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ID PMID Title PublicationDate abstract
11040307 Evaluating hand surgery in patients with rheumatoid arthritis: short-term effect on dexter 2000 Sep Short-term effect of hand surgery on hand function in activities of daily life (dexterity) and pain were studied in 70 patients with rheumatoid arthritis. Only surgical interventions aimed at improvement of function and/or pain relief were included in the study. Patients were assessed before surgery and 6 and 12 months after surgery. Clinical change in the surgical group was observed in the number of painful and swollen joints, observed dexterity, and pain in the hand. Six months after surgery 74% of the patients showed positive clinical change in hand functioning and/or hand pain. Clinical effects remained stable between 6 and 12 months after surgical assessments. Both change in observed dexterity and pain had an independent impact on the patient's satisfaction with the results of the surgery.
10794554 Giant distal humeral geode. 2000 Mar We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized.
10378708 Risk taking in patients with rheumatoid arthritis: are the risks of haemopoietic stem cell 1999 Apr OBJECTIVES: Autologous haemopoietic stem cell transplantation (HSCT), which carries defined risks of early treatment-related mortality (TRM), has recently been proposed as an experimental therapy for severe rheumatoid arthritis (RA). The aim of this study was to establish whether the risks of this approach are acceptable to patients with RA and whether risk taking related to disease-associated or personal/social parameters. METHODS: A standard gamble questionnaire was used to determine the acceptable risk of mortality for a potentially curative procedure in patients with RA aged <70 yr. Additional data collected included age, sex, duration of RA, number of second-line agents, domestic and workforce information, and self-assessed disability. RESULTS: The 53 patients (age range 24-69 yr, 39 female, 14 male, disease duration 2-43 yr) interviewed were prepared to accept a broad range of treatment-related mortality in order to be returned to normality off all drugs (median 5%, range 0-50%). Risk taking was significantly related to degree of disability measured by the disability section of the Health Assessment Questionnaire (HAQ; P = 0.001) and negatively related to age (P = 0.04), although only HAQ score maintained significance on multivariate analysis. Using linear regression, we were able to determine that current TRM of autologous HSCT in Australia (3.3%) would be acceptable to patients with HAQ scores of >0.44 (84% of our sample), but allogeneic HSCT (with a TRM of 13.1%) would be acceptable only to severely disabled patients with HAQ scores of >2.45 (4% of our sample), assuming the procedure to be curative. CONCLUSION: Along with previous studies, these results suggest that, if long-term efficacy can be proven, then the risks of autografting may be acceptable to most patients with RA, particularly those with significant disability.
11383403 Common patterns of person-environment interaction in persons with rheumatoid arthritis. 2001 Jun This study's purpose was to identify and describe common patterns of person-environment interaction in persons with rheumatoid arthritis. Newman's propositions about pattern provided the theoretical foundation, and a combination of quantitative and qualitative techniques were used to recognize pattern. Sixty-six adults diagnosed with rheumatoid arthritis completed questionnaires that assessed characteristic ways of functioning. Iterative cluster analysis of the data identified five distinct groups of individuals with similar response profiles. Content analysis of each group's characteristics produced a core theme representing the nature of the common pattern. The finding of multiple, distinct common patterns of person-environment interaction within the population of persons with RA is consistent with findings in other populations. Further study of the common patterns, in relation to health outcomes, has potential for increasing knowledge about the sources of different health experiences among persons with the same chronic illness.
10672799 Open and closed arthrodesis of the rheumatoid wrist using a modified (Stanley) Steinmann p 1999 Dec In a series of 21 patients (22 wrists) with rheumatoid arthritis, arthrodesis of the wrist was done using a modified Steinmann pin (Stanley) either by an open or closed technique. The open technique, which included fragmenting the carpal bones (12 cases), was mainly used when additional procedures were needed simultaneously. The closed technique simply required insertion of the Stanley pin under fluoroscan control through a small incision over the metacarpal head. Nine out of 12 wrists treated with the open technique and nine out of ten of those treated by the closed technique were successfully fused. Complications were few. A single patient was dissatisfied due to continuing pain. Two out of the four pins that migrated (both involving the open technique) have been removed.
11937986 [Team management of rheumatoid arthritis]. 2001 Dec The main objectives of team management of rheumatoid arthritis are to stop structural damage of joints and to reduce functional, psychological, socioprofessional and economic consequences. Team management requires the collaboration, around the patient, of a rheumatologist, a nurse, a psychologist, a physiotherapist, an occupational therapist, an orthopaedic surgeon at the same time, in the same place. More and more patients wish to manage their disease by themselves. Team care should not be proposed to every patient; it must be reserved to patients whose condition required such an approach because of the severity of the disease, comorbidity, psychological or socioprofessionnal difficulties. Team management should be personalized. Utility of team management is now accepted; out-patient administration is as effective as in-patient one. A good educational program is very important. However, search is still needed to define optimal modalities of team management and tools to measure the efficiency of this approach.
9501618 [Extra-articular manifestations of rheumatoid polyarthritis]. 1997 Nov 15 Rheumatoid arthritis is mainly a chronic and disabling articular disease. If most patients do well (because of limited form or efficient treatment), in some cases they present with extra-articular rheumatoid arthritis. The clinical manifestations of extra-articular rheumatoid arthritis are wide, ranging from common and benign manifestations such as rheumatoid nodules to severe events such as Felty's syndrome or systemic vasculitis. The incidence of systemic rheumatoid arthritis seems cumulative over the course of the chronic disease, and the severity of individuals lesions when fully developed can be of major importance and even life threatening. A classification of the main features of extra-articular rheumatoid arthritis is given (even if not perfect), and the clinical manifestations are described.
9523380 Diagnostic value for rheumatoid arthritis of antiperinuclear factor at the 1:100 threshold 1998 Jan Six hundred sera from patients with chronic rheumatic diseases including 429 with rheumatoid arthritis were tested in a blind fashion for IgG antiperinuclear factor using an indirect fluorescent antibody assay on buccal cells. Using the dilution of 1:100 found to be optimal in an earlier study, 283 of the 429 (66%) rheumatoid arthritis sera and 22 of the 171 (13%) control sera were positive for antiperinuclear factor. Titers were higher in the rheumatoid arthritis group than in the control group. A meta-analysis of studies that used sera diluted 1:80 or 1:100 (2853 sera including 939 from patients with rheumatoid arthritis, 1539 from patients with other rheumatic diseases and 375 from healthy controls or patients with unclassified rheumatic diseases) yielded a sensitivity of 0.75, a specificity of 0.93, and a positive predictive value of 0.87. These data demonstrate that antiperinuclear factor testing contributes usefully to the diagnosis of rheumatoid arthritis.
11224732 Update on work disability in rheumatic diseases. 2001 Mar Two recent studies suggest the prevalence of rheumatic condition-related work disability is considerably lower than was suggested in previous studies. However, the samples in the recent studies did not include older workers and included persons who gained employment after disease onset. In other recent studies, the rate of work disability among persons employed at disease onset is still high; a fair amount of work disability occurs in the early years of disease. There is no clear evidence yet that treatment improvements have altered the rates of work disability. Because work characteristics, like level of physical demand, influence risk for work disability and are potentially amenable, other interventions are needed to reduce rheumatic disease-associated work disability. Accommodation provided to alleviate problems in doing work and outside of work activities is the most promising intervention, followed by job/career change. Assessment tools are just now becoming available to help clinicians identify patients in need of assistance.
10685831 Issues involved in a metaanalysis of rheumatoid arthritis radiographic progression. Analys 2000 Feb Missing data in controlled clinical trials may create uncertainty in the results of a study based on non-missing data. We used 4 approaches of sensitivity analysis to address this problem. Radiographic progression data were used from a randomized controlled trial of patients with rheumatoid arthritis treated with leflunomide, methotrexate, or placebo for 12 months as an example. The mean change from baseline of the Sharp total radiographic score was the primary efficacy variable for the evaluation of leflunomide in comparison with placebo in the retardation of radiographic progression. Computer simulations were used in some of these approaches. The proportion of missing radiographic data was 26.4%. Result from the non-missing data showed that leflunomide was highly statistically significantly better than placebo in the retardation of radiographic progression. Results from the sensitivity analysis showed that radiographic data are sufficiently robust that it is unlikely that the missing data would have changed the conclusions from the analysis based on non-missing data. The potential effect of missing data in the results of a clinical trial may be addressed by various methods of sensitivity analysis. Computer simulation can be a useful tool in some of these approaches.
9555126 [Combination therapy in early rheumatoid arthritis: the COBRA study]. 1997 Dec 13 The scheme 'Combination therapy in rheumatoid arthritis' (COBRA) in early rheumatoid arthritis (RA) involves administration of not only sulfasalazine but also prednisolone and methotrexate during the first six months. The trial showed that the COBRA scheme over a period of 1.5 years was superior to sulfasalazine alone: less disease activity in the major part of the year of treatment, less articular damage on radiographs, fewer side effects and equal or reduced costs. An 'aggressive' treatment in patients with early RA is indicated, with (re)assessment of the use of corticosteroids.
11296976 Rating of arthritis health states by patients, physicians, and the general public. Implica 2001 Mar We elicited preferences for 2 arthritis health states (mild and severe) using visual analog scales, time tradeoff, and standard gamble by interviewing 104 individuals from the general public, 51 patients with rheumatoid arthritis, and 43 health professionals. The health scenarios were based on attributes described in a health status classification instrument, the EuroQol (EQ-5D). In addition, we compared the ratings in our survey with those obtained for the same scenarios by one of the scoring algorithms used for the EQ-5D (York weights). Statistically significant differences were observed in the ratings of the health scenarios, mostly for the severe vignette. Most of the variability was related to the method employed. The cost-utility ratio for a hypothetical intervention varied according to the method employed to determine the utility of the health states, from $15,000 to $111,000 US per quality adjusted life year (QALY). Patient derived weights resulted in cost-utility ratios that ranged from $39,000 to $222,000. Our findings show that the methodology used to elicit and analyze utilities can have substantial implications in the economic evaluation of interventions for patients with RA.
11668008 Rheumatoid nodule of the nasal septum. 2001 Oct Necrotizing granulomatous nodules are a common feature in patients with rheumatoid disease, affecting 20 per cent of seropositive patients. Although most commonly found subcutaneously at points of pressure, these nodules may occur in the connective tissues elsewhere in the body. In the upper aerodigestive tract, nodules have been described in diverse locations, but commonly in the trachea, larynx and the ear. We present the first reported case of a rheumatoid nodule affecting the nasal septum.
11688257 Pain and the cervical spine. 2001 Persistent neck symptoms following flexion-extension type injuries are common and may respond to early mobilization. Cervical degenerative disc and joint disease probably account for most chronic neck-related problems. Most often symptoms result from compression of neural structures, especially nerve roots. The cervical spine is commonly affected by rheumatoid arthritis, ankylosing spondylitis, and other inflammatory arthropathies. Potentially serious complications usually result from subluxations at C1-C2, usually in chronic rheumatoid arthritis. Most problems causing neck pain without neurologic signs or symptoms can be managed conservatively with physical therapy maneuvers, especially interrupted traction.
10223032 Using nurse case management to promote self-efficacy in individuals with rheumatoid arthri 1998 Nov Rheumatoid arthritis is a chronic disabling illness commanding a large portion of healthcare resources. The literature indicates that the holistic management of chronic illness has demonstrated a favorable impact on the course of the disease and its outcome. In response to these reports, a nurse case manager delivery system was implemented within a tertiary care teaching hospital to coordinate an interdisciplinary treatment plan for patients with rheumatoid arthritis. The system supported the belief that although intervention is important, self-efficacy skills have an impact on patients' coping skills. Patient care incorporates inpatient and ambulatory care services, and patients are discharged after completing scheduled visits through ambulatory care services. This article describes how patients can manage their own disease if they are provided with the necessary tools. Patients can learn to trust and use their own judgment which can lead to self-efficacy. Another study is currently under way to further evaluate this method of care delivery.
10680204 Prayer and spirituality. 2000 Feb Many patients with arthritis are strongly influenced by religious beliefs and often participate in religious healing activities such as prayer and worship attendance. Scientific studies demonstrate, and most patients confirm, that faith and involvement in religious healing activities can be helpful in preventing and treating illness, recovering from surgery, reducing pain, and improving quality of life. To improve the care of patients, clinicians should develop a patient-centered, spiritually sensitive form of medical practice in which religious issues are addressed gently and appropriately with dignity, respect, and integrity.
10648017 Inflammatory patterns in rheumatoid arthritis estimated by the number of swollen and tende 2000 Jan OBJECTIVE: To investigate the association of individual plots and time-integrated values of repeated measures of inflammatory variables with radiographic outcome in rheumatoid arthritis (RA). METHODS: In 112 patients with RA, examinations of joint swelling and joint tenderness of 68 joints, and measurement of hemoglobin (Hb) and erythrocyte sedimentation rate (ESR) were performed each year for up to 22 years after the first visit. For each of these 4 variables, the patients were divided arbitrarily into 5 characteristic subgroups by means of inspection of individual plots of longitudinal observations of the variables and divided into 5 other subgroups according to 20% percentiles of the cumulative mean values of the variables. The outcome of the subgroups was evaluated by varying degrees of radiographic events estimated by Larsen scoring of consecutive radiographs of 46 joints. RESULTS: An increasing number of radiographic events in subgroups with increasing severity (increasing values of joint swelling, joint tenderness, and ESR, decreasing values of Hb) was seen for both the arbitrary subgroups and the percentile subgroups of joint swelling, Hb, and ESR, whereas the association of joint tenderness to radiographic progression was weak. CONCLUSION: A highly significant association between inflammatory variables and radiographic outcome could be observed, indicating that the degree of inflammation is important for the development of destructive joint damage in RA.
10503567 Massive gastrointestinal hemorrhage in a case of amyloidosis secondary to rheumatoid arthr 1999 A case of a 60-year-old woman with secondary gastrointestinal amyloidosis to rheumatoid arthritis is reported. Biopsy findings in the mucosa of the stomach and lower gastrointestinal tract revealed amyloidosis. Endoscopic examination of the lower gastrointestinal tract revealed multiple nodular elevations. The patient showed massive melena. Emergency angiography was performed and an extravasation was found at branches of the jejunal artery. Embolization was performed and this lead to a good prognosis. Patients with massive hemorrhages following gastrointestinal amyloidosis generally have a poorer prognosis. Embolotherapy performed for the present case might represent an effective therapeutic method for gastrointestinal hemorrhage in gastrointestinal amyloidosis.
10599392 Accelerated nodulosis during methotrexate therapy for refractory rheumatoid arthritis. A c 1999 Accelerated nodulosis (AN) is a potential complication of methotrexate (MTX) therapy for rheumatoid arthritis (RA). We report on a 62-year old man affected by seropositive RA who developed AN after five months of MTX treatment. MTX-dose reduction was followed by rapid regression of the skin nodules. The Authors describe the typical features of AN and discuss on the pathogenetic mechanisms.
11494445 [MR imaging in the diagnosis of rheumatoid arthritis]. 2001 AIM: To study diagnostic potential of MR imaging (MRI) in rheumatoid arthritis (RA). MATERIAL AND METHODS: Clinical-radiation and MRI examinations of the joints were performed in 110 patients. RESULTS: MRI symptoms of RA were determined including accumulation of liquid in the joint cavity, degeneration of the joint cartilage, meniscus, ligaments, proliferation of synovial coating, destructive changes in bone epiphysis. CONCLUSION: Comparative analysis of x-ray and MRI results showed advantages of MRI in detection of inflammatory changes in soft-tissue structures of the joints in RA.