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ID PMID Title PublicationDate abstract
15194575 High intensity exercise or conventional exercise for patients with rheumatoid arthritis? O 2004 Jul OBJECTIVE: To examine the outcome expectations of RA patients, rheumatologists, and physiotherapists regarding high intensity exercise programmes compared with conventional exercise programmes. METHODS: An exercise outcome expectations questionnaire was administered to 807 RA patients, 153 rheumatologists, and 624 physiotherapists. The questionnaire consisted of four statements regarding positive and negative outcomes of high intensity exercise programmes and four similar statements for conventional exercise programmes. A total expectation score for both conventional and high intensity exercise was calculated, ranging from -2 (very negative expectation) to 2 (very positive expectation). RESULTS: The questionnaire was returned by 662 RA patients (82%), 132 rheumatologists (86%), and 467 physiotherapists (75%). The mean (95% confidence interval) scores for high intensity exercise programmes were 0.30 (0.25 to 0.34), 0.68 (0.62 to 0.74), and -0.06 (-0.15 to 0.02), and for conventional exercise programmes were 0.99 (0.96 to 1.02), 1.13 (1.09 to 1.17), and 1.27 (1.21 to 1.34) for RA patients, rheumatologists, and physiotherapists, respectively. In all three respondent groups, the outcome expectations of high intensity exercise were significantly less positive than those of conventional exercise programme. CONCLUSIONS: Despite the existing evidence regarding the effectiveness and safety of high intensity exercise programmes, RA patients, rheumatologists, and physiotherapists have more positive expectations of conventional exercise programmes than of high intensity exercise programmes. Physiotherapists were the least positive about outcomes of high intensity exercise programmes while rheumatologists were the most positive. To help the implementation of new insights in the effectiveness of physical therapy modalities in rheumatology, the need for continuous education of patients, rheumatologists and physiotherapists is emphasised.
12528105 Elucidation of the relationship between synovitis and bone damage: a randomized magnetic r 2003 Jan OBJECTIVE: To simultaneously image bone and synovium in the individual joints characteristically involved in early rheumatoid arthritis (RA). METHODS: Forty patients with early, untreated RA underwent gadolinium-enhanced magnetic resonance imaging (MRI) of the second through fifth metacarpophalangeal joints of the dominant hand at presentation, 3 months, and 12 months. In the first phase (0-3 months), patients were randomized to receive either methotrexate alone (MTX) or MTX and intraarticular corticosteroids (MTX + IAST) into all joints with clinically active RA. The MTX-alone group received no further corticosteroids until the second phase (3-12 months), when both groups received standard therapy. RESULTS: In the first phase, MTX + IAST reduced synovitis scores more than MTX alone. There were significantly fewer joints with new erosions on MRI in the former group compared with the latter. During the second phase, the synovitis scores were equivalent and a similar number of joints in each group showed new erosions on MRI. In both phases, there was a close correlation between the degree of synovitis and the number of new erosions, with the area under the curve for MRI synovitis the only significant predictor of bone damage progression. In individual joints, there was a threshold effect on new bone damage related to the level of synovitis; no erosions occurred in joints without synovitis. CONCLUSION: In early RA, synovitis appears to be the primary abnormality, and bone damage occurs in proportion to the level of synovitis but not in its absence. In the treatment of patients with RA, outcome measures and therapies should focus on synovitis.
15304674 Development of the M-SACRAH, a modified, shortened version of SACRAH (Score for the Assess 2004 Nov OBJECTIVES: The Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (SACRAH) is a self-administered questionnaire assessing functional status, stiffness and pain in patients suffering from hand osteoarthritis (HOA) as well as rheumatoid arthritis (RA) of the hand. It consists of 23 questions in three domains, to be answered on 100 mm visual analogue scales (VAS). Our goal was to shorten the original SACRAH by elimination of redundant questions in order to make it easier to use for patients and physicians. METHODS: Following an arbitrary procedure employing high intervariable correlations, redundant questions were eventually eliminated. To validate the shortened version, 60 patients with HOA, recruited at four rheumatological centres in Austria, completed the original SACRAH as well as the shortened version. Fifty-five patients suffering from RA of the hands treated at the Second Department of Medicine, Humanis Klinikum Stockerau, also completed both questionnaires. RESULTS: A total of 11 questions (nine from the function domain and two from the pain domain) were eliminated, leading to the modified score consisting of 12 questions. Comparing the results of SACRAH and M-SACRAH, as well as the domain scores in individual patients, correlation coefficients were r = 0.978 for HOA patients (P < 0.0001) and r = 0.986 for RA patients (P < 0.0001). CONCLUSION: M-SACRAH, the shortened and simplified version of the original SACRAH questionnaire, proved to be as reliable and as representative as SACRAH for hand status in individual HOA and RA patients.
15593231 Effect of glucocorticoids on the arteries in rheumatoid arthritis. 2004 Dec OBJECTIVE: Glucocorticoids are suspected to cause atherosclerosis. Because of the possibility that their antiinflammatory effect may be antiatherogenic, this study investigated the effect of glucocorticoids on the arteries of patients with rheumatoid arthritis (RA). METHODS: We assessed the arteries of 647 patients with RA. Central atherosclerosis was measured using high-resolution carotid ultrasound for the presence of plaque and for the extent of carotid artery intima-media thickness (CaIMT). Peripheral atherosclerosis was assessed using the systolic pressures of the dorsal pedal, posterior tibial, and brachial arteries to obtain the ankle-brachial index (ABI). Cumulative glucocorticoid dose was determined using pharmacy records, supplemented by self-report. Cardiovascular (CV) risk factors and RA clinical manifestations were ascertained using clinical and laboratory methods. RESULTS: Among the RA patients studied, 427 (66%) had received glucocorticoids. Of those who had never received glucocorticoids, 100 (47%) of 215 had carotid plaque and 17 (8%) of 219 had > or =1 incompressible lower-limb artery (ABI >1.3). Among patients in the highest tertile of lifetime glucocorticoid exposure (>16.24 gm prednisone), the frequency of carotid plaque increased to 85 (62%) of 138 (P = 0.006) and that of lower-limb arterial incompressibility increased to 24 (17%) of 140 (P = 0.008), with differences remaining significant after adjustment for age at onset, disease duration, sex, CV risk factors, and RA clinical manifestations (tender, swollen, and deformed joint counts, subcutaneous nodules, rheumatoid factor seropositivity, and erythrocyte sedimentation rate). The CaIMT also displayed an increase with higher glucocorticoid exposure, but the differences did not reach significance. Lower-limb artery obstruction (ABI < or =0.9) was not associated with glucocorticoid exposure. CONCLUSION: In this RA sample, glucocorticoid exposure was associated with carotid plaque and arterial incompressibility, independent of CV risk factors and RA clinical manifestations. This supports a role for glucocorticoids in the CV complications that occur in RA.
12095825 Rheumatoid hyperviscosity syndrome: reversibility of microvascular abnormalities after tre 2002 Jul PURPOSE: To report a case of rheumatoid hyperviscosity syndrome involving both retinal and choroidal circulation that resolved after treatment. DESIGN: Interventional case report. METHODS: A 58-year-old woman with clinical and serologic evidence of an inflammatory connective tissue disease without any visual complaints was referred for a funduscopic evaluation. RESULTS: Funduscopic examination revealed marked dilation and beading of the venous system, microaneurysms, and telangiectatic capillary beds in the posterior pole. Fluorescein angiography disclosed delayed choroidal filling, prolonged arteriovenous transit time, and areas of capillary nonperfusion. These findings were accompanied by a severe polyclonal hypergammaglobulinemia and a 10-fold increase in serum viscosity. The ocular findings were reversible after plasmapheresis and steroid treatment. CONCLUSION: Rheumatoid hyperviscosity syndrome can involve both retinal and choroidal circulation. The prominent microvasculopathy is reversible after appropriate treatment.
15643569 Imaging of bone erosion in rheumatoid arthritis. 2004 Dec Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis, with a prevalence of 1% in the United States. Recently introduced disease-modifying antirheumatic drugs have been extremely successful in preventing irreversible joint damage, particularly if initiated early. Accordingly, accurate and early diagnosis of RA has become imperative. This shift places increased demands on imaging to identify even the slightest traces of erosive joint damage and predict future structural and functional deterioration. Unfortunately, conventional radiography has been shown to be insensitive for bone erosions, particularly in early stages of the disease. Computed tomography (CT) is rarely used, but its tomographic perspective offers advantages over projectional radiography. Ultrasound (US) detects more erosions than radiography does and also can evaluate synovitis. Scintigraphy also can detect inflammation and bone turnover at sites of active erosion. It lacks spatial resolution but offers greater anatomical coverage, making whole-body assessments possible. Of all imaging modalities, however, magnetic resonance imaging (MRI) shows the greatest sensitivity for detecting and monitoring bone erosions and also can detect and follow pre-erosive features of RA, such as synovitis, bone marrow edema or osteitis, and tendinous and ligamentous abnormalities. In this article, we review the appearance of bone erosions on conventional radiography and alternative imaging modalities including MRI, CT, US, and scintigraphy. We also review alternative acquisition techniques for MRI in RA and discuss the utility of fat suppression and contrast enhancement.
12508775 TNF +489 polymorphism does not contribute to susceptibility to rheumatoid arthritis. 2002 Nov OBJECTIVES: To determine if a tumour necrosis factor (TNF +489) polymorphism is associated with susceptibility to rheumatoid arthritis (RA). METHODS: Two European populations were studied: 217 controls and 238 patients from the north of England and 145 controls and 179 patients from Spain. HLA-DRB1 and TNF +489 markers were typed using polymerase chain reaction based methods. RESULTS: Strong associations were demonstrated with shared epitope (SE) encoding HLA-DRB1 alleles in the English (OR = 2.9 [2.2-3.9]) and Spanish (OR = 2.3 [1.6-3.3]) populations, however no association was found with TNF +489 alleles. Furthermore carriage of TNF +489A was not associated with the presence of radiological erosions, rheumatoid nodules or rheumatoid factor. CONCLUSION: The role of the TNF locus in the genetic background of RA is unclear, however, our data does not support the previous reported association of the TNF +489A allele with RA susceptibility or severity.
16341903 Antineutrophil cytoplasmic antibodies in Bulgarian patients with rheumatoid arthritis: cha 2005 Dec OBJECTIVE: The aim of this study was to study the prevalence, subspecificities, and immunoglobulin (Ig)G subclass distribution of antineutrophil cytoplasmic antibodies (ANCA) in 90 Bulgarian patients with rheumatoid arthritis (RA) and to investigate the clinical associations of ANCA in these patients. METHODS: The ANCA were detected by indirect immunofluorescence, while antigen specificities were determined by enzyme-linked immunosorbent assay (ELISA) directed against myeloperoxidase (MPO), proteinase 3 (PR3), bactericidal/permeability-increasing protein (BPI), lactoferrin (LF), leukocyte elastase (LE), and cathepsin G (CG). The IgG subclass reactivity of antibodies to BPI and LF was measured. RESULTS: Antineutrophil cytoplasmic antibodies were found in 18 RA patients. Only a P-ANCA fluorescence pattern was seen. Six sera reacted to BPI, five to LF, one to MPO, one to PR3, and one to CG by ELISA testing. Immunoglobulin-G1 was the predominant subclass for LF-ANCA, whereas IgG1/3 contributed mainly to BPI-ANCA. Compared to P-ANCA-negative RA patients, the P-ANCA-positive patients exhibited significantly higher inflammatory activity, as estimated by disease activity score, C-reactive protein, erythrocyte sedimentation rate, and higher levels of IgM rheumatoid factor. CONCLUSION: Twenty percent of Bulgarian patients with RA have P-ANCA in their sera. These antibodies are directed against variable antigen specificities, while ANCA positivity in RA reflects disease and inflammatory activity.
15116599 Surgical management of the arthritic wrist. 2004 Wrist destruction by rheumatoid arthritis adversely affects hand function and increases the risk of finger deformities. Surgical management is indicated not only for salvage of end-stage wrist deformity but to alleviate pain and reduce progression of deformity at earlier stages. Available procedures include arthroscopic synovectomy, partial and complete arthrodesis, and implant arthroplasty. Procedure selection is highly dependent on disease characteristics and patient needs.
12794820 Predicting mortality in patients with rheumatoid arthritis. 2003 Jun OBJECTIVE: A number of different variables have been proposed as risk factors for mortality in patients with rheumatoid arthritis (RA), but limited prospective information on the magnitude of their effects is available. This study was undertaken to evaluate the relative predictive strength and usefulness of a wide range of variables on the risk of mortality in a large, long-term, prospectively studied cohort of patients with RA. METHODS: Over a 20-year period of followup beginning in 1981, 1387 consecutive RA patients were seen in a single clinic. A wide range of clinical and demographic assessments were recorded and entered into a computer database at the time of each clinical assessment. Assessment of predictive strength included determination of standardized and fourth-versus-first-quartile odds ratios (ORs), goodness-of-fit measures, and contributing fraction. RESULTS: The Health Assessment Questionnaire (HAQ) disability index was the strongest clinical predictor of mortality. A 1-SD change in the HAQ resulted in a much larger increase in the odds ratio for mortality compared with a 1-SD change in global disease severity, the next most powerful predictor of mortality (OR 2.31 versus 1.83). Considering the contributing fraction, mortality would be reduced by 50% for the HAQ and by 33% for global disease severity if patients in the fourth quartile for these variables could be switched to the first quartile. Global disease severity, pain, depression, anxiety, and laboratory and radiographic features were significantly weaker predictors. Disease duration, nodules, and tender joint count were clinical variables that provided very little predictive information. In multivariable analyses, HAQ and other patient self-report measures were significantly better predictors than were radiographic and laboratory variables. A single baseline observation provided the least information, with substantially increasing predictive ability associated with 1-year, 2-year, and all-time point followup observations (time-varying covariates). CONCLUSION: In this large 20-year study from routine clinical practice, the HAQ was the most powerful predictor of mortality, followed by other patient self-report variables. Laboratory, radiographic, and physical examination data were substantially weaker in predicting mortality. We recommend that clinicians collect patient self-report data, since they produce more useful clinical outcome information than other available clinical measures.
12110136 The role of human T-lymphocyte-monocyte contact in inflammation and tissue destruction. 2002 Contact-mediated signaling of monocytes by human stimulated T lymphocytes (TL) is a potent proinflammatory mechanism that triggers massive upregulation of the proinflammatory cytokines IL-1 and tumor necrosis factor-alpha. These two cytokines play an important part in chronic destructive diseases, including rheumatoid arthritis. To date this cell-cell contact appears to be a major endogenous mechanism to display such an activity in monocyte-macrophages. Since TL and monocyte-macrophages play a pivotal part in the pathogenesis of chronic inflammatory diseases, we investigated the possible ligands and counter-ligands involved in this cell-cell interaction. We also characterized an inhibitory molecule interfering in this process, apolipoprotein A-I. This review aims to summarize the state of the art and importance of contact-mediated monocyte activation by stimulated TL in cytokine production in rheumatoid arthritis and mechanisms that might control it.
12594114 Can we rely on magnetic resonance imaging when evaluating unstable atlantoaxial subluxatio 2003 Mar OBJECTIVES: To examine whether functional radiography and functional magnetic resonance imaging (MRI) are equally efficient in detecting the extent of unstable anterior atlantoaxial subluxation (aAAS) in rheumatic patients. METHODS: 23 patients with unstable aAAS (diagnosed by functional radiography) were examined by functional MRI because of a neck symptom. Twenty two patients had rheumatoid arthritis and one had juvenile idiopathic arthritis. aAAS was diagnosed if the anterior atlantoaxial diameter (AAD) was >3 mm and was considered unstable if the AAD differed by >2 mm between flexion and extension radiographs. The AAD was measured from radiographs (flexion and extension) and MRI images (flexion and neutral). RESULTS: The extent of aAAS during flexion measured by radiography was greater than that found by MRI in all 23 patients (mean difference 3 mm (95% confidence interval 2 to 4)). In four (17%) patients flexion MRI could not demonstrate aAAS detected by radiography. The difference between the AAD measurements during flexion by these two methods was substantial (that is, >or=4 mm) in nine (39%) cases. Severe aAAS (>or=9 mm) was seen in 15 (65%) patients by functional radiography and in four (17%) by functional MRI. CONCLUSIONS: The magnitude of aAAS was often substantially smaller when measured by functional MRI rather than by functional radiography. Thus one cannot rely on the result of functional MRI alone; functional radiographs are needed to show the size of unstable aAAS. The maximal extent of the subluxation must be taken into account when the possible compression of neural structures is evaluated by MRI.
11874828 Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based dev 2002 Apr BACKGROUND: Effective treatment of active rheumatoid arthritis (RA) requires early diagnosis and early disease modifying antirheumatic drug (DMARD) treatment to have an impact on long term morbidity and mortality. Clinical criteria would facilitate early referral of the patient with suspected RA to a rheumatologist for definitive diagnosis and initiation of DMARD treatment at that point in the disease most likely to have an impact on the long term outcome. OBJECTIVE: To develop a referral recommendation that may serve as a clinical guide for primary care doctors, enabling them to identify patients with suspected RA during the early inflammatory stages. METHODS: Key points of the referral criteria were formed based on a thorough literature review targeting early RA, early arthritis clinics, DMARD treatment for early RA, prognostic factors of disease progression, early RA clinical trials, and quality of life. Evidence was graded using the methods defined by Shekelle et al. A draft version of the criterion was circulated among the authors for critical evaluation. A consensus integrated these comments. RESULTS: Clinical evidence strongly supports the observations that structural damage occurs early in active RA and that early DMARD treatment improves the long term outcome of the disease. The observations indicate that rapid referral to a rheumatologist is advised when RA is suspected. This may be supported by the presence of any of the following: >or=3 swollen joints, metatarsophalangeal/metacarpophalangeal involvement, and morning stiffness of >or=30 minutes. CONCLUSION: The proposed early referral recommendation is a viable tool for primary care doctors to identify potential patients with active RA early in the disease. Early referral to a rheumatologist for definitive diagnosis and early DMARD treatment should improve the long term outcome of RA.
12564667 Intervention programs for arthritis and other rheumatic diseases. 2003 Feb Disability reduction or prevention programs for people with arthritis and other rheumatic conditions reduce long-term pain and disability but reach only a fraction of their target audience. Few public health professionals are aware of these programs or their benefits. The objective of this study is to review and describe packaged (ready-to-use) arthritis self-management education and exerciselphysical activity programs that have had at least preliminary evaluation. Nine intervention programs (five self-management education programs, and four exercise/physical activity programs met study criteria). Several of the packaged arthritis interventions reviewed help people with arthritis and other rheumatic conditions maximize their abilities and reduce pain, functional limitations, and other arthritis-related problems. Other packaged interventions show promise in reducing pain, disability, and depression and in increasing self-care behaviors, but they need to be evaluated more extensively.
12851358 Uncemented STAR total ankle prostheses. Three to eight-year follow-up of fifty-one consecu 2003 Jul BACKGROUND: The feasibility of replacing the ankle joint has been a matter of speculation for a long time. In recent years, the designs of ankle prostheses have been improved, and three designs, all used without bone cement, currently dominate the market. However, documentation of the clinical results of the use of these prostheses is sparse. We reviewed the intermediate-term results of fifty-one consecutive Scandinavian Total Ankle Replacements (STAR). METHODS: Between 1993 and 1999, fifty-one consecutive ankles were replaced with an uncemented, hydroxyapatite-coated STAR total ankle prosthesis. Clinical examination for the present study was performed by one surgeon who had not taken part in the operations. Standardized radiographs were used. Complications and failures were recorded, and patient satisfaction and functional outcome scores were determined for all patients with an unrevised implant. RESULTS: Twelve ankles had to be revised. Seven were revised because of loosening of at least one of the components; two, because of fracture of the meniscus; and three, for other reasons. A component was exchanged in seven of the twelve revisions, whereas the ankle was successfully fused in the other five. An additional eight ankles had radiographic signs of loosening. The thirty-nine unrevised ankles (thirty-seven patients) were examined after thirty-six to ninety-seven months (median, fifty-two months). The patient was satisfied with the result after thirty-one of the ankle replacements, somewhat satisfied after two, and not satisfied after six. The median Kofoed score increased from 39 points before the surgery to 70 points at the time of the follow-up examination. A median follow-up score of 74 points was recorded when the system described by Mazur et al. and the AOFAS (American Orthopaedic Foot and Ankle Society) system were used. The median range of motion was approximately the same preoperatively and postoperatively. The estimated five-year survival rate, with revision for any reason as the end point, was 0.70. When radiographic loosening of either component was used as the end point, the estimated five-year radiographic survival rate was significantly better for the last thirty-one ankles treated in the series (p = 0.032). CONCLUSIONS: Total ankle replacement may be a realistic alternative to arthrodesis, provided that the components are correctly positioned and are of the correct size. However, the risks of loosening and failure are still higher than are such risks after total hip or total knee replacement.
12455819 Bone metabolism and histomorphometric changes in rheumatoid arthritis. 2002 OBJECTIVE: We studied bone metabolism and histomorphometry in 66 patients with rheumatoid arthritis. METHODS: Cross-sectional study. RESULTS: BMD at the forearm but not at the lumbar spine was decreased. Age. body mass index and fibrinogen correlated significantly with decreased BMD, whereas age and disease duration were predictors of vertebral fractures. Biochemical parameters were normal but 25 vitamin D levels were markedly reduced. There were significant decreases in bone volume, mean wall thickness, mineral apposition rate (with highly prolonged mineralisation lag time), number of osteoclasts, and osteoclast surface, and increases in resorption surfaces. Mean plate trabecular separation and density were also deeply affected. CONCLUSIONS: Patients with rheumatoid arthritis showed a reduced bone volume and decreased bone turnover, which is further aggravated by microarchitectural deterioration stressing the severe osteoporosis associated with the disease. These findings are consistent with the effect of hypovitaminosis D and low values of vitamin D in serum.
12687511 Ethnic variation in the clinical manifestations of rheumatoid arthritis: role of HLA-DRB1 2003 Apr 15 OBJECTIVE: To assess the extent of ethnic variation in the clinical expression of rheumatoid arthritis (RA) and the role of HLA-DRB1 alleles in this variation. METHODS: We assessed consecutive RA patients for joint findings, subcutaneous nodules, laboratory and radiographic findings, and treatment. We typed HLA-DRB1 alleles to identify those that contain the shared epitope (SE). We adjusted ethnic comparisons for age and sex, and tested for ethnic heterogeneity in the effect of the SE. RESULTS: We studied 777 RA patients, 498 of whom were women (64%), 432 were Hispanic (56%), 272 were non-Hispanic white (NHW; 35%), 53 were African American (AA; 7%), and 20 were Asian (3%). Compared with NHW, Hispanics had significantly more tender joints (17 versus 11), more swollen joints (8 versus 7), more frequent rheumatoid factor (RF) positivity (93% versus 84%), higher erythrocyte sedimentation rate (ESR; 45 versus 36 mm/hr), and a lower number of lifetime disease-modifying antirheumatic drugs (1.9 versus 2.5). AA were older at onset (46 versus 44 years), had less frequent subcutaneous nodules (18% versus 28%), and higher ESR (42 versus 36 mm/hour) than did NHW. Hispanics and AA were more likely than NHW to be null for the SE (odds ratio [OR] = 4.59 for AA; and OR = 1.61 for Hispanics), and less likely to have 2 SE-carrying alleles (OR = 0.59 for Hispanics and OR = 0.25 for AA). The number of SE copies was associated with subcutaneous nodules, ESR, RF, and radiographic changes. Ethnic heterogeneity in the effect of the SE was modest. CONCLUSIONS: There is ethnic variation in the clinical expression of RA and in both the frequency and types of SE-carrying HLA-DRB1 alleles. Some ethnic variation in clinical findings is associated with differences in SE frequency. However, we found that the effect of the SE on the clinical features of RA varies little between ethnic groups.
12380030 Diagnosing early-onset rheumatoid arthritis: the role of anti-CCP antibodies. 2002 Aug Although the role of citrullinated peptides in the pathogenesis of RA is yet to be elucidated, their use as markers for early diagnosis and prognosis of RA seems promising. CCPs show much potential, particularly when employed in user-friendly ELISAs. All recent studies suggest an important role for citrullinated antigens in the diagnosis, prognosis, and general therapeutic management of RA. In addition to their optimal specificity, ability to distinguish between erosive and nonerosive disease, and ability to diagnose very early stage RA, they also hold promise in becoming a key serological marker for RA in the near future.
15088289 Oxygen uptake during walking in patients with rheumatoid arthritis--a controlled study. 2004 Apr OBJECTIVE: To analyze the energy expenditure of patients with rheumatoid arthritis (RA) of functional classes I, II, and III during walking at different speeds on a treadmill. METHODS: Thirty-five consecutive patients selected from the rheumatology outpatient clinic were studied and compared with a control group consisting of 35 healthy individuals paired for age, sex, body weight, and body mass index. An incremental test on a treadmill consistent with normal walking was developed, with metabolic analysis performed at 30 s intervals using a gas analyzer connected to a computerized system. Heart rate, rate of perceived exertion, visual analog scale of pain, Ritchie index, the Scale of the Escola Paulista de Medicina for Evaluation of Articular Movement Range, and the Health Assessment Questionnaire were also used to evaluate functional capacity. RESULTS: Patients with RA showed a greater energy expenditure than controls at the following walking speeds: 3.0 km/h (RA = 229.36 +/- 56.47 kcal/h; controls = 197.44 +/- 52.59), 4.5 km/h (RA = 266.41 +/- 58.94 kcal/h; controls = 231.41 +/- 56.14), and 5.0 km/h (RA = 289.11 +/- 65.35 kcal/h; controls = 250.18 +/- 56.67). Patients with RA presented higher values for all test measures except heart rate. The functional class II group differed significantly from the controls, whereas the functional class I group had values close to normal. CONCLUSION: Patients with RA had a greater energy expenditure during walking compared to healthy controls under the same conditions, and patients with functional class II experienced a greater energy expenditure compared to controls.
15371047 Consequences of stroke, arthritis and chronic pain--are there important similarities? 2004 Aug 19 PURPOSE: This study aimed to explore the applicability of a previously derived model of what mattered most to people with arthritis across a number of different disabling conditions. METHOD: A qualitative study using interviews with 30 participants from three out-patient groups (rheumatoid arthritis, stroke and chronic pain) was conducted. Participants were asked to identify and discuss the most important consequences of living with their condition. Narratives were explored for similarities and differences within and across conditions. RESULTS: While diagnostically related differences were clearly evident, particularly in categories within the Intrinsic, Extrinsic and Future Issues themes, a marked level of similarity in view was apparent in two themes, Taking Charge and Perceptions of Normality. CONCLUSIONS: The study identified a shared perspective about a number of issues, but also detailed where there were differences. We suggest explicit consideration of the themes highlighted in this research, and a deeper understanding of the inter-relatedness of seemingly separate issues will help health professionals and researchers re-think ways of working with people who have disabling conditions, and identify different factors to address in measuring the success of rehabilitation.