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ID PMID Title PublicationDate abstract
11932880 The number of deformed joints as a surrogate measure of damage in rheumatoid arthritis. 2002 Feb OBJECTIVE: To evaluate the reliability and validity of the number of deformed joints (NDJ) as a surrogate measure of joint damage in rheumatoid arthritis (RA). METHODS: We tested interrater reliability and validity in determining the NDJ as a surrogate for joint damage in consecutive patients with RA. We rated each of 48 joints as normal or abnormal in terms of alignment and range of motion, and expressed the results as the total number of deformed joints. We compared the NDJ with the severity of damage on a plain radiograph of the hands, scored using Sharp's technique, as the gold standard measure of joint damage. We also compared the correlation between the NDJ and radiographic joint damage, on the one hand, and disease duration, performance-based measures of physical function, and the self-reported level of disability. RESULTS: The interrater reliability of the NDJ was excellent, with an intraclass correlation among four examiners of 0.94. To assess validity of the NDJ, we studied 273 RA patients from 5 clinical settings. Their average NDJ was 14 (range 0-43), and their average Sharp's score for joint space narrowing and erosions combined was 106 (range 4-309). The NDJ and the total Sharp's score were highly correlated (r = 0.83). Both measures were correlated to a similar degree with disease duration (r = 0.51 for each measure), grip strength (r = -0.49 for NDJ, and r = -0.51 for Sharp's score), walking velocity (r = -0.44 for NDJ, and r = -0.45 for Sharp's score), the timed button test (r = -0.62 for NDJ, and r = -0.57 for Sharp's score), and the Modified Health Assessment Questionnaire (r = 0.38 for NDJ, and r = 0.38 for Sharp's score). Both the Sharp's score and the NDJ worsened significantly in 38 patients for whom 1-2 year followup data were available. CONCLUSION: The NDJ is reliable and is strongly associated with the standard measure of joint damage in RA. Because it is easily performed in a clinical setting, it could be used as an economical surrogate of joint damage in studies of the long-term outcome of RA.
15162835 Madimadi, Korean folk medicine, blocks TNF-alpha, IL-1beta, and IL-8 production by activat 2004 Feb 21 Madimadi, a Korean folk medicine, has been applied to treat rheumatoid arthritis (RA). However, its mechanisms of action have not been examined. The involvement of inflammatory cytokines, particularly TNF-alpha, IL-1beta, and IL-8, resulting in local inflammation in the pathogenesis of RA is now widely accepted. Madimadi dose-dependently inhibited TNF-alpha, IL-1beta, and IL-8 production from activated human mast cells (HMC-1). RT-PCR revealed inhibition of TNF-alpha and IL-1beta transcription in activated HMC-1. In addition, we confirmed potent inhibition of TNF-alpha and IL-1beta production by Madimadi using purified human blood PBMC from an active RA group, but not from healthy or disease control groups. These novel insights into the immunosuppressive action of Madimadi are likely to impact the clinical use of this agent.
12114253 Perspectives on the relationship of adrenal steroids to rheumatoid arthritis. 2002 Jun An expanded model of RA is presented that incorporates cumulative multifactorial processes operating over a prolonged physiological phase prior to initial clinical manifestations. During this phase, progressive imbalances in the homeostasis of core neuroendocrine, immunological, and microvascular systems are believed to occur. Normal adrenal function plays an essential role in helping to maintain homeostasis of core systems in health. In RA, chronic adrenal hypocompetence is suspected to occur in a minority subset of females who have younger clinical onset and males who have associated low serum testosterone levels. Chronic, relative glucocorticoid insufficiency is believed to contribute to development of inflammatory manifestations in RA patients. Androgenic deficiencies, particularly of gonadal origin in males, may also contribute to RA, particularly its decreased anabolic features. Precise influences of hypocompetent adrenal steroid function on long-term modeling of the immunological compartment and control of microvascular activation processes are not well understood. These complex mechanisms need to be elucidated for better understanding of the physiopathogenesis of RA. Nevertheless, at a clinical level, sufficient data are currently available to endorse further controlled studies of early clinical onset patients and prospective investigations to determine more definitively the roles of adrenal (and gonadal) steroids in subsets of RA patients and unaffected susceptible persons in the population.
11861275 Bone marrow progenitor cell reserve and function and stromal cell function are defective i 2002 Mar 1 Based on previous reports for impaired hematopoiesis in rheumatoid arthritis (RA), and in view of the current interest in exploring the role of autologous stem cell transplantation (ASCT) as an alternative treatment in patients with resistant disease, we have evaluated bone marrow (BM) progenitor cell reserve and function and stromal cell function in 26 patients with active RA. BM progenitor cells were assessed using flow cytometry and clonogenic assays in short-term and long-term BM cultures (LTBMCs). BM stroma function was assessed by evaluating the capacity of preformed irradiated LTBMC stromal layers to support the growth of normal CD34(+) cells. We found that RA patients exhibited low number and increased apoptosis of CD34(+) cells, defective clonogenic potential of BM mononuclear and purified CD34(+) cells, and low progenitor cell recovery in LTBMCs, compared with healthy controls (n = 37). Patient LTBMC stromal layers failed to support normal hematopoiesis and produced abnormally high amounts of tumor necrosis factor alpha (TNF alpha). TNF alpha levels in LTBMC supernatants inversely correlated with the proportion of CD34(+) cells and the number of colony-forming cells, and positively with the percentage of apoptotic CD34(+) cells. Significant restoration of the disturbed hematopoiesis was obtained following anti-TNF alpha treatment in 12 patients studied. We concluded that BM progenitor cell reserve and function and BM stromal cell function are defective in RA probably due, at least in part, to a TNF alpha-mediated effect. The role of these abnormalities on stem cell harvesting and engraftment in RA patients undergoing ASCT remains to be clarified.
15670444 Use of complementary therapies among primary care clinic patients with arthritis. 2004 Oct INTRODUCTION: Use of complementary and alternative medicine (CAM) for chronic conditions has increased in recent years. There is little information, however, on CAM use among adults with clinic-confirmed diagnoses, including arthritis, who are treated by primary care physicians. METHODS: To assess the frequency and types of CAM therapy used by Hispanic and non-Hispanic white women and men with osteoarthritis, rheumatoid arthritis, or fibromyalgia, we used stratified random selection to identify 612 participants aged 18-84 years and seen in university-based primary care clinics. Respondents completed an interviewer-administered survey in English or Spanish. RESULTS: Nearly half (44.6%) of the study population was of Hispanic ethnicity, 71.4% were women, and 65.0% had annual incomes of less than 25,000 dollars. Most (90.2%) had ever used CAM for arthritis, and 69.2% were using CAM at the time of the interview. Current use was highest for oral supplements (mainly glucosamine and chondroitin) (34.1%), mind-body therapies (29.0%), and herbal topical ointments (25.1%). Fewer participants made current use of vitamins and minerals (16.6%), herbs taken orally (13.6%), a CAM therapist (12.7%), CAM movement therapies (10.6%), special diets (10.1%), or copper jewelry or magnets (9.2%). Those with fibromyalgia currently used an average of 3.9 CAM therapies versus 2.4 for those with rheumatoid arthritis and 2.1 for those with osteoarthritis. Current CAM use was significantly associated with being female, being under 55 years of age, and having some college education. CONCLUSION: Hispanic and non-Hispanic white arthritis patients used CAM to supplement conventional treatments. Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessments and treatment planning.
12915153 Genetics in rheumatoid arthritis. 2003 Oct This chapter reviews the latest original research on the genetics of rheumatoid arthritis (RA), with a focus on its relevance for the clinical rheumatologist. The following questions will be dealt with in order to appreciate the recent progress in this field. * Why is a knowledge of genetics useful for an understanding of the pathogenesis of RA? * Is a knowledge of genetic risk factors relevant for day-to-day clinical practice? * What methods are used for identifying genetic risk factors? * Which genetic regions have been identified in susceptibility to RA? * What risk factors have been identified? * What are the future prospects and research agenda?
12405019 [How I treat...rheumatoid arthritis. The arrival of a new therapeutic era: anti-tumor necr 2002 Aug Rheumatoïd arthritis (RA) is the most frequent autoimmune inflammatory arthropathy. Chronic synovial inflammation usually results in cartilage destruction, bone erosion and subsequent joint deformities with impaired physical function. These consequences are more or less delayed by standard disease-modifying antirheumatic drugs (DMARDs). A better knowledge of the basic mechanisms of the disease and new biomolecular tools led to the development of novel biological agents including TNF alpha blockers. TNF alpha is a key inflammatory cytokine that plays a critically important role in the pathogenesis of RA. TNF alpha blockers brought dramatic improvements in efficacy of RA treatment. Here we will review the pathophysiological elements of RA wich explain the therapeutic efficacy of these TNF alpha blockers and we will describe in details the molecules, Remicade (Infliximab) and Enbrel (Etanercept), wich will be very soon used in daily practice in Belgium.
12114311 Serum osteocalcin levels in premenopausal rheumatoid arthritis patients. 2002 Jun The objective of this study was to assess the occurrence of generalized bone loss in rheumatoid arthritis (RA) patients and to evaluate the factors influencing bone loss, in particular, the usefulness of bone turnover markers. Twenty-five premenopausal patients (mean age, 40 x 5 years) with active RA were compared with 27 age-matched premenopausal patients with RA but without active disease and 30 age-matched healthy premenopausal controls. Serum concentrations of osteocalcin, intact parathyroid hormone (PTH), spot urine concentrations of crosslinked N-telopeptidases of type 1 collagen (NTX), and deoxypyridinoline (DPD) were detected by ELISA and radioimmunoassay. Serum osteocalcin levels were found to be significantly lower (p < 0.001) in patients with active RA compared with patients without active RA and controls. Similarly, serum intact PTH was significantly lower (p < 0.01) in patients with active RA than in patients with RA without active disease and controls. Spot urine concentrations of NTX and DPD were significantly higher (p < 0.01) in active RA patients than in patients with nonactive RA and controls. Positive correlations between osteocalcin and marker of disease activity were found to be significant (p < 0.01). There were no significant correlations between serum intact PTH, urine concentrations of NTX and DPD, and markers of inflammation. This study suggests that generalized bone loss occurs in active RA and is characterized by an evident bone resorption correlated with the high levels of inflammation.
14657509 The impact of escalating conventional therapy in rheumatoid arthritis patients referred fo 2004 Mar OBJECTIVE: To assess the impact of escalating conventional therapy in patients with RA who satisfy BSR/NICE criteria for biologics. METHODS: A total of 308 consecutive patients referred to a tertiary centre for biological therapy between January 1999 and February 2001 were studied prospectively. They were considered by their own consultant to have failed standard therapy. Prior to biologics, conventional therapy was escalated to include combination and parenteral methotrexate treatment. Patients were assessed at 12-weekly intervals for 1 yr and therapy was changed if response was not satisfactory. The subsequently released BSR/NICE biologic eligibility criteria were applied retrospectively. Response (disease activity, disability and quality of life) to escalated therapy in those patients who did or did not satisfy current eligibility criteria were compared. RESULTS: In total, 159 satisfied BSR/NICE criteria and would have been eligible for immediate treatment with biologics [DAS28 > 5.1, failed methotrexate (20 mg/week or lower dose owing to toxicity) and one other DMARD]; however, 93 of these responded to escalated conventional therapy and did not require biologics [significant improvement (P < 0.01) in disease activity, disability and quality of life]. However, mild disease activity (DAS28 < 3.2) was only achieved in 7% of these patients at 12 months. CONCLUSIONS: Although over half the patients who satisfied standard criteria for biologics responded satisfactorily to escalated therapy, only a minority achieved mild disease activity. The savings achieved by treating with conventional therapies need to be weighed against the risk of persistent disease activity.
14969070 The Utrecht experience with different treatment strategies in early rheumatoid arthritis. 2003 Sep Since 1990 the Utrecht Rheumatoid Arthritis Cohort study group has performed several clinical trials on different treatment strategies in early rheumatoid arthritis (RA) patients. From 1990 till 1994, patients were randomly assigned to the pyramid strategy group or the early DMARD group. Patients in the early DMARD group were allocated to one of the three following treatment strategies: strategy I, starting with hydroxychloroquine (HCQ); strategy II, starting with intramuscular gold (iAU); or strategy III, starting with oral methotrexate (MTX). After one year, statistically significant advantages for the early DMARD group compared with the pyramid group were found for disability, pain, joint score, and ESR. The increase in radiological damage did not differ significantly between the two strategy groups. These first year results proved that early introduction of DMARDs is more beneficial than a delayed introduction. After 5 years, however, no prolongation of the clinical advantages in favor of the early DMARD group, as observed after one year, was found. It was found that patients assigned to the pyramid group received more intra-articular injections during the first two years; at the end of this period 75% of them used DMARDs, especially the more aggressive DMARDs. Based on the first year results, all patients were randomly assigned to one of the three treatment strategies in the early DMARD group between 1994 and 1998. Patients who started with MTX or iAU as the first DMARD demonstrated better results regarding clinical efficacy and radiological damage after 2 years. However, more patients who received iAU therapy had to discontinue their therapy compared with patients who took MTX. We therefore conclude that MTX is the DMARD of first choice and that treatment should be tailored to the individual patient.
15088299 Sjögren's syndrome with myalgia is associated with subnormal secretion of cytokines by pe 2004 Apr OBJECTIVE: To measure in vitro cytokine release from peripheral blood mononuclear cells (PBMC) and serum cytokines in patients with primary Sjögren's syndrome (SS) with and without myalgia, compared to patients with rheumatoid arthritis (RA) and healthy controls. METHODS: Sixteen women with SS (8 with myalgia, 8 without pain), 15 women with RA, and 14 healthy women were studied. PBMC were isolated and cultured. Secretion of interleukin 1 beta (IL-1 beta), IL-6, IL-10, and tumor necrosis factor-alpha (TNF-alpha) was measured in cell supernatants with or without stimulation with phytohemagglutinin, tetanus toxoid, or purified protein derivative (PPD). Enzyme-linked immunospot was used to enumerate interferon-gamma (IFN-gamma) and IL-4-secreting cells. Serum concentrations of IL-8 and IL-18 were analyzed by ELISA. RESULTS: PPD-stimulated PBMC from SS patients responded with less production of IL-10, TNF-alpha, and IFN-gamma compared to controls. Patients with SS and pain were hyporesponsive also with respect to IL-1 beta and IL-6. The generally subnormal cytokine release was statistically significant in myalgic patients with SS compared to healthy controls. Serum IL-18 was increased in both SS groups as well as in patients with RA, and the highest levels were found in myalgic patients with SS. Serum IL-8 was increased in RA but not in SS. CONCLUSION: Patients with SS, especially those with myalgia, had diminished PBMC cytokine release and increased serum IL-18. This finding suggests that impaired cytokine regulation may have pathogenetic importance for myalgia in SS.
15458960 Effects of infliximab treatment on insulin resistance in patients with rheumatoid arthriti 2005 May BACKGROUND: Tumour necrosis factor alpha (TNFalpha) may be an important mediator of insulin resistance. Infliximab is a chimeric monoclonal, high affinity antibody against the soluble and transmembrane TNFalpha, which can reduce markedly the biological activity of circulating and tissue TNFalpha and is used to treat various autoimmune disorders. OBJECTIVE: To assess the effects of infliximab infusions on insulin sensitivity in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). METHODS: 45 patients (28 with RA, 17 with AS) aged 19-74 years were studied. All patients were treated with intravenous infliximab. A complete biochemical profile was obtained before and after 6 months' treatment with infliximab. The Homoeostasis Model Assessment (HOMA) Index was used to measure insulin resistance and the Quantitative Insulin Sensitivity Check Index (QUICKI) to measure insulin sensitivity. RESULTS: In the whole study group, no significant changes of the HOMA Index or QUICKI were seen. In the tertile of patients with the highest insulin resistance, a significant decrease of the HOMA Index and increase of the QUICKI was found (p<0.01 for both). CONCLUSIONS: The results suggest that infliximab treatment may have beneficial effects on insulin sensitivity in the most insulin resistant patients with RA and AS.
14718388 Membrane glucocorticoid receptors (mGCR) are expressed in normal human peripheral blood mo 2004 Jan Glucocorticoids mediate their therapeutic actions mostly by genomic effects via cytosolic receptors, but some effects are too rapid to be mediated by changes at the genomic level. The detailed mechanisms of these nongenomic actions are still unclear. Membrane-bound glucocorticoid receptors (mGCR) have been suggested to be involved, although their physiological existence in humans so far is hypothetical. For the first time we demonstrate the existence of mGCR on monocytes and B cells obtained from healthy blood donors using high-sensitivity immunofluorescent staining. Immunostimulation with lipopolysaccharide increases the percentage of mGCR-positive monocytes, which can be prevented by inhibiting the secretory pathway. Overexpression of the human glucocorticoid receptor alpha alone is not sufficient to enhance mGCR expression. These in vitro findings are consistent with our clinical observation that in patients with rheumatoid arthritis the frequency of mGCR positive monocytes is increased and positively correlated with disease activity. We conclude that mGCR are 1) indeed physiologically present in healthy blood donors, but remained unidentified by conventional techniques due to their small number per cell and 2) actively up-regulated and transported through the cell after immunostimulation. These receptors may reflect a feedback mechanism of the organism upon immunostimulation and/or play a role in pathogenesis.
12972472 Survival and effectiveness of leflunomide compared with methotrexate and sulfasalazine in 2003 Oct OBJECTIVE: To determine the survival and clinical effectiveness of leflunomide (LEF) compared with methotrexate (MTX) and sulfasalazine (SSZ) for RA in an observational study. METHODS: An observational database of 1088 patients and 5141 patient years of DMARD treatment (2680 courses) from two academic hospitals was filtered for treatment with LEF, MTX, and SSZ. LEF treatment groups were matched for patients' age, baseline ESR, number of previous DMARDs, and hospital cohort with MTX and SSZ treatment groups. For these treatments, Kaplan-Meier analyses of time until the drug was discontinued (drug "survival"), and the effectiveness and safety of continuation of treatment, were performed. The change in disease activity markers (CRP, ESR) was compared between the groups. RESULTS: The median dose during the study increased from 10 to 15 mg MTX/week and from 1.5 to 2.0 g SSZ/day. Matched survival analysis showed better retention rates for MTX (mean (SEM) survival 28 (1) months) than for LEF (20 (1) months; p=0.001), whereas retention rates of SSZ (23 (1) months) were similar to those of LEF (p=NS). Treatments were stopped earlier because of adverse events (AEs, 3 months) than because of ineffectiveness (IE, 10 months; p<0.001). LEF and MTX were less likely to be stopped because of AEs than SSZ. LEF courses were stopped earlier for AEs (p<0.001) than MTX. CONCLUSIONS: Current dosing strategies should be re-evaluated, and coping strategies for common AEs should be investigated. This will be necessary to achieve better drug retention of LEF. At present, MTX continues to be the most effective drug in clinical practice.
12415581 Antioxidant vitamins and lipid peroxidation in patients with rheumatoid arthritis: associa 2002 Nov OBJECTIVE: We evaluated vitamin status in relation to inflammatory markers and lipid peroxidation measures in patients with rheumatoid arthritis (RA). METHODS: Thirty patients with RA and 30 controls were studied. Lipid profile, vitamin A, vitamin E, and inflammatory markers were analyzed in all subjects. Susceptibility to low density lipoprotein (LDL) oxidation was evaluated in both groups by measuring the kinetics of conjugated dienes induced by hemin. RESULTS: Patients and controls had similar lipid profiles, except with LDL cholesterol, which was lower in the patients (p < 0.05). Patients had significantly higher plasma levels of inflammatory markers with respect to controls (p < 0.01). Plasma levels of vitamin A were lower in patients, and similar levels of vitamin E were observed in both groups. Oxidative variables, measured as the different phases of conjugated diene formation, were similar in patients and controls. We found a significant inverse correlation between vitamin A, vitamin E, and secretory type II phospholipase A2 in patients. We found a positive correlation between the affinity constant of LDL binding to glycosaminoglycans (GAG), Kd-LDL, and the lag phase of LDL oxidation (p < 0.05) in patients. CONCLUSION: This report supports the hypothesis that chronic inflammation affects antioxidant vitamin levels in RA. Combined with the presence of a chronic inflammatory process and high LDL affinity for GAG, this may explain the high risk of cardiovascular disease in patients with RA.
11874987 Cleavage of denatured natural collagen type II by neutrophil gelatinase B reveals enzyme s 2002 Mar During acute inflammation, leukocytes release proteolytic enzymes including matrix metalloproteinases (MMPs), but the physiopathological mechanisms and consequences of this process are not yet fully understood. Neutrophils, the predominant leukocyte type, produce neutrophil collagenase (MMP-8) and gelatinase B (MMP-9) but not the tissue inhibitors of MMPs. After stimulation, these cells also activate MMPs chemically. In arthritic diseases, neutrophils undergo great chemoattraction to the synovium, are activated by interleukin-8, and are stimulated to release gelatinase B in vivo. Production levels and net activities of gelatinase B were found to be absent in degenerative osteoarthritis but significantly increased in rheumatoid arthritis. The cleavage sites in cartilage type II collagen by gelatinase B were determined by a combination of reverse phase high-performance liquid chromatography, Edman degradation, and mass spectrometry analysis. The analysis revealed the site specificity of proline and lysine hydroxylations and O-linked glycosylation, the cleavage specificities by gelatinase B, and the preferential absence and presence of post-translational modifications at P2' and P5', respectively. Furthermore, gelatinase B leaves the immunodominant peptides intact, which are known from studies with (autoreactive) T cells. Lysine hydroxylation was detected at a critical position for T-cell activation. These data lend support to the thesis that extracellular proteolysis and other post-translational modifications of antigenic peptides may be critical in the establishment and perpetuation of autoimmune processes.
15627197 Anti-TNFalpha therapy in rheumatoid arthritis and autoimmunity. 2006 Jan The aim of the study was to evaluate a panel of autoantibodies in patients affected by rheumatoid arthritis (RA) treated with anti-TNFalpha blockers, and to consider a different autoantibody induction effect by infliximab and etanercept; and in addition to evaluate in these cases a relationship between antinuclear antibody (ANA) titre and both C-reactive protein (CRP) and Blys levels. Fifty-four patients (8 men, 46 women, mean age 51.4 years, mean duration of disease 13.6 years) affected by refractory RA were treated with anti-TNFalpha blockers for 12 consecutive months; 43 patients were given infliximab and 11 etanercept. At baseline and every 4 months a panel of autoantibodies consisting of rheumatoid factor, antinuclear, anti-double-stranded DNA, anti-ENA, anti-mitochondrial, anti-thyroid and anti-neutrophil cytoplasmic antibodies (ANCA) was tested. At the same time CRP level was measured. Blys level was determined at baseline and after 1 year in five cases that developed a strong positivity for ANA during infliximab therapy. In 41 cases (95.3%) treated with infliximab, ANA were detected on at least one occasion, and in almost half of these cases the titre was very high, equal to or higher than 1:1.280. On the other hand, patients treated with etanercept presented ANA positivity in a lower percentage of cases and at a low titre. No correlation was found between ANA titre and CRP level; Blys level did not present a constant trend in patients who developed a very high positivity for ANA. Anti-double-stranded DNA, anti-thyroid or ANCA were found only in a few patients, in the absence of a clinical picture indicative of systemic lupus erythematosus, autoimmune thyroiditis or ANCA-associated vasculitis. A different incidence of ANA positivity was found in infliximab- and etanercept-treated RA patients; this finding might be due to the partially different method of inhibition of TNFalpha between the two drugs. Both CRP and Blys do not seem to participate in this phenomenon. Other autoantibodies were detected in a few patients, but no case of onset of new autoimmune disorders was observed.
12755020 [Osteopontin and arthritis]. 2003 May Osteopontin is an RGDS-containing protein which acts as an intercellular signaling molecule as well as a cellular attachment protein. Expression of osteopontin has been observed in the joints of patients with rheumatoid arthritis as well as osteoarthritis. However, the functions of osteopontin in such diseased articular components have not yet been elucidated. Recent investigations using knockout mice lacking osteopontin indicated that the presence of osteopontin could play a role in the development of arthritis induced by injection with monoclonal antibodies raised against type II collagen.
12790252 Effect of valued activity disability, social comparisons, and satisfaction with ability on 2003 May This longitudinal study identified a model through which function affects the psychologicalwell-being of individuals with rheumatoid arthritis (RA). Results of hierarchical linear regression analyses (N = 436) demonstrated that greater physical impairment resulted in greater disability in valued activities and engagement in unfavorable social comparisons. All 3 factors--greater physical impairment, greater disability in valued activities, and unfavorable comparison evaluations--predicted low satisfaction with abilities. Low satisfaction with abilities was the most important predictor of higher depressive symptoms and mediated the impact of physical impairment, valued activity disability, and unfavorable comparisons on depressive symptoms. Results highlight the role of personal meaning attached to changes in functional status in predicting the long-term psychological well-being of individuals with chronic illnesses such as RA.
15362003 [Alexithymia and anger in women with fibromyalgia syndrome]. 2004 Fall OBJECTIVE: Fibromyalgia syndrome is characterized by both somatic and psychic symptoms and it is suggested that psychic factors contribute to the clinical presentation of this syndrome. This study was planned to have a better understanding of fibromyalgia through elaborating the role of alexithymia and anger in the pathogenesis of this illness. METHOD: The study was carried out in the Physical Therapy and Rehabilitation outpatient clinic with 101 women with fibromyalgia syndrome, 30 women with rheumatoid arthritis and 59 healthy women with no current or past medical history. The subjects were evaluated by the Visual Analog Scale, Toronto Alexithymia Scale-20 items, Spielberger State-Trait Anger Inventory, Beck Depression Scale, Fibromyalgia Impact Questionnaire and a sociodemographic data form. RESULTS: All these groups were similar to each other in means of age, years of education, marital and economical status. In the fibromyalgia syndrome group, the scores of anxiety and anger-in were calculated significantly higher than other groups. The depression and alexithymia scores were found higher than healthy group. DISCUSSION: These findings suggest that fibromyalgia patients suffer more anxiety and anger toward oneself, which is anger-in, than rheumatoid arthritis patients. Though the patient groups were more alexithymic than the healthy group, alexitimia scores of the two patient groups were not different. This situation suggest that anger-in, which is suppressed and unexpressed anger style is a part of the fibromyalgia syndrome together as well as high anxiety.