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ID PMID Title PublicationDate abstract
7657406 Clinical activity of leukotriene inhibitors. 1995 Feb Data from the emerging clinical trials with compounds such as zileuton, ICI 204,219, Bay X1005, MK571, MK679, and MK591 are demonstrating the importance of the leukotrienes as mediators of asthma and possibly other diseases such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease. One of the major questions facing the asthma community is how much improvement in the FEV1 is needed to improve the quality of life of the asthmatic patient. Comparing the various approaches to asthma treatment, there is typically 15-20% improvement in the lung function with inhaled steroids. Leukotriene interventions apparently will improve lung function to similar levels as with inhaled steroids, and thus may offer an alternative to steroids. Like the steroids, zileuton appears to also reduce the inflammatory cell influx into the antigen-challenged site, which may have the long-term effect of reversing some of the tissue alterations that occur as a result of the inflammation seen with asthma. Importantly, the reported experience to date has shown that the leukotriene modulators do not have the same side-effects as the current therapies, and thus offer the hope that both safe and effective treatment may be derived from this approach. The clinical data reported do not yet define a preferred approach to the modulation of leukotriene pathology. As more studies are published in other diseases the broad spectrum use of these inhibitors will become known.
8668946 The role of CD8+, CD57+ cells in human cytomegalovirus and other viral infections. 1995 Peripheral blood lymphocytes expressing CD8 and CD57 determinants are a small (1-15%) subset in healthy humans. CD8+, CD57+ peripheral blood lymphocytes may be divided by the level of CD8 expression, into CD8+high (CD57+) T-cells and CD8+low (CD57+) natural killer (NK) cells. CD8+high (CD57+) T-cell numbers are increased in human cytomegalovirus (HCMV)-seropositive subjects, and there is substantial evidence that HCMV is integral in the development of this subset in health and disease. Furthermore, the CD8+high (CD57+) subset is clonally derived, expressing a limited range of T-cell receptors, and are therefore likely to have restricted antigen specificity. Functionally, CD8+low(CD57+) cells exhibit NK activity, while CD8+high(CD57+) T-cells from healthy subjects mediate contact-dependent suppression in several in vitro systems including: (i) pokeweed mitogen-induced proliferation and immunoglobulin synthesis, and (ii) generation of antiviral MHC-restricted cytotoxic T-lymphocytes. This is distinct from the nonspecific, soluble factor-mediated suppression exhibited from a phenotypically similar subset in human immunodeficiency virus (HIV) and bone marrow transplant recipients. This suggests an important immunoregulatory, suppressive role for CD8+high(CD57+) T-cells that may be potentiated by HCMV and altered in diseases associated with higher numbers of this subset including HIV, allograft recipients and rheumatoid arthritis.
7699691 Prevalence and characteristics of anti-56K/annexin XI autoantibodies in systemic autoimmun 1995 Jan OBJECTIVE: To investigate the occurrence and features of anti-56K/annexin XI autoantibodies in sera from patients with various systemic autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, systemic sclerosis, polymyositis and Raynaud's phenomenon. METHODS: Anti-56K/annexin XI autoantibodies were detected by an enzyme linked immunosorbent assay using the bacterially expressed recombinant protein as antigen. RESULTS: Anti-56K/annexin XI autoantibodies were found in a substantial number of patient sera (4.1-10.1%), but are rarely detected in sera from healthy controls and from patients with infectious diseases. Disease specificity was not observed. The majority of these autoantibodies belong to the IgG class and their titers in positive sera are at least as high as those of other well defined autoantibodies. CONCLUSION: Anti-56K/annexin XI autoantibodies frequently occur in systemic autoimmune diseases in contrast to infectious diseases and healthy individuals and are primarily of the IgG isotype, consistent with an antigen driven mechanism of autoantibody production.
7865477 Autoantibodies to annexins: a diagnostic marker for cutaneous disorders? 1994 Dec Annexins/lipocortins are a group of structurally related calcium and lipid binding proteins which have been implicated as mediators of the anti-inflammatory action of corticosteroids. Autoantibodies against annexin-1 have been reported in association with autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis and their presence has been hypothesized as the reason for the steroid resistance phenomenon. In this study we investigated IgG- and IgM-autoantibodies against annexin-1,-2,-3,-4,-5 and -6 in sera of 221 patients with skin disorders and 114 healthy blood donors with newly established ELISAs. Patients were clustered into 5 groups according to their diagnosis: autoimmune diseases, psoriasis, leg ulcer, malignant melanoma, and miscellaneous diseases. Autoantibodies directed against each annexin were detectable in all investigated groups, in the control group as well as in the disease groups, without displaying any significant correlation to any of the disease states. The homogenous distribution of annexin-autoantibodies throughout the control group and all the disease groups studied, do not support the implication of annexin-autoantibodies in pathophysiological states and make them an unlikely candidate for use as a diagnostic marker.
7879705 Leflunomide: inhibition of S-antigen induced autoimmune uveitis in Lewis rats. 1994 Oct Leflunomide (LEF) is a novel immunomodulator which has been reported to be efficacious in experimental models of systemic autoimmune diseases and in treating rheumatoid arthritis in man. Leflunomide's ability to ameliorate ocular disease processes was investigated in a model of autoimmune eye disease, experimental autoimmune uveitis (EAU). EAU was induced by the injection of retinal S-antigen (S-Ag) into the foot-pad of Lewis rats. Leflunomide, or the reference compound cyclosporin A (CSA), was administered orally or topically (to one eye) each day beginning on the day of S-Ag injection. Drug efficacy was measured by the suppression in clinical signs of ocular inflammation and confirmed by histology. Both oral and topical ocular treatment with LEF suppressed the ocular disease signs and symptoms and retinal necrosis and reduced the S-Ag antibody levels associated with EAU in a dose-dependent manner. Both LEF and CSA were able to inhibit totally the disease manifestations of EAU; however, a comparison of the IC50 and IC90 values indicate that LEF is more potent than CSA in inhibiting EAU. These results suggest that leflunomide may be useful for treating autoimmune diseases of the eye.
8190504 [Arthroscopic partial double meniscectomy]. 1994 Apr Arthroscopic treatment of meniscal pathology has become a routine procedure within the last 10 years. In our patients who underwent arthroscopic surgery for multiple reasons we found 226 cases with combined lesions of the medial and lateral menisci. Eliminating the patients with instabilities, chondral lesions grade IV and general diseases like rheumatoid arthritis and those who had had surgery previously, 71 patients were left. Forty-four (62%) were male and 27 (38%) female. The average age was 52 years. The lesion was located in the right knee in 41 cases (58%) and in 31 cases (42%) in the left one. The duration of symptoms was more than 3 months in most cases. Eleven patients (15%) had a trauma in their history. A standardized interview according to the Tapper and Hoover score was carried out in each patient. Out of the 77 patients with partial double meniscectomy we were able to examine 55 patients. According to the Tapper and Hoover score the following results were evaluated: 17 patients (31%) rated excellent. In 28 cases (51%) the result was good. 8 patients (15%) showed fair results. The main cause in this group was a slight feeling of instability and a mild loss of function (lack of flexion < 5 degrees, lack of extension < 10 degrees). Two patients (3.6%) were rated poor. Of the patients 89% were satisfied with this surgical procedure and would choose it again. Only 11% (n = 6) were not satisfied with the outcome of the procedure and would prefer arthrotomy. Our follow-up study indicates that arthroscopic double partial meniscectomy gives good results.(ABSTRACT TRUNCATED AT 250 WORDS)
7996066 Chronic autoimmune hemolytic anemia in children: a report of four patients. 1994 Four children, ages seven to ten years, with direct antiglobulin test (DAT)-positive chronic hemolytic anemia are presented. The patients were followed for 3 to 10 years. Autoantibody against red cell antigens was nonspecific IgG type in all of the patients. In one of the four patients, anemia was associated with splenomegaly and jaundice. In this patient, the third component of the complement was also detected on the red cell surface. In one patient, serum IgA deficiency and frequent pulmonary infections were associated with the disease. This patient developed rheumatoid arthritis five years after diagnosis of hemolytic anemia. The third patient initially had thrombocytopenia subsequently developed DAT-positive hemolytic anemia, vitiligo and alopecia without any evidence of serologic changes suggestive of collagen vascular disorders. In these three patients, partial response was obtained with steroid therapy. The fourth patient developed DAT-positive hemolytic anemia twice during the five year follow-up period. Anemia resolved completely with steroid therapy in two months during the first episode, and in five months in the second. Generalized and peripheral lymphadenopathies which developed at the time of the second hemolytic anemia episode have persisted for the last three years. Administration of cyclosporine in two of the four patients did not result in any amelioration of the symptoms.
8228083 Clinical implications of liver biopsy findings in collagen-vascular disorders. 1993 Oct We surveyed over a 5-year period liver abnormalities in all patients with collagen-vascular disorders in whom liver histology was obtained, including 46 patients with systemic lupus erythematosus, rheumatoid arthritis, primary Sjogren's syndrome, periarteritis nodosa, mixed cryoglobulinemia, Wegener's granulomatosis, systemic sclerosis, and other conditions. Histological appearances diagnostic of the primary condition were only found in three patients, each of whom had periarteritis nodosa. Significant chronic liver disease was found in 11 patients (24%), in five of whom a strong clinical suspicion of severe chronic liver disease already existed. Clinically inapparent but potentially significant chronic liver disease was found predominantly in patients with mixed cryoglobulinemia or sicca syndrome. Seventeen percent of all biopsies suggested drug induced hepatitis. In patients with collagen-vascular diseases and abnormal liver function tests, histological examination of the liver is most frequently of value in indicating drug-induced liver damage. Significant chronic liver disease is common but usually clinically apparent. In patients with periarteritis nodosa and mixed cryoglobulinemia, liver biopsy may be of value diagnostically, revealing serious liver disease with prognostic and therapeutic implications.
8275589 Immunogenetics of polymyalgia rheumatica. 1993 Sep The distribution of HLA-D region antigens was studied in 17 patients with well-documented polymyalgia rheumatica (PMR). HLA-D region antigens were defined by the oligonucleotide typing of polymerase chain reaction (PCR)-amplified genomic DNA. The results demonstrate that the prevalence of DR4 was significantly higher (p < 0.0002; RR = 8.10) in patients (70.6%) compared to normal controls (22.9%), and the frequency of DR1 and/or DR4 in patients (82.4%) was also higher (p < 0.0006; RR = 8.40) than that in normal healthy controls (35.7%). Of the subtypes of DR4,Dw13 was significantly higher (p < 0.002; RR = 9.30) in patients (29.4%) than in normal controls (4.3%). However, these data must still be confirmed by other investigators. The distribution of the remaining DR antigens and of the DQ and DP alleles in patients did not differ significantly from those in controls. The results suggest immunogenetic similarity between PMR and late onset rheumatoid arthritis in elderly populations.
8253060 Interleukin-8: an important neutrophil chemotaxin in some cases of exudative pleural effus 1993 Sep It was hypothesized that IL-8, a neutrophil chemotaxin, contributes to the influx of neutrophils into the pleural cavity of patients with pleural effusions. Pleural fluids were collected from 57 patients including 13 with effusions due to congestive heart failure, 28 with pleural involvement by carcinoma, 5 with empyema, 4 with parapneumonic effusions complicating bacterial pneumonia, 3 with hemothorax, 3 with tuberculosis, and 1 with rheumatoid arthritis. All exudate groups had significantly higher IL-8 concentrations than the CHF group (p < .001). In 18 of the exudate fluids, the concentrations of IL-8 was equal to or in excess of the optimal concentration of IL-8 which causes neutrophil chemotaxis in vitro. Between 20 and 90% of the chemotactic activity in the fluids was removed by absorbing the IL-8 with an IL-8 affinity column. These data showed that IL-8 is a major chemotaxin in the fluid. The percentage of neutrophils in the fluids was not correlated with the IL-8 concentration. Although TNF alpha, a potent stimulator of IL-8 production, is present in some pleural effusions, no correlation was found between the concentrations of IL-8 and TNF alpha in the fluids. The data suggest that IL-8 contributes to the neutrophil influx into the pleural space of patients with pleural exudates in conjunction with other chemoattractants. It is unlikely that TNF alpha is the sole stimulus for the IL-8 production in pleural disease states.
8272476 Drug use and somatic illnesses with psychological component: a nation-wide survey among ad 1993 A cross-sectional home survey on drug use, mental health, somatic illnesses and psychosocial issues was carried out with a nation-wide multi-stage probability sample of 4,292 persons aged 12-17, 18-24 and 25-64. This article aims at investigating the relationship of specific categories of somatic illnesses with a psychological component to the use of licit and illicit drugs. For the purpose of analysis the total sample was divided into three mutually exclusive groups: group A included respondents who have reported illicit drug use 1-3 or more times in their lives; group B comprised respondents who have reported the use of licit psychotropic drugs 3 or more times in their lives; group C included non-user respondents. A higher proportion of respondents of groups A and B of both sexes in all three age strata reported the presence of a specific somatic illness such as bronchial asthma, essential hypertension, peptic ulcer, irritable bowel syndrome, rheumatoid arthritis, dermatitis or eczema, in comparison to group C (non-user) respondents. This difference was greater in the adolescent group 12-17 years of age. Possible explanations of the association between somatic illness with a psychological component and drug use are discussed.
1520483 The prevalence of selective IgA deficiency in type 1 diabetes mellitus. 1992 Aug A significant increase in the prevalence of selective IgA deficiency has been observed in patients with autoimmune disorders such as systemic lupus erythematosus and rheumatoid arthritis. Insulin-dependent diabetes mellitus (IDDM) is an autoimmune disease and susceptibility to both IDDM and IgA deficiency is associated with HLA DQB1 alleles encoding non-Asp amino acids at position 57. In order to assess whether the prevalence of selective IgA deficiency is increased in IDDM, we have screened a homogeneous series of adult patients with IDDM for selective IgA deficiency. One patient (1:261) was found to have a selective IgA deficiency. The prevalence of selective IgA deficiency among adult French blood donors is 1:1400. Thus, although IDDM and selective IgA deficiency are both associated with the presence of non-Asp amino acids at position 57 of the HLA DQ beta chain, the frequency of this immunodeficiency in adult IDDM patients is not significantly increased.
1375756 Interleukin 6: insights to its function in skin by overexpression in transgenic mice. 1992 Jun 1 Interleukin 6 (IL-6) is a cytokine that mediates a wide range of inflammatory and immune responses. Its expression is elevated in inflammatory or immunodeficient diseases, including psoriasis, rheumatoid arthritis, and AIDS. To explore the role of IL-6 in skin, we utilized a human keratin 14 (K14) promoter to express IL-6 in the basal cells of stratified squamous epithelia of transgenic mice. Mice expressing the K14-IL-6 transgene were smaller than normal and exhibited retarded hair growth. Surprisingly, IL-6 expression did not lead to enhanced epidermal proliferation, but it did result in a thicker stratum corneum, with an otherwise seemingly normal program of differentiation. IL-6 expression did not lead to leukocytic infiltration, making it unlikely that it has direct proinflammatory activity in skin. Based on this study, one role of IL-6 relevant to host defense may be to enhance the stratum corneum, thereby providing increased protection from injurious stimuli or infection. If IL-6 plays additional roles in the skin, it is likely to act synergistically with factors that IL-6 alone cannot induce.
1563592 Hyaluronan. 1992 Apr Hyaluronan (hyaluronic acid) is a high-molecular-mass polysaccharide found in the extracellular matrix, especially of soft connective tissues. It is synthesized in the plasma membrane of fibroblasts and other cells by addition of sugars to the reducing end of the polymer, whereas the nonreducing end protrudes into the pericellular space. The polysaccharide is catabolized locally or carried by lymph to lymph nodes or the general circulation, from where it is cleared by the endothelial cells of the liver sinusoids. The overall turnover rate is surprisingly rapid for a connective tissue matrix component (t1/2 0.5 to a few days). Hyaluronan has been assigned various physiological functions in the intercellular matrix, e.g., in water and plasma protein homeostasis. Hyaluronan production increases in proliferating cells and the polymer may play a role in mitosis. Extensive hyaluronidase-sensitive coats have been identified around mesenchymal cells. They are either anchored firmly in the plasma membrane or bound via hyaluronan-specific binding proteins (receptors). Such receptors have now been identified on many different cells, e.g., the lymphocyte homing receptor CD 44. Interaction between a hyaluronan receptor and extracellular polysaccharide has been connected with locomotion and cell migration. Hyaluronan seems to play an important role during development and differentiation and has other cell regulatory activities. Hyaluronan has also been recognized in clinical medicine. A concentrated solution of hyaluronan (10 mg/ml) has, through its tissue protective and rheological properties, become a device in ophthalmic surgery. Analysis of serum hyaluronan is promising in the diagnosis of liver disease and various inflammatory conditions, e.g., rheumatoid arthritis. Interstitial edema caused by accumulation of hyaluronan may cause dysfunction in various organs.
1593167 [Experience in the treatment of acute fulminating myasthenia gravis]. 1992 Feb During past 15 years, 188 myasthenia gravis (MG) patients underwent thymomectomy or thymectomy with extended resection of the adipose tissue around the thymus in our institution. Four of 188 patients (2%) had to be given respiratory support within 2 months after the onset of MG. We defined this MG as the acute fulminating type. There were 2 male and 2 female patients, ranging in age from 22 to 44 years (average, 32.5 years). Three of these patients had thymoma. One of these patients was post-thymomectomy myasthenia gravis and another patient was d-penicillamine induced myasthenia gravis. Two patients admitted on respirator for respiratory crisis. All patients underwent operation within 2 weeks after admission. The duration of respiratory support ranged from 10 to 120 days (mean 44) after operation. The period of the hospital stay ranged from 8 months to 2 years 1 month (mean 1 year 5 months). During acute stage after operation, the patients needed ACTH, steroid, immunosuppressants (azathioprine, Bredinin) and plasma pheresis depending on their severity of myasthenic symptoms. In 2 patients dose of steroid could be reduced without deterioration of the symptoms. They are doing well with small dose of steroid. In one patient plasma pheresis was performed 6 years after thymectomy. Various symptoms due to myasthenia gravis and rheumatoid arthritis has recurred 10 years after thymectomy. The titer of acetylcholine receptor antibody of this patient has been continuing in high level.
1734017 Capitellocondylar total elbow replacement. A long-term follow-up study. 1992 Jan Fifty-one capitellocondylar elbow replacements were inserted in forty-one patients between 1976 and 1986. Thirty-nine patients had rheumatoid arthritis and two had traumatic osteoarthrosis. The average age of the patients at the time of the operation was fifty-six years (range, twenty-one to seventy-seven years). Thirty-one patients who had thirty-nine retained elbow prostheses had an average length of follow-up of 6.5 years (range, two to thirteen years). Flexion improved an average of 20 degrees; extension, 4 degrees; pronation, 22 degrees; and supination, 36 degrees. Relief of pain was complete in 85 per cent of the thirty-nine elbows, and in 15 per cent there was only mild pain. Noteworthy postoperative complications in the original fifty-one elbows included infection in four elbows (8 per cent), dislocation in three (6 per cent), and ulnar neuropathy in sixteen (31 per cent). Three elbows were revised: one for a humeral fracture, one for recurrent dislocation, and one for aseptic loosening. Aseptic loosening was evident on radiographs of two elbows; one patient was completely asymptomatic, and one had mild pain with deformity. The Souter zonal radiographic assessment system for identification of radiolucencies at the bone-cement interface was utilized; there was no significant difference in radiolucencies between ulnar components backed with metal and those that were not backed with metal. Kaplan-Meier cumulative survivorship analysis demonstrated that a functional prosthesis was retained in 88 per cent of the elbows at 1.4 years postoperatively and in 83 per cent at 5.5 years.(ABSTRACT TRUNCATED AT 250 WORDS)
7585998 Clinical analysis of mid-laser versus placebo treatment of arthralgic TMJ degenerative joi 1995 Jan Laser therapy has been found effective in the management of pain associated with rheumatoid and degenerative joint arthritis and disease. The efficacy of mid-laser therapy has been tested specifically on patients with degenerative joint disease (DJD) involving the temporomandibular joint (TMJ). The following controlled clinical study was designed to test the efficacy of mid-laser therapy to placebo therapy in the reduction of pain associated with TMJ disorders specific to arthralgic DJD.
1428121 Enzymatic activity and immunoreactivity of extracellular phospholipase A2 in inflammatory 1992 Oct Synovial fluid PLA2 concentration was measured by an ELISA technique using monoclonal antibodies raised against human recombinant "synovial-type" group II phospholipase A2. This ELISA was specific for synovial-type PLA2 and did not detect pancreatic (group I) PLA2. In all synovial fluids examined, including rheumatoid, osteoarthritic, psoriatic, and gouty fluids, synovial fluid PLA2 enzyme activity significantly correlated with PLA2 immunoreactivity (P < 0.001). Within the limits of the ELISA technique, there was no evidence for the presence of specific or nonspecific modulation of PLA2 activity by either putative PLA2 activating or inhibitory proteins.
1303070 Recurrent cutaneous erythralgia and arthralgia. 1992 Two cases are reported of Vietnamese men who presented in young adult life with recurrent, painful, erythematous patches (which we have termed "erythralgia") over and adjacent to joints and accompanied by marked constitutional symptoms of malaise and lethargy, arthralgia and in one patient, fever. In the other, from the onset of the disease there were nodules over the bony prominences and in the interphalangeal regions of the fingers. The duration of the disease was over 12 years, the duration of each episode without therapy was one week and the interval between episodes was one to two weeks. In addition the patients showed a raised ESR and peripheral neutrophil leucocytosis of over 70%. There was a rapid response, within hours, to non-steroidal anti-inflammatory agents. Skin biopsies taken at varying stages of the disease episode failed to demonstrate neutrophils thereby failing to satisfy one major criterion of Sweet's Syndrome. Direct immunofluorescence studies were negative. Biopsy of the nodules did not show rheumatoid pathology. The serum rheumatoid factor was negative. Investigations failed to demonstrate any recognised pattern of cutaneous or rheumatologic disease; infections such as borreliosis were excluded. Both patients showed evidence of past hepatitis B infection. As recurrent painful cutaneous erythema is an uncommon phenomenon in dermatology except where the patient is suffering from recurrent cellulitis of the lower limbs, the patients reported here exhibit a pattern of disease not previously described.
8591655 Psycho-educational interventions in the treatment of arthritis. 1995 Nov Patient education has a long history as an integral part of clinical practice; however, controlled clinical trials of psycho-educational interventions for the rheumatic disorders emerged in significant numbers over the last 15 to 20 years. In this chapter, the efficacy of these interventions was reviewed in 34 reports (54 separate treatment arms) published in the last 10 years. Psycho-educational interventions included both traditional educational or teaching activities and psychological interventions. The most common types of intervention were self-management programmes ((21 treatment arms) and cognitive-behavioral therapy (10 treatment arms). Both approaches emphasize learning new skills helpful in managing one's disease. Self-management programmes are broadly focused on using information, problem-solving and coping skills for symptom management. Cognitive-behavioural therapy usually emphasizes control of pain by understanding the interaction of emotions and cognition with the physical and behavioral aspects of pain. Other interventions, tested either individually or as comparisons for self-management or cognitive-behavioural therapy interventions, included traditional classroom-type programmes (four treatment arms), 'materials' including pamphlets, books and computerized instruction (seven treatment arms), individualized instruction (five treatment arms), psychotherapy (one), and support groups (three treatment arms). Sixty per cent of studies used clinic samples, 52% rheumatoid arthritis and 8% with osteoarthritis. The remaining studies recruited from community samples where the exact diagnosis was not always clear, though most had either RA or OA. The majority of self-management interventions used community samples. The average effect size for treatment compared to non-intervention controls (weighted for sample size) for RA patient pain, functional ability and depression at post intervention was 0.13, -0.16 and 0.01 compared with 0.44, 0.28 and 0.56 for OA patients and 0.21, 0.08 and 0.12 for community samples. At 3 months follow-up, self-management programmes demonstrated improvement compared to controls for self-efficacy (effect sizes 0.22 to 0.29) with community patients while cognitive-behavioural therapy interventions demonstrated similar improvements in active coping skills (effect sizes 0.09 to 0.18) with RA patients. Effect sizes ranged from 0.6 to 1.1 for exercise compliance following self-management interventions. In the few studies with follow-up evaluations extending beyond 3 months post-intervention, effects generally weaken. As expected, psycho-educational interventions do not alter physical functioning with functional abilities continuing to decline over time. Lorig and colleagues have demonstrated in 4-year outcome studies important reductions in the use of health care services for participants in self-management programmes despite the progression of functional disability. Psycho-educational interventions are difficult to evaluate because of the differences in interventions, methods of assessment and varying follow-up times. Studies of these interventions differ in quality, patient population, etc., precluding a useful meta analysis. Overall, there is improvement in pain, depressive symptoms, self-efficacy, coping abilities, and self-management behaviours such as exercise compliance following psycho-educational interventions, with a trend to greater improvement for OA than RA patients. Utilization of health care services may be reduced following educational interventions. Although the overall improvement is small, it is probably of the order of that seen with therapy with NSAIDs and is independent of medical treatment. Psycho-educational interventions are a useful additional modality in the management of rheumatic diseases and may improve treatment effects and patient quality of life.