that had been stored for ten and five years, respectively. At the ages of 79 and 81 the serum concentrations of thyroid-stimulating hormone were determined in connection with the sampling. For comparison, thyroid-stimulating-hormone concentrations were also measured in another representative population sample of women at ages 70 (n = 297) and 76 (n = 342), in whom measurements were carried out in direct connection to the clinical study. History of previous thyroid disease, e.g. thyroid surgery and thyroid hormone treatment, was obtained through a questionnaire. Information about previous treatment with radio-iodine was obtained from records. At the age of 70, 1.9% had had thyroid surgery but none had been treated with radio-iodine. L-Thyroxine had been prescribed for 3.5%, and another 3.9% had high thyroid-stimulating-hormone concentrations (greater than 10.0 mU/l) indicating thyroid hypofunction. Between 70 and 79 years of age, eight of the 514 women had developed high concentrations of thyroid-stimulating hormone and another two women had received treatment with L-thyroxine. Three women had received radio-iodine therapy. In addition, one woman at the age of 81 was discovered to have hyperthyroidism. The retrospective analysis showed that markedly elevated TSH concentrations had been present in several women for at least nine years.(ABSTRACT TRUNCATED AT 250 WORDS)     

Seasonal variation of disease activity of systemic lupus erythematosus in Finland: a 1 year follow up study

OBJECTIVES: To study the role of different seasons in the disease activity of patients with systemic lupus erythematosus (SLE). Additionally, to evaluate whether the outdoor behaviour during the summer or a photoprovocation test affects disease activity. METHODS: 33 patients with SLE were examined by a rheumatologist and a dermatologist at a university hospital in winter, spring, and summer. The activity of SLE was assessed by the ECLAM index. Their outdoor behaviour was recorded by a questionnaire during the summer. In the winter, 12 patients were photoprovoked by ultraviolet A and B radiation on a small skin area. RESULTS: The ECLAM scores were higher in spring and tended to be higher in summer than in winter (p = 0.006 and p = 0.051). This finding, as well as the outdoor behaviour, were independent of the patients' own impression of their photosensitivity. Overall, the sun protection actions were inadequate. The photoprovocation had no statistical effect on disease activity, but one patient had a violent exacerbation of SLE manifestations shortly after the photoprovocation. CONCLUSIONS: In the northern climate SLE may be activated during the sunny season. Therefore, more effort should be focused on sun protection of patients with SLE.     

Risk factors for hyperuricemia in congenital heart disease patients and its relation to cardiovascular death

Introduction: Hyperuricemia has been associated with cardiovascular risk factors but it remains controversial if uric acid is an independent predictor of cardiac mortality.
Methods: A total of 503 CHD patients (457 nonhypoxemic and 46 hypoxemic) and 772 control patients fulfilled inclusion criteria. Demographic, clinical, and analytical data [serum uric acid and 24h urine uric acid levels, N‐terminal pro‐B‐type natriuretic peptide (NT‐pro‐BNP), and C‐reactive‐protein (CRP) concentrations] were studied. Survivals curves to determine cardiac death and arterial thrombosis in CHD patients were also examined.
Results: Noncyanotic and cyanotic CHD patients had significant higher serum uric acid concentration (5.2 ± 1.5 vs 4.9 ± 1.3mg/dL, P = .007 and 6.7 ± 2.1 vs 4.9 ± 1.3mg/ dL, P < .001, respectively) and gout (1% vs 0%, P = .003 and 4% vs 0%, P < .01, respec‐ tively) than the control population. Among CHD patients, hyperuricemic patients were significant older and with overweight, used more diuretics, were more cyanotic and had higher serum creatinine, NT‐pro‐BNP and CRP concentrations than nonhy‐ peruricemic. In the multivariable analysis, the body mass index (BMI) (OR 1.09; 95% CI 1.01–1.18), cyanosis (OR 6.2; 95 CI 1.5–24.6), serum creatinine concentration (OR 49; 95% CI 44–538), and being under diuretic treatment (OR 4.5; 95% CI 1.4–14.5) proved to be risk factors for hyperuricemia in CHD patients. The Kaplan–Meier events free survival curves, during a 5.2 ± 2.7 years follow‐up of up time, showed that hyperuricemic CHD patients had significant higher cardiovascular death (P = .002). However, after applying the Cox regression analysis uric acid levels lost its statistical significance. No significant differences were seen in relation to thrombotic events between CHD patients with and without hyperuricemia.
Conclusions: CHD patients, noncyanotic and cyanotic, have higher serum uric acid levels and gout than patients in the general population. BMI, renal insufficiency, cya‐ nosis, and the use of diuretics were risk factor for hyperuricemia among CHD patients.     

Life course socioeconomic conditions,adulthood risk factors and cardiovascular mortality among men and women: A 17-year follow up of the GLOBE study

Background

Our goal was to study associations between childhood socioeconomic position (SEP), adulthood SEP, adulthood risk factors and cardiovascular disease (CVD) mortality, by investigating the critical period and pathway models.

Methods

The prospective GLOBE study in the Netherlands, with baseline data from 1991, was linked with cause of death register data from Statistics Netherlands in 2007. At baseline, respondents reported information on childhood SEP (i.e. occupational level of respondent's father), adulthood SEP (educational level), and adulthood risk factors (health behaviours, material circumstances, and psychosocial factors). Analyses included 4894 men and 5572 women. Data were analysed by Cox proportional hazard ratios (HR) with CVD mortality as the outcome.

Results

Childhood SEP was associated with CVD mortality among men with the lowest childhood SEP only (HR 1.32, 95% CI 1.00–1.74), and not among women. The majority of childhood SEP inequalities in CVD mortality among men (88%) were explained by material, behavioural and psychosocial risk factors in adulthood, and adulthood SEP. This was mostly due to the association of childhood SEP with adulthood SEP, and the interrelations of adulthood SEP with risk factors, and partly via the direct association of childhood SEP with adulthood risk factors, independent of adulthood SEP.

Conclusion

This study supports the pathway model for men, but found no evidence that socioeconomic conditions in childhood are critical for CVD mortality in later life independent of adulthood conditions. Developing effective methods to reduce material and behavioural risk factors among lower socioeconomic groups should be a top priority in cardiovascular disease prevention.     

Arterial properties in acromegaly: relation to disease activity and associated cardiovascular risk factors

Purpose

Acromegaly is associated with increased cardiovascular morbidity and mortality when inadequately treated, which may be secondary to associated comorbidities or to direct IGF-1 effects on the cardiovascular system. By using a control group carefully matched for traditional cardiovascular risk factors, we aimed to assess the direct contribution of disease activity and IGF-1 levels to arterial damage as assessed by measurements of arterial stiffness and endothelial function.

Methods

Twenty-nine subjects with acromegaly (11 males, 52 ± 14 year; 15 active acromegaly) and 24 matched controls underwent evaluation of large and small artery compliance using applanation tonometry, pulse wave velocity (PWV), augmentation index (Alx), carotid ultrasonography intima-media thickness, (IMT) and flow-mediated dilatation (FMD).

Results

IGF-1 expressed as times the upper limit of the normal range (x ULN) was 2.2 ± 1.1 in patients with active disease versus 0.7 ± 0.2 in patients in remission. Irrespective of disease activity, FMD was lower in patients with acromegaly than in control subjects, (3.4 ± 2.7 % in active acromegaly, 4.4 ± 3.3 % in controlled acromegaly and 7.5 ± 3.8 % in controls; p = 0.004). There were no significant differences in PWV, Alx, and IMT between groups. A positive correlation was found between IGF-1× ULN and IMT (r = 0.4; P = 0.02). Asymmetric dimethylarginine (ADMA), a novel cardiovascular risk factor, was positively correlated to arterial stiffness (r = 0.46; p = 0.017) and negatively with small vessel compliance (r = ?0.44, p = 0.02).

Conclusions

Patients with acromegaly have significantly impaired endothelial function as assessed by FMD, but other tested vascular parameters were similar to a control group that was adequately matched for cardiovascular risk factors.

     

Q waves and ventricular extrasystoles in resting electrocardiograms. A 16 year follow up in Busselton study.

Isolated abnormalitites in the resting electrocardiograms of 1546 Busselton people with no history of angina or past myocardial infarction were examined in relation to 16 year mortality. Multivariate discriminate analysis in men showed significant independent relationship for Q waves with coronary heart disease and for ventricular extrasystoles with cardiovascular disease. In women multivariate analysis showed significant relations for ventricular extrasystoles with total mortality and coronary heart disease. There were higher trends in mortality for both men and women with frequent ventricular extrasystoles compared with those with infrequent ventricular extrasystoles.     

Controlled trial of antituberculous chemotherapy in Crohn's disease: a five year follow up study

Background—It has been suggested thatMycobacterium paratuberculosis is the cause of Crohn'sdisease. In a previous report the immediate effect of two yearstreatment with antituberculous chemotherapy showed no clinical benefit.
Aims—To assess both the immediate and longer termeffect of treatment on the disease.
Methods—Patients were followed for five yearsfrom their date of entry to the study. One hundred and thirty patientsentered the initial study, and of these 111 (81%) were followed regularly.
Results—Overall, there was no evidence ofconsistent benefit or disadvantage from antituberculous chemotherapy inany of the assessments made, including the number of acute relapses,surgical episodes, hospital admissions, disease activity, blood tests, or medication required for Crohn's disease during the follow up period.
Conclusion—The absence of any benefit at the endof the initial two year trial period, and during the three yearsubsequent follow up, fails to support the hypothesis that mycobacteriaplay an important part in the pathogenesis of Crohn's disease, or that antituberculous chemotherapy may be of benefit.

Keywords:Crohn's disease; mycobacteria; antituberculuschemotherapy

     

A cohort study of incident hypertension in relation to changes in vigorous physical activity in men and women

OBJECTIVE: To assess the dose-response relationship between changes in vigorous exercise (running distance, Deltakm per week) and physician-diagnosed hypertension. DESIGN: Twenty-four thousand, five hundred and fifty men and 10 113 women were followed prospectively for (mean +/- SD) 7.8 +/- 1.8 and 7.5 +/- 2.0 years, respectively. RESULTS: Among those who maintained their running distance within +/-5 km per week (5841 men), logistic regression showed that the log odds for hypertension was significantly lower for those who ran longer distances (coefficient+/-SE:-0.019 +/- 0.003 per km per week; P < 0.0001) even when adjusted for body mass index (-0.010 +/- 0.003 per km per week; P = 0.002). Analyses of all 24 550 male and 10,113 female runners showed that the log odds for hypertension declined significantly in relation to Deltakm per week in men (-0.009 +/- 0.001; P < 0.0001) and women (-0.006 +/- 0.003; P = 0.03), which remained significant when adjusted for body mass index in men (-0.005 +/- 0.001; P < 0.0001) but not in women (-0.004 +/- 0.003; P = 0.13). In both sexes, the decline was related to the distance run at the end of follow-up but not at baseline. Compared with men who ran less than 8 km per week, the age-specific rate for incident hypertension in those who ran more than 40 km per week at the end of follow-up was 80% lower in those aged between 35 and 44 years, 66% lower in those between 45 and 54 years, 69% lower in those aged between 55 and 64 years (all P < 0.0001), and 57% lower in those older than 65 years (P = 0.08). CONCLUSION: The odds of developing hypertension are reduced in those who remain vigorously active and increased in those whose vigorous activity declined. These effects are dependent on the exercise dose and are due in part to metabolic processes associated with body weight.     

Acromegaly: Cardiovascular risk factors,cardiovascular manifestations and early vascular alterations in relation to disease activity

Acromegaly is associated with increased cardiovascular morbidity and mortality. 49 acromegaly patients were evaluated for presence of cardiovascular risk factors and manifestations using 2D-Echocardiography, strain, strain-rate, carotid intima media thickness (CIMT) and flow mediated dilatation (FMD) and correlated with disease activity. 32 patients with growth hormone (GH) level >1 ng/ml were considered active. Patients with active disease have more LV dysfunction as assessed by strain(p-0.031) and strain rate(p-0.001); trend towards lower ejection fraction(p-0.11) with significant correlation to GH(cc −0.252,p-0.05). Patient with active disease have reduced FMD(p- 0.042); with no difference in prevalence of cardiovascular risk factors and CIMT inrelation to disease activity.     

Relation of glenohumeral and acromioclavicular joint destruction in rheumatoid shoulder. A 15 year follow up study

OBJECTIVES: To evaluate the relation of glenohumeral (GH) and acromioclavicular (AC) joint involvement in a cohort of 74 patients with seropositive and erosive rheumatoid arthritis (RA) followed up prospectively. METHODS: At the 15 year follow up radiographs of 148 shoulders were evaluated, and the grade of destruction of GH and AC joints were assessed by the Larsen method. One GH joint arthroplasty had been performed after 13 years of the disease onset and the preoperative radiograph was evaluated. RESULTS: Erosive involvement (Larsen grade >/= 2) was observed in 96 of 148 (65%) of the shoulders. Both GH and AC joints were affected in 62 of 148 (42%) shoulders. GH joint alone was involved in nine (6%) shoulders and only AC joint was affected in 25 (17%) shoulders. AC joint destruction correlated with the GH joint destruction, r=0.74 (95% confidence intervals (CI) 0.65 to 0.80 ). CONCLUSION: In RA AC joint is affected more often than the GH joint, but in half of the patients both joints are involved. This should be remembered when treating painful rheumatoid shoulder.