bluuebunny/crossref_metadata_2025 huggingface dataset:
Lymphoma in rheumatoid arthritis: The effect of methotrexate and anti–tumor necrosis factor therapy in 18,572 patients
Authors: Wolfe Frederick , Michaud Kaleb
Published: June 2004

Objective

The risk of lymphoma is increased in patients with rheumatoid arthritis (RA), and spontaneous reporting suggests that methotrexate (MTX) and anti–tumor necrosis factor (anti‐TNF) therapy might be associated independently with an increased risk of lymphoma. However, data from clinical trials and clinical practice do not provide sufficient evidence concerning these issues because of small sample sizes and selected study populations. The objective of this study was to determine the rate of and standardized incidence ratio (SIR) for lymphoma in patients with RA and in RA patient subsets by treatment group. Additionally, we sought to determine predictors of lymphoma in RA.

Methods

We prospectively studied 18,572 patients with RA who were enrolled in the National Data Bank for Rheumatic Diseases (NDB). Patients were surveyed biannually, and potential lymphoma cases received detailed followup. The SEER (Survey, Epidemiology, and End Results) cancer data resource was used to derive the expected number of cases of lymphoma in a cohort that was comparable in age and sex with the RA cohort.

Results

The overall SIR for lymphoma was 1.9 (95% confidence interval [95% CI] 1.3–2.7). The SIR for biologic use was 2.9 (95% CI 1.7–4.9) and for the use of infliximab (with or without etanercept) was 2.6 (95% CI 1.4–4.5). For etanercept, with or without infliximab, the SIR was 3.8 (95% CI 1.9–7.5). The SIR for MTX was 1.7 (95% CI 0.9–3.2), and was 1.0 (95% CI 0.4–2.5) for those not receiving MTX or biologics. Lymphoma was associated with increasing age, male sex, and education.

Conclusion

Lymphomas are increased in RA. Although the SIR is greatest for anti‐TNF therapies, differences between therapies are slight, and confidence intervals for treatment groups overlap. The increased lymphoma rates observed with anti‐TNF therapy may reflect channeling bias, whereby patients with the highest risk of lymphoma preferentially receive anti‐TNF therapy. Current data are insufficient to establish a causal relationship between RA treatments and the development of lymphoma.
Regulation of interleukin‐18 binding protein production by blood and synovial cells from patients with rheumatoid arthritis
Authors: Kawashima Masanori , Novick Daniela , Rubinstein Menachem , Miossec Pierre
Published: June 2004

Objective

To study the regulation of interleukin‐18 binding protein (IL‐18BP) production by rheumatoid arthritis (RA) or control peripheral blood mononuclear cells (PBMCs) and by RA synovial tissue cells, and to compare the levels of IL‐18BP messenger RNA (mRNA) expression in whole blood from RA patients and controls.

Methods

Unstimulated or phytohemagglutinin and phorbol myristate acetate (PHA/PMA)–stimulated PBMCs from 10 RA patients and 12 healthy controls and unstimulated or PHA/PMA‐stimulated synovial tissue cells from 8 RA patients were cultured with or without IL‐12 (1 ng/ml) and IL‐18 (5 ng/ml) alone or in combination. IL‐18BP and interferon‐γ (IFNγ) levels in supernatants were measured by enzyme‐linked immunosorbent assay. Levels of IL‐18BP and IFNγ mRNA expression in whole blood samples from 22 RA patients and 12 healthy controls were determined by quantitative reverse transcriptase–polymerase chain reaction.

Results

IL‐12 decreased the basal levels of IL‐18BP production by freshly isolated RA or control PBMCs, but increased those of synovial cells or PHA/PMA‐stimulated PBMCs. IL‐18 alone had no direct effect on IL‐18BP production by PBMCs or RA synovial cells, with or without stimulation. Unstimulated whole blood samples from RA patients showed lower levels of IL‐18BP mRNA expression than those from healthy controls.

Conclusion

The production of IL‐18BP in response to IL‐12 and IL‐18 was regulated differently in blood and synovial cells. The difference appears to be related to the level of cell activation.
Unmet demands for health care among patients with rheumatoid arthritis: Indications for underuse?
Authors: Jacobi Catharina E. , Rupp Ines , Boshuizen Hendriek C. , Triemstra Mattanja , Dinant Huibert J. , Van Den Bos Geertrudis A. M.
Published: June 2004

Objective

To assess the prevalence of unmet health care demands among rheumatoid arthritis (RA) patients, and to determine if these unmet demands indicate underuse.

Methods

A total of 679 patients with RA participated in a questionnaire survey and clinical examination. Unmet health care demands and health care use were assessed for orthopedic care, allied health care, home care, and psychosocial care. Indications for underuse were determined by comparing health outcomes of patients with unmet health care demands and of health care users.

Results

Of the 679 patients, 28.7% had an unmet demand for 1 of the 4 services: 13.4% for allied health care, 9.7% for orthopedic care, 9.4% for home care, and 6.2% for psychosocial care. Underuse of allied health care, home care and psychosocial care was observed.

Conclusion

Unmet demands for health care are frequent among RA patients. Most unmet demands indicate underuse. Health care professionals should therefore be more responsive to the demands of patients.
Knee adduction moment and development of chronic knee pain in elders
Authors: Amin Shreyasee , Luepongsak Niyom , McGibbon Chris A. , LaValley Michael P. , Krebs David E. , Felson David T.
Published: June 2004

Objective

To determine whether the adduction moment at the knee during locomotor activity contributes to the development of future chronic knee pain.

Methods

We studied 132 community‐dwelling elders who had undergone a full kinetic and kinematic motion analysis while performing 4 different activities: standing, walking, rising from a chair, and descending stairs. We contacted the participants 3–4 years after their baseline locomotion analysis and identified those who reported no knee pain at the time of motion analysis but who subsequently developed new chronic knee pain at followup. We examined whether the development of new chronic knee pain was associated with higher peak adduction moment at the knee during activities, measured at baseline.

Results

Of the 132 elders evaluated in 1995–1996, 118 (89%) were contacted in 1999. Of the 118 contacted, 80 (mean age 75 years; 78% women) had no lower extremity prosthetic joints at baseline, no known underlying inflammatory arthritis at baseline nor followup, and no baseline knee pain. At followup, 7 had developed new chronic knee pain defined as pain or stiffness on most days of the month and with walking 2 blocks or using stairs. Compared with those who did not develop knee pain, those who did develop new chronic knee pain had higher baseline adduction moments for all activities (P = 0.01), ranging from 8% higher during chair rise to 39% higher during stair descent.

Conclusion

We found that greater adduction moment at the knee during activities contributes to the development of future chronic knee pain. Our results suggest that biomechanical factors may play an important role in the pathogenesis of knee pain and should be studied further.
Normal scores for nine maneuvers of the Childhood Myositis Assessment Scale
Authors: Rennebohm Robert M. , Jones Karla , Huber Adam M. , Ballinger Susan H. , Bowyer Suzanne L. , Feldman Brian M. , Hicks Jeanne , Katona Ildy M. , Lindsley Carol B. , Miller Frederick W. , Passo Murray H. , Perez Maria D. , Reed Ann M. , Wallace Carol A. , White Patience H. , Zemel Lawrence S. , Lachenbruch Peter A. , Hayes John R. , Rider Lisa G. ,   for the Juvenile Dermatomyositis Disease Activity Collaborative Study Group
Published: June 2004

Objective

To document and evaluate the scores that normal, healthy children achieve when performing 9 maneuvers of the Childhood Myositis Assessment Scale (CMAS).

Methods

A total of 303 healthy children, 4–9 years of age, were scored as they performed 9 CMAS maneuvers. The data were then evaluated to determine whether normal scores for some maneuvers are age and sex dependent.

Results

All children were able to achieve maximum possible scores for the supine to prone, supine to sit, floor sit, floor rise, and chair rise maneuvers. All but 2 4‐year‐olds achieved a maximum possible score for the arm raise/duration maneuver. Performance of the head lift and sit‐up maneuvers varied significantly, depending primarily on age. Children in all age groups had less difficulty performing the leg lift than the head lift or sit‐up.

Conclusion

The normative data generated by this study are of value for interpreting the serial CMAS scores of children with idiopathic inflammatory myopathies.
Quality of life of people with rheumatoid arthritis as measured by the World Health Organization Quality of Life Instrument, Short Form (WHOQOL‐BREF): Score distributions and psychometric properties
Authors: Taylor William J. , Myers Julie , Simpson Russell T. , McPherson Kathryn M. , Weatherall Mark
Published: June 2004

Objective

To assess the psychometric properties, including responsiveness, of the World Health Organization Quality of Life instrument, short form (WHOQOL‐BREF) in people with rheumatoid arthritis.

Methods

A sample of 142 persons with rheumatoid arthritis were randomly selected from a regional disease register and completed questionnaires by postal survey. An additional sample of 72 consecutive inpatients completed questionnaires a few days prior to admission, the day of admission, the day of discharge, and 2 weeks following discharge.

Results

Test‐retest reliability was adequate (intraclass correlation coefficient 0.71–0.91). Internal consistency was adequate except for the social relationships domain (Cronbach's alpha 0.64–0.87). Factor structure was fairly similar to that previously reported. Correlation with other measures of quality of life was supportive of concurrent validity. Indices of responsiveness were satisfactory except for the social relationships and environment domains, although there was actually no statistical difference in the area under a receiver operating characteristic plot between the WHOQOL‐BREF domains and the Health Assessment Questionnaire.

Conclusion

The WHOQOL‐BREF has adequate psychometric properties in people with rheumatoid arthritis and should be considered a valid outcome measure for interventions that aim to improve quality of life for people with this disease.
Development and validation of Cedars‐Sinai Health‐Related Quality of Life in Rheumatoid Arthritis (CSHQ‐RA) short form instrument
Authors: Chiou Chiun‐Fang , Sherbourne Cathy D. , Ofman Joshua , Lee Martin , Lubeck Deborah P. , Paulus Harold E. , Weisman Michael
Published: June 2004

Objective

To develop an abridged version of the 33‐item Cedars‐Sinai Health‐Related Quality of Life in Rheumatoid Arthritis instrument (CSHQ‐RA) and test the validity and reliability of the abridged instrument.

Methods

Items from the original 33‐item, 5‐domain CSHQ‐RA were assessed using psychometric and regression analyses of survey responses from 274 patients with rheumatoid arthritis. Items were retained in the final instrument based on statistical analysis and evaluation by an expert panel. Test‐retest reliability, internal consistency, convergent and discriminant validity, and ceiling and floor effects were examined for the shortened CSHQ‐RA.

Results

Statistical analysis and expert assessment yielded an 11‐item instrument including questions in 4 domains. Test‐retest reliability and internal consistency were high and the instrument showed good convergent and discriminant validity.

Conclusion

The abridged CSHQ‐RA short form is a valid and reliable instrument that can be used to examine the impact of RA on patients' health‐related quality of life. Prospective validation in clinical trial settings is warranted.
Short‐term corticosteroids then lamivudine and plasma exchanges to treat hepatitis B virus–related polyarteritis nodosa
Authors: Guillevin L. , Mahr A. , Cohen P. , Larroche C. , Queyrel V. , Loustaud‐Ratti V. , Imbert B. , Hausfater P. , Roudier J. , Bielefeld P. , Petitjean P. , Smadja D. ,   The French Vasculitis Study Group
Published: June 2004

Objective

To assess the efficacy and safety of lamivudine, an antiviral agent that strongly inhibits hepatitis B virus (HBV) DNA replication, combined with plasma exchanges after short‐term corticosteroids for HBV‐related polyartertitis nodosa (PAN).

Methods

Ten patients (8 men, 2 women, mean ± SD age 50.4 ± 14.4 years) with previously untreated HBV‐related PAN were included in a multicenter, prospective, observational trial. Oral prednisone (1 mg/kg/day) was given for 1 week, then tapered and withdrawn within 1 week. Then, lamivudine (100 mg/day or less in the case of renal insufficiency) was started for a maximum of 6 months. Plasma exchanges were performed simultaneously and scheduled as follows: 3/week for 3 weeks, 2/week for 2 weeks, then 1/week until hepatitis B e antigen (HBeAg) to anti‐HBe antibody (HBeAb) seroconversion was obtained or until 2–3 months of clinical recovery was sustained. The primary trial endpoint was clinical recovery from HBV‐PAN at 6 months. The secondary endpoint was loss of detectable serum HBeAg and HBV DNA, and HBeAg to HBeAb seroconversion at 9 months.

Results

One death, attributed to catheter‐related septicemia, was recorded. At 6 months, all 9 survivors had achieved clinical recovery and by 9 months, 6 of 9 (66%) had seroconverted.

Conclusion

The strategy of short‐term steroids followed by lamivudine and plasma exchanges effectively led to recovery from HBV‐PAN. Because of its oral administration and good safety profile, lamivudine should henceforth be considered the antiviral agent of choice to treat HBV‐related PAN.
Effect of knee osteoarthritis on the perception of quality of life in Venezuelan patients
Authors: Chacón José G. , González Nancy E. , Véliz Aleida , Losada Benito R. , Paul Hernando , Santiago Luís G. , Antúnez Ana , Finol Yelitza , González María E. , Granados Isabel , Maldonado Irama , Maldonado Teolinda , Marín Francisco , Zambrano Gisela , Rodríguez Martín A.
Published: June 2004

Objective

To measure the perception of quality of life in Venezuelan patients with knee osteoarthritis and to identify those variables that may influence it.

Methods

A multicenter, cross‐sectional study of 126 mestizo patients with knee osteoarthritis recruited from 8 rheumatology centers in Venezuela. We used a Spanish‐translated version of the Arthritis Impact Measurement Scales (AIMS), as adapted in Venezuela. One‐way analysis of variance was used to compare the AIMS mean total score among subgroups of knee pain, anatomic stage, and socioeconomic status (SES); a post‐hoc test was performed to identify significant intragroup differences. Pearson's correlation coefficient was used to examine correlations between age, body mass index (BMI), disease duration, knee pain, and AIMS score. Associations between radiologic stage, SES, and AIMS scores were examined using Spearman's rank correlation. Multiple regression analysis was used to estimate predictor factors of AIMS scores.

Results

A significant correlation was found between total AIMS scores and knee pain, age, and socioeconomic status, but not with BMI, disease duration, or anatomic stage. Patients with severe knee pain differed from those with mild and moderate pain, and the highest AIMS mean total score was seen in patients within the severe knee pain subset. Patients in the highest socioeconomic levels differed from those within lowest categories. Patients classified as being at the levels of relative and critical poverty showed the highest AIMS scores. Multiple regression analysis showed that knee pain was the only variable that exerted an independent effect on the quality of life in our patients.

Conclusion

The perception of quality of life is negatively affected by increasing levels of joint pain, old age, and low socioeconomic status in Venezuelan patients with knee osteoarthritis. Our study supports the need for an early and vigorous approach to treat pain in this group of patients.
Multifaceted intervention to improve rheumatologists' management of glucocorticoid‐induced osteoporosis: A randomized controlled trial
Authors: Solomon Daniel H. , Katz Jeffrey N. , La Tourette Alison M. , Coblyn Jonathan S.
Published: June 2004

Objective

To assess the effectiveness of a multifaceted intervention to improve the management of glucocorticoid‐induced osteoporosis (GIOP).

Methods

Of 21 rheumatologists, 11 were randomly assigned to a 3‐part intervention consisting of a lecture and discussion regarding optimal management of GIOP, a confidential doctor‐specific audit regarding management of GIOP, and a reminder mailing including concise pharmacologic recommendations. The remaining 10 rheumatologists received no special education. Patients with rheumatoid arthritis (RA) taking oral glucocorticoids seen in the 2 months after the intervention were followed for 6 months. Medical records were assessed to determine the proportion undergoing bone mineral density testing or receiving pharmacologic interventions for GIOP during the 6 months before and 6 months after the intervention.

Results

There were 373 patients with RA taking oral glucocorticoids whose records were assessed. Patients in both arms of the trial were similar with respect to age, sex, menopausal status, glucocorticoid dosage and duration, duration of RA, disease‐modifying antirheumatic drug use, and the proportion with comorbid conditions. At baseline, there was no significant difference between the patients with respect to osteoporosis medication use (intervention 32% versus control 34%) or bone densitometry use (intervention 9% versus control 5%). After the intervention and a 6‐month followup period, there were no differences in treatment (intervention 33% versus control 38%) or bone densitometry use (intervention 8% versus control 8%). Adjusting for patient and physician characteristics did not significantly change these results.

Conclusion

A multifaceted intervention for GIOP, including doctor education, practice audit, and treatment suggestions, had no significant benefit on testing or treatment by rheumatologists over a 6‐month followup period. Other intervention approaches need to be tested.
A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: Evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy
Authors: Shoji Akira , Yamanaka Hisashi , Kamatani Naoyuki
Published: June 2004

Objective

To evaluate the proposed relationship between persistent reduction of serum urate into the subsaturating range and reduction in the frequency of acute gouty attacks.

Methods

We retrospectively examined data derived from 267 patients who had experienced at least 1 gouty attack before their first visit to our clinic. Serum urate concentration, history of recurrent gouty attacks, and information about antihyperuricemic drug use were collected on each visit for up to 3 years from the first visit of each patient. Data derived from visits >1 year after study entry were subjected to statistical analysis.

Results

When adjusted for baseline serum urate level and the number of gouty attacks prior to study entry, reduction of followup serum urate concentration and antihyperuricemic drug use were each significantly associated with a reduced risk of gouty attacks (odds ratio [OR] 0.42, 95% confidence interval [95% CI] 0.31–0.57; OR 0.22, 95% CI 0.10–0.47, respectively).

Conclusion

The data indicate that reduction of serum urate concentrations to 6 mg/dl or lower will eventually result in a reduced frequency or prevention of future gouty attacks.
Active but transient improvement of endothelial function in rheumatoid arthritis patients undergoing long‐term treatment with anti–tumor necrosis factor α antibody
Authors: Gonzalez‐Juanatey Carlos , Testa Ana , Garcia‐Castelo Alberto , Garcia‐Porrua Carlos , Llorca Javier , Gonzalez‐Gay Miguel A.
Published: June 2004

Objective

Cardiovascular disease is the major cause of excessive mortality in rheumatoid arthritis (RA). Atherosclerosis and RA share similar inflammatory mechanisms that include involvement of tumor necrosis factor α (TNFα). Anti‐TNFα antibody improved endothelial function in RA patients after a 12‐week treatment. The aim of the present study was to assess whether improvement of endothelial function is still effective in long‐term infliximab‐treated RA patients.

Methods

Seven RA patients (5 women; age range 25–73 years) were studied. They had been treated with infliximab for at least 1 year and were currently being treated with this drug every 8 weeks. Endothelial‐dependent and independent vasodilatation were measured by brachial ultrasonography.

Results

Following infliximab infusion, a rapid increase in the percentage of endothelial‐dependent vasodilatation was found in all patients (mean ± SD 9.4 ± 5.5% 2 days postinfusion compared with 2.8 ± 2.5% 2 days before infusion). However, values returned to baseline by 4 weeks after infusion. There were no differences in the percentage of endothelial‐independent vasodilatation prior to and after infusion. A decrease in the individual disease activity score for each patient was observed at day 7 postinfusion (P = 0.02).

Conclusion

Our study confirms an active but transient effect of infliximab on endothelial function in RA patients treated periodically with this drug. It may support long‐term use of drugs that block TNFα function to reduce the high incidence of cardiovascular complications in RA.
Systemic lupus erythematosus in a multiethnic lupus cohort (LUMINA). XVII. Predictors of self‐reported health‐related quality of life early in the disease course
Authors: Alarcón Graciela S. , McGwin Gerald , Uribe América , Friedman Alan W. , Roseman Jeffrey M. , Fessler Barri J. , Bastian Holly M. , Baethge Bruce A. , Vilá Luis M. , Reveille John D. ,   for the LUMINA Study Group
Published: June 2004

Objective

To determine the baseline factors predictive of self‐reported health‐related quality of life (HRQOL) early in the course of systemic lupus erythematosus patients (SLE) from a multiethnic LUMINA (Lupus in Minorities: Nature versus nurture) cohort.

Methods

LUMINA patients with ≥2 visits were studied. Self‐reported HRQOL was examined with the 8 subscales and 2 summary measures (the Physical Component Summary [PCS], and the Mental Component Summary [MCS]) of the Short Form 36 (SF‐36). Bivariable and multivariable analyses were done with the PCS, MCS and 8 subscales as the dependent variables. The analyses were performed including and excluding the corresponding SF‐36 measure from the independent variables. Age, sex, and ethnicity were included in all models. Time was modeled in all regressions.

Results

A total of 1,351 visits (346 patients [80 Hispanics‐Texas, 34 Hispanics‐Puerto Rico, 126 African Americans, and 106 Caucasians]) were included in these analyses. Mean ± SD PCS and MCS scores were 36.7 ± 12.0 and 46.6 ± 11.5, respectively. The scores for the eight subscales of the SF‐36 were also lower than those for the general population. Baseline SF‐36 measures were highly predictive of subsequent HRQOL. In the same set of regressions, older age was found to consistently predict poor self‐reported HRQOL whereas fibromyalgia, helplessness, fatigue, and abnormal illness‐related behaviors were also predictive, but less consistently. Estimated adjusted variances in these regressions ranged from 23% (Role‐Emotional [RE]) to 43% (Physical Functioning [PF]).

Conclusion

In patients with SLE, poor baseline HRQOL was highly predictive of subsequent poor HRQOL. Other predictive variables of poor functioning were primarily psychological/behavioral and socioeconomic‐demographic.
Survey of the use and effect of assistive devices in patients with early rheumatoid arthritis: A two‐year followup of women and men
Authors: Thyberg Ingrid , Hass Ursula A. M. , Nordenskiöld Ulla , Skogh Thomas
Published: June 2004

Objective

To identify activity limitation in early rheumatoid arthritis (RA) to detect patients needing assistive devices. To evaluate the effects of assistive devices.

Methods

A multicenter cohort of 284 early RA patients was examined using the Evaluation of Daily Activity Questionnaire 12 and 24 months after diagnosis.

Results

The extent of activity limitation was stable over time for both women and men. Most limitations concerned eating and drinking. Women reported more difficulties than did men. The use of assistive devices was related to subgroups with severe disease and more disability. Use of assistive devices reduced difficulties significantly. For both women and men, assistive devices were mostly used in activities related to eating and drinking.

Conclusion

Already 1 year after diagnosis, RA patients reported activity limitation that remained stable over time. Use of assistive devices was related to more severe disease and more pronounced disability. Use of devices reduced difficulties significantly.
Factors associated with attrition of African Americans during the recruitment phase of a clinical trial examining adherence among individuals with rheumatoid arthritis
Authors: Dunbar‐Jacob Jacqueline , Holmes Janice L. , Sereika Susan , Kwoh C. Kent , Burke Lora E. , Starz Terence W. , McCall Maura , Foley Susan M.
Published: June 2004

Objective

To examine factors contributing to the loss of potential minority participants in a study of medication adherence among rheumatoid arthritis patients.

Methods

Chi‐square statistics were used to test for differences in refusal/ineligibility by race and site at 4 screening points (initial eligibility review, initial patient contact, adherence screening, and informed consent). Differences in criteria‐specific risks for exclusion at initial eligibility review were examined across 4 sites by race. Odds ratios (95% confidence intervals) were estimated if differences were significant. Multivariate logistic regression was used to examine sociodemographic factors associated with the probability for ineligibility at the initial eligibility review. Stated reasons for refusal were qualitatively quantified.

Results

A greater percentage of African Americans were lost at every screening point when compared with whites, but only the difference at the initial eligibility review was statistically significant.

Conclusion

Factors associated with attrition included selection of area medical sites, research design issues, comorbid conditions, alcohol abuse, and being younger, unmarried, African American, and male.
Validation exercise of the Ankylosing Spondylitis Assessment Study (ASAS) group response criteria in ankylosing spondylitis patients treated with biologics
Authors: Stone Millicent A. , Inman Robert D. , Wright James G. , Maetzel Andreas
Published: June 2004

Objectives

To define what expert clinicians consider a dramatic response in ankylosing spondylitis (AS) patients treated with biologic therapies based on patient and physician assessments of global disease activity. To compare this expert clinician‐derived criteria to the Ankylosing Spondylitis Assessment Study (ASAS) Group criteria for improvement.

Methods

Forty consecutive AS patients were treated in a 1‐year open‐label protocol with infliximab. Response to treatment at week 52 was defined using ASAS response criteria. For the purpose of this exercise, improvement using ASAS criteria was defined by consensus among experts as good with 50% improvement from baseline (ASAS50) and dramatic with 70% improvement from baseline (ASAS70). Experts established separate criteria for improvement in disease activity as good or dramatic based on patient and physician global assessment of disease activity.

Results

Twelve of 40 patients met the ASAS70 criteria, however, only 8 met the expert definition of a dramatic improvement based on physician global scores and 5 met the expert definition of a dramatic improvement based on patient global assessment of disease activity. Agreement was poor between ASAS50 or ASAS70 and expert definition of improvement based on physician global scores (κ < 0.3), but agreement was moderate to good between ASAS50 or ASAS70 and expert definition of improvement based on patient global scores, (κ = 0.6–0.7).

Conclusions

Differential response experienced by AS patients treated with infliximab was adequately captured by the ASAS composite improvement criteria. Overall, this study demonstrates the validity of the ASAS criteria for the detection of improvement in AS patients treated with biologics. However, the patient global assessment of disease activity may be sufficient to monitor changes in disease activity in these patients.
High work disability rate among rheumatoid arthritis patients in Lithuania
Authors: Dadoniene Jolanta , Stropuviene Sigita , Venalis Algirdas , Boonen Annelies
Published: June 2004

Objective

To evaluate labor force characteristics among patients with rheumatoid arthritis (RA) in Lithuania. To assess if Lithuania's transition from a state‐planned to a free‐market economy after 1990 changed the employment perspectives of patients with RA.

Methods

RA patients, age 16–65 years (n = 238), were randomly selected from the RA register in Vilnius. They completed questions about sociodemographics, working status, and disease characteristics, they underwent a clinical examination, and they completed the modified Health Assessment Questionnaire and the Short Form 36.

Results

Age‐ and sex‐adjusted employment was 24.2% lower and work disability 51.7% higher in patients compared with the general population in Lithuania. After 10 years of disease, 48% of the patients had withdrawn from the labor force. In those with a paid job, the average sick leave in the past year was 31.9 days compared with the national average of 10.8 days. Although disease activity was not significantly different in employed compared with work‐disabled patients, physical function and perceived quality of life (except general health) were worse among patients with work disability. The change in economic organization in 1990 was noted to increase the risk for work withdrawal by a factor of 2.75 (95% confidence interval 1.68–4.53).

Conclusion

In Lithuania, the impact of RA on work disability is important. Although work disability in Lithuanian patients with RA seems more pronounced compared with reports from Western societies, variables associated with work disability are comparable. The transition to a market‐orientated economy in 1990 increased the risk of becoming work disabled.
Cardiovascular care and cancer screening in female nurses with and without rheumatoid arthritis
Authors: Solomon Daniel H. , Karlson Elizabeth W. , Curhan Gary C.
Published: June 2004

Objective

To compare frequencies of cancer screening and cardiovascular treatments aimed at reducing acute myocardial infarction in women with and without rheumatoid arthritis (RA).

Methods

Data from the prospective Nurses' Health Study were analyzed for the 491 women diagnosed with RA prior to 1998 and the 82,884 women without RA. Cardiovascular treatments included aspirin use, treatment with a cholesterol‐lowering agent, cardiac catheterization, and coronary artery revascularization; cancer screening consisted of mammography and bimanual pelvic examinations. Adjustments were made for potential confounders using multivariate logistic regression.

Results

After adjusting for cardiovascular risk factors, use of nonsteroidal antiinflammatory drugs, and a history of gastric or duodenal ulcer, women with RA and no history of cardiac disease were 35% less likely to report taking aspirin regularly (odds ratio [OR] 0.65, 95% confidence interval [95% CI] 0.51–0.84). The use of cholesterol‐lowering treatment, angiography, and revascularization was not statistically different in women with and without RA. After adjusting for cancer risk factors, there appeared to be an increased likelihood of mammography in women with RA compared with those without RA (OR 1.41, 95% CI 0.97–2.04), although this result was not statistically significant. Bimanual pelvic examination was reported with similar frequency between the 2 groups.

Conclusion

Other than aspirin use, care to prevent acute myocardial infarction and cancer screening practices were similar among women with RA compared with women without RA.
Could the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) be a valid measure of disease activity in patients with psoriatic arthritis?
Authors: Taylor William J. , Harrison Andrew A.
Published: June 2004

Objective

To determine whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) could be a valid indicator of disease activity in psoriatic arthritis (PsA).

Methods

Patients with PsA identified from a disease‐register and case‐note review answered a questionnaire by mail (n = 133); some patients (n = 86) consented to examination. In a second sample of 47 consecutive clinic attendees with PsA, logistic regression examined the independent contribution of BASDAI to disease activity, as judged by treatment decisions at that time.

Results

BASDAI correlated highly with patient perception of disease activity (r = 0.739) and there was no significant effect of the pattern of disease (axial or peripheral) on this relationship. However, only physician perception of disease activity was significantly associated with high or low disease activity (odds ratio 18.4, 95% confidence interval 2.9–118.3). BASDAI, patient perception, and erythrocyte sedimentation rate failed to contribute significantly to the model.

Conclusion

BASDAI performs similarly for axial and peripheral PsA but does not correlate well with external indicators of disease activity, such as treatment decisions.
Measuring quality in arthritis care: The Arthritis Foundation's quality indicator set for analgesics
Authors: Saag Kenneth G. , Olivieri Jason J. , Patino Fausto , Mikuls Ted R. , Allison Jeroan J. , MacLean Catherine H.
Published: June 2004

Objective

To develop systematically validated quality indicators (QIs) addressing analgesic safety.

Methods

A comprehensive literature review of existing quality measures, clinical guidelines, and evidence supporting potential QIs concerning nonselective (traditional) nonsteroidal anti‐inflammatory drugs (NSAIDs) and newer cyclooxygenase 2–selective NSAIDs was undertaken. An expert panel then validated or refuted potential indicators utilizing a proven methodology.

Results

Eleven potential QIs were proposed. After panel review, 8 were judged to be valid; an additional 10 were proposed by the panel, of which 7 were rated as valid. Quality indicators focused upon informing patients about risk, NSAID choice and gastrointestinal prophylaxis, and side effect monitoring.

Conclusion

The 15 validated indicators were combined, where appropriate, to yield 10 validated processes of care indicators for the safe use of NSAIDs. These indicators developed by literature review and finalized by our expert panel process can serve as a basis to compare the quality of analgesic use provided by health care providers and delivery systems.
Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor α antagonists
Authors: Bergstrom Laurie , Yocum David E. , Ampel Neil M. , Villanueva Isidro , Lisse Jeffrey , Gluck Oscar , Tesser John , Posever James , Miller Margaret , Araujo Julio , Kageyama Dana M. , Berry Martin , Karl Linda , Yung Christianne M.
Published: June 2004

Objective

To describe a group of patients who were treated with tumor necrosis factor α (TNFα) antagonists and who developed coccidioidomycosis, and to test the hypothesis that patients with inflammatory arthritis receiving TNFα antagonist therapy are at higher risk for developing symptomatic coccidioidomycosis.

Methods

Cases of coccidioidomycosis were identified and reviewed from among patients receiving TNFα antagonist therapy from May 1998 through February 2003 in 5 practices within the areas endemic for coccidioidomycosis (Arizona, California, and Nevada). In addition, the relative risk of developing symptomatic coccidioidomycosis was calculated in patients with inflammatory arthritis who were receiving treatment with infliximab, in comparison with patients with inflammatory arthritis who were not receiving infliximab, from January 2000 to February 2003 in a single medical center.

Results

Thirteen cases of documented coccidioidomycosis were associated with TNFα antagonist therapy. Twelve cases were associated with the use of infliximab and 1 case with etanercept. Among the cohort of patients from a single medical center, 7 of the 247 patients receiving infliximab and 4 of the 738 patients receiving other therapies developed symptomatic coccidioidomycosis (relative risk 5.23, 95% confidence interval 1.54–17.71; P < 0.01).

Conclusion

Patients with inflammatory arthritis who are undergoing treatment with infliximab appear to be at higher risk for developing symptomatic coccidioidomycosis as compared with those not receiving infliximab.
An architecture for effective music information retrieval
Authors: Uitdenbogerd Alexandra L. , Zobel Justin
Published: June 2004

We have explored methods for music information retrieval for polyphonic music stored in the MIDI format. These methods use a query, expressed as a series of notes that are intended to represent a melody or theme, to identify similar pieces. Our work has shown that a three‐phase architecture is appropriate for this task in which the first phase is melody extraction, the second is standardization, and the third is query‐to‐melody matching. We have investigated and systematically compared algorithms for each of these phases. To ensure that our results are robust, we have applied methodologies that are derived from text information retrieval: We developed test collections and compared different ways of acquiring test queries and relevance judgments. In this article we review this program of work, compare it to other approaches to music information retrieval, and identify outstanding issues.
Ineffective oesophageal motility does not affect the clinical outcome of open Nissen fundoplication
Authors: Munitiz V , Ortiz A , Martinez de Haro L F , Molina J , Parrilla P
Published: June 2004

Background

Nissen fundoplication is considered the ‘gold standard’ in antireflux surgery but some surgeons employ a different surgical strategy when gastro-oesophageal reflux disease (GORD) is associated with motor disorders of the oesophageal body.

Methods

Ninety-three patients undergoing surgery for GORD were divided into two groups: 52 patients (group 1) had normal oesophageal body motility and 41 (group 2) had ineffective oesophageal motility (IOM). All patients had a short Nissen fundoplication via a laparotomy. The median follow-up was 5 years in group 1 and 6·5 years in group 2.

Results

The clinical outcome was satisfactory in more than 90 per cent of the patients in both groups. Only one of ten patients with IOM and dysphagia before operation still had dysphagia after surgery. One patient in each group developed postoperative dysphagia. Six of 52 patients with normal motility and eight of 41 with IOM had persistent pathological acid reflux after surgery. Significant increases in contractile wave pressure and a decrease in the percentage of non-propagated waves were found in group 2 after fundoplication.

Conclusion

Patients with IOM did not have an increased rate of dysphagia after total fundoplication compared with those with normal motility, but they did have a higher rate of recurrence of endoscopic and pH-proven reflux.
Lanthanide Chelates Containing Pyridine Units with Potential Application as Contrast Agents in Magnetic Resonance Imaging
Authors: Platas‐Iglesias Carlos , Mato‐Iglesias Marta , Djanashvili Kristina , Muller Robert N. , Elst Luce Vander , Peters Joop A. , de Blas Andrés , Rodríguez‐Blas Teresa
Published: June 2004

A new pyridine‐containing ligand, N,N′‐bis(6‐carboxy‐2‐pyridylmethyl)ethylenediamine‐N,N′‐diacetic acid (H4L), has been designed for the complexation of lanthanide ions. 1H and 13C NMR studies in D2O solutions show octadentate binding of the ligand to the LnIII ions through the nitrogen atoms of two amine groups, the oxygen atoms of four carboxylates, and the two nitrogen atoms of the pyridine rings. Luminescence measurements demonstrate that both EuIII and TbIII complexes are nine‐coordinate, whereby a water molecule completes the LnIII coordination sphere. Ligand L can sensitize both the EuIII and TbIII luminescence; however, the quantum yields of the EuIII‐ and TbIII‐centered luminescence remain modest. This is explained in terms of energy differences between the singlet and triplet states on the one hand, and between the 0‐phonon transition of the triplet state and the excited metal ion states on the other. The anionic [Ln(L)(H2O)]− complexes (Ln=La, Pr, and Gd) were also characterized by theoretical calculations both in vacuo and in aqueous solution (PCM model) at the HF level by means of the 3–21G* basis set for the ligand atoms and a 46+4 fn effective core potential for the lanthanides. The structures obtained from these theoretical calculations are in very good agreement with the experimental solution structures, as demonstrated by paramagnetic NMR measurements (lanthanide‐induced shifts and relaxation‐rate enhancements). Data sets obtained from variable‐temperature 17O NMR at 7.05 T and variable‐temperature 1H nuclear magnetic relaxation dispersion (NMRD) on the GdIII complex were fitted simultaneously to give insight into the parameters that govern the water 1H relaxivity. The water exchange rate (k${{298\hfill \atop {\rm ex}\hfill}}$=5.0×106 s−1) is slightly faster than in [Gd(dota)(H2O)]− (DOTA=1,4,7,10‐tetrakis(carboxymethyl)‐1,4,7,10‐tetraazacyclododecane). Fast rotation limits the relaxivity under the usual MRI conditions.
Cytotoxic trans‐Oriented Platinum Complexes only Form Adducts with Single‐Stranded Oligodeoxynucleotides
Authors: Vinje Jo , Intini Francesco P. , Natile Giovanni , Sletten Einar
Published: June 2004

The reactions of the anticancer complex trans‐[PtCl2{(E)‐HNC(OMe)Me}2] (trans‐EE) with both single‐stranded and double‐stranded deoxyribonucleotides have been studied by HPLC and 2D [1H,15N] HMQC NMR spectroscopy and compared with those of cis‐[PtCl2(NH3)2] (cis‐DDP). Reactions of trans‐EE with the single‐stranded oligonucleotides d(CCTCGCTCTC) and d(CCTGGTCC) proceed rapidly through solvolysis of the starting substrate and subsequent formation of G‐N7/monochloro trans‐EE adducts. The rate of reaction is comparable to that of formation of an adduct from trans‐EE and the dinuclotide d(ApG). Quite unexpectedly, the double‐helical duplexes, d(TATGGTACCATA)2 and d(TATGGCCATA)2, with no terminal G residues, are practically inert towards trans‐EE, and only minor species (<5 % as estimated from HPLC traces) appear during 24 h reaction time. However, the duplexes d[(CCTCGCTCTC)⋅ (GAGAGCGAGG)] and d(GATAGGCCTATC)2, which contain both terminal and central G residues, undergo platination only at the terminal, solvent‐exposed, G residues, thereby confirming that the interior of the duplex is not accessible to trans‐EE due to steric hindrance. In contrast, cis‐DDP was found to bind exclusively to the central GG pair in d(GATAGGCCTATC)2.
Control of Molecular Topology and Metal Nuclearity in Multimetallic Assemblies: Designer Metallosiloxanes Derived from Silanetriols
Authors: Roesky Herbert W. , Anantharaman Ganapathi , Chandrasekhar Vadapalli , Jancik Vojtech , Singh Sanjay
Published: June 2004

Lipophilic N‐bonded silanetriol RSi(OH)3 (R=(2,6‐iPr2C6H3)N(SiMe3)) can be utilized as an effective synthon for building a variety of multimetallic assemblies containing the Si‐O‐M motif. The type of metallosiloxane synthesized—its nuclearity and its molecular topology—can be readily modulated by the choice of the metal substrate, reaction stoichiometry, and reaction conditions. It is anticipated that the synthetic principles elaborated here will allow the design of many other multifunctional synthons.
Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival
Authors: Jemal Ahmedin , Clegg Limin X. , Ward Elizabeth , Ries Lynn A. G. , Wu Xiaocheng , Jamison Patricia M. , Wingo Phyllis A. , Howe Holly L. , Anderson Robert N. , Edwards Brenda K.
Published: June 2004

BACKGROUND

The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the U.S. This year's report features a special section on cancer survival.

METHODS

Information concerning cancer cases was obtained from the NCI, CDC, and NAACCR and information concerning recorded cancer deaths was obtained from the CDC. The authors evaluated trends in age‐adjusted cancer incidence and death rates by regression models and described and compared survival rates over time and across racial/ethnic populations.

RESULTS

Incidence rates for all cancers combined decreased from 1991 through 2001, but stabilized from 1995 through 2001 when adjusted for delay in reporting. The incidence rates for female lung cancer decreased (although not statistically significant for delay adjusted) and mortality leveled off for the first time after increasing for many decades. Colorectal cancer incidence rates also decreased. Death rates decreased for all cancers combined (1.1% per year since 1993) and for many of the top 15 cancers occurring in men and women. The 5‐year relative survival rates improved for all cancers combined and for most, but not all, cancers over 2 diagnostic periods (1975–1979 and 1995–2000). However, cancer‐specific survival rates were lower and the risk of dying from cancer, once diagnosed, was higher in most minority populations compared with the white population. The relative risk of death from all cancers combined in each racial and ethnic population compared with non‐Hispanic white men and women ranged from 1.16 in Hispanic white men to 1.69 in American Indian/Alaska Native men, with the exception of Asian/Pacific Islander women, whose risk of 1.01 was similar to that of non‐Hispanic white women.

CONCLUSIONS

The continued measurable declines for overall cancer death rates and for many of the top 15 cancers, along with improved survival rates, reflect progress in the prevention, early detection, and treatment of cancer. However, racial and ethnic disparities in survival and the risk of death from cancer, and geographic variation in stage distributions suggest that not all segments of the U.S. population have benefited equally from such advances. Cancer 2004. Published 2004 by the American Cancer Society.
Expression patterns of Xenopus FGF receptor‐like 1/nou‐darake in early Xenopus development resemble those of planarian nou‐darake and Xenopus FGF8
Authors: Hayashi Shuichi , Itoh Mari , Taira Sumiko , Agata Kiyokazu , Taira Masanori
Published: June 2004

Fibroblast growth factors (FGFs) mediate many cell‐to‐cell signaling events during early development. Nou‐darake (ndk), a gene encoding an FGF receptor (FGFR)‐like molecule, was found to be highly and specifically expressed in the head region of the planarian Dugesia japonica, and its functional analyses provided strong molecular evidence for the existence of a brain‐inducing circuit based on the FGF signaling pathway. To analyze the role of ndk during vertebrate development, we isolated the Xenopus ortholog of ndk, the vertebrate FGFR‐like 1 gene (XFGFRL1). Expression of XFGFRL1/Xndk was first detected in the anterior region at the late gastrula stage and dramatically increased at the early neurula stage in an overall anterior mesendodermal region, including the prechordal plate, paraxial mesoderm, anterior endoderm, and archenteron roof. This anterior expression pattern resembles that of ndk in planarians, suggesting that the expression of FGFRL1/ndk is conserved in evolution between these two distantly diverged organisms. During the tail bud stages, XFGFRL1/Xndk expression was detected in multiple regions, including the forebrain, eyes, midbrain–hindbrain boundary, otic vesicles, visceral arches, and somites. In many of these regions, XFGFRL1/Xndk was coexpressed with XFGF8, indicating that XFGFRL1/Xndk is a member of the XFGF8 synexpression group, which includes sprouty, sef, and isthmin. Developmental Dynamics 230:700–707, 2004. © 2004 Wiley‐Liss, Inc.