bluuebunny/crossref_metadata_2025 huggingface dataset:
Histologic/histochemical grading system for osteoarthritic articular cartilage. Reproducibility and validity
Authors: Ostergaard Keld , Petersen Jorgen , Andersen Claus B. , Bendtzen Klaus , Salter Donald M.
Published: February 2007

Objective. To evaluate the reproducibility and validity of the histologic/histochemical grading system (HHGS) for osteoarthritis (OA) developed by Mankin and coworkers.

Methods. Sections of human articular cartilage from macroscopically normal and osteoarthritic femoral heads were graded by the HHGS (0‐14 scale) twice by 3 observers, and intra‐ and interobserver reproducibility was determined.

Results. The exact intra‐ and interobserver reproducibilities ranged from 22% to 33% and from 13% to 25%, respectively. Intra‐ and interobserver variation ranged from −7 to 5. Although scores were generally higher in cartilage from osteoarthritic joints as compared with cartilage from normal joints, the difference reached statistical significance for only 2 observers. Additionally, the average scores from all observers were within the definitive range for OA (>5) in 30% of sections from normal joints, and in only 47% of sections from OA joints.

Conclusion. The results indicate that the reproducibility and the validity of the HHGS are inadequate, and an improved histopathologic grading system for OA is needed.
Significant correlation between thrombospondin 1 and serine proteinase expression in rheumatoid synovium
Authors: Gotis‐Graham Ian , Hogg Philip J. , McNeil H. Patrick
Published: February 2007

Objective. Thrombospondin 1 (TSP1) is a potent active site inhibitor of leukocyte elastase and cathepsin G. This effect is markedly dependent on the disulfidebond conformation of TSPI, with one isoform, TSPI0.1, being the most potent. The aims of this study were to examine the expression of different disulfide‐bonded isoforms of TSP1 in inflammatory environments in which elastase and cathepsin G are present in variable amounts, and to determine the relationship between these proteinases and their potential inhibitor.

Methods. Immunohistochemical staining and histomorphometric analysis were used to examine adjacent sections of synovial tissue from patients with rheumatoid arthritis (RA), osteoarthritis (OA), and meniscal trauma (MT), for expression of TSPl and the TSPl0.1 isoform, elastase, cathepsin G, and chymase.

Results. TSPl localized to vessels and cells within the synovium. TSPl expression was highly up‐regulated in RA (mean density 98 cells and vessels / mm2, compared with 13 / mm2 in OA and 17 / mm2 in MT). The TSPl0.1 isoform was found virtually exclusively in RA, with 44% of vascular TSPl staining being due to the TSPl0.1 isoform in RA, as compared with 7% in OA (P = 0.0047). Elastase‐ and cathepsin G‐positive cells were abundant in RA, with mean densities of 106 cells / mm2 and 103 cells / mm2, respectively, compared with 2 cells / mm2 and 11 cells / mm2 in OA. There was a wide range of both TSPl and proteinase expression within the RA group, but samples containing large numbers of elastase‐ and cathepsin G‐positive cells also showed high expression of TSPl, especially TSPl0.1,. A strong correlation was found between elastase or cathepsin G densities and TSPl0.1 expression in blood vessels (r = 0.86 and r = 0.76 respectively, P < 0.01).

Conclusion. TSPl0.1, with the most potent inhibitory activity in vitro, is specifically up‐regulated in RA, and this up‐regulation is in proportion to the numbers of surrounding leukocytes containing elastase and cathepsin G. One role of TSPl may be to act as a matrix‐based regulator of leukocyte‐derived serine proteinases in vivo.
Crucial role of interleukin‐10/interleukin‐12 balance in the regulation of the type 2 T helper cytokine response in reactive arthritis
Authors: Yin Zhinan , Braun Jürgen , Neure Lucia , Wu Peihua , Liu Lanzhen , Eggens Ulrich , Sieper Joachim
Published: February 2007

Objective. To investigate whether a predominant type 1 T helper (Thl) or Th2 cytokine pattern is present in the joints of patients with reactive arthritis (ReA), and whether the cytokine pattern can be modulated by cytokines or anticytokines.

Methods. Eleven patients with ReA following infection with either Chlamydia trachomatis, Yersinia enterocolitica, or Salmonella enteritidis were investigated for the presence of Th1/Th2 cytokines in the joints. Release of the bacteria‐specific cytokines interferon‐γ (IFNγ), tumor necrosis factor α (TNFα), interleukin‐10 (IL‐10), and IL‐4 was measured in synovial fluid mononuclear cells (SFMC) using enzyme‐linked immunosorbent assay and polymerase chain reaction. In the synovial membrane, secretion of IFNγ and IL‐4 was determined by immunohistologic analysis. Cytokine regulation was studied by adding cytokines and anticytokines to the cultures.

Results. Upon stimulation with specific bacteria, SFMC secreted low amounts of IFNγ and TNFα, but high amounts of IL‐10. IL‐10 was responsible for the suppression of IFNγ and TNFα, as judged by the effect of adding either anti‐IL‐10 antibodies or exogenous IL‐10 to these cultures. The addition of neutralizing anti‐IL‐12 to the cultures completely abolished the effects of anti‐IL‐10, suggesting that inhibition of the Th1‐like cytokines by IL‐10 is mediated through suppression of IL‐12 synthesis. Exogenous IL‐12 clearly enhanced IFNγ and TNFα secretion. In the synovial membrane, a higher number of cells were positive for the Th2 cytokine IL‐4, compared with the amount of IFNγ‐secreting cells.

Conclusion. These data indicate that a Th2 cytokine pattern predominates in the joints of patients with ReA. Since Thl cytokines are necessary for the elimination of ReA‐associated bacteria, Th2 cytokines might contribute to bacterial persistence in the joint. Therefore, the IL‐10/IL‐12 balance appears to be crucial for regulation of the cytokine pattern in the joints of patients with ReA.
Mortality studies in psoriatic arthritis. Results from a single outpatient clinic. I. Causes and risk of death
Authors: Wong Katy , Gladman Dafna D. , Husted Janice , Long Jennifer A. , Farewell Vernon T. , Long Jennifer A.
Published: February 2007

Objective. To identify the causes of death and mortality risk in patients with psoriatic arthritis (PsA) who were being followed up at a single outpatient clinic in Toronto, Ontario, Canada.

Methods. Patients enrolled in the PsA Clinic between 1978 and 1993 were compared with the general population of Ontario. Deaths were identified from the clinic database and through linkage with the provincial mortality database, and causes were confirmed by death certificates. A standardized mortality ratio (SMR) was computed, based on the assumption that patients lost to followup were alive at the end of the study.

Results. Of the 428 patients with PsA (194 women and 234 men), 53 (26 women and 27 men) died. The 4 leading causes of death were diseases of the circulatory (36.2%) or respiratory (21.3%) system, malignant neoplasms (17.0%), and injuries/poisoning (14.9%). The SMR for the female cohort was 1.59, and for the men, it was 1.65, indicating a 59% and 65% increase in the death rate, respectively. Deaths due to respiratory causes were particularly increased in these patients.

Conclusion. The results suggest that this PsA Clinic outpatient population had an increased mortality risk.
Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica
Authors: Gabriel Sherine E. , Sunku Jayasimha , Salvarani Carlo , O'Fallon W. Michael , Hunder Gene G.
Published: February 2007

Objective. To evaluate the incidence and risks of adverse events associated with therapy (both corticosteroids [CS] and nonsteroidal antiinflammatory drugs [NSAIDs]) among a previously identified, populationbased cohort of patients first diagnosed with polymyalgia rheumatica (PMR) between 1970 and 1991 who were followed up over the long term.

Methods. Information on demographics, PMR diagnosis, disease course, and drug therapy, in addition to data on adverse events commonly associated with CS and NSAID treatment, was obtained from the Rochester Epidemiology Project database. Cox proportional hazards and regression analysis models were used to evaluate the relationship between the occurrence of these events and therapy.

Results. Of the 232 patients (69 male, 163 female) included in the study, the mean age at PMR diagnosis was 72.9 years, the average followup was 8.0 years, and 30 patients were also diagnosed with giant cell (temporal) arteritis. Among the 175 patients (49 male, 126 female) treated with CS, the mean duration of CS therapy was 2.4 years, the average daily dose was 9.6 mg, and the mean cumulative dose was 8.4 gm. In total, 65% of the 124 patients treated with CS alone experienced at least 1 adverse event, compared with 67% of the 57 patients treated with NSAIDs alone and 80% of the 51 patients treated with CS and NSAIDs. The average time from initiation of therapy to the first adverse event was 1.6 years (n = 160). Proportional hazards modeling identified 3 variables that independently increased the risk of adverse events: age at PMR diagnosis, a cumulative dose of prednisone ≥1,800 mg, and female sex. Person‐year analysis revealed that the risks of diabetes mellitus, vertebral fractures, femoral neck fractures, and hip fractures were 2–5 times greater among PMR patients compared with age‐ and sex‐matched individuals from the same population. Medical care or consultation by a rheumatologist was a highly significant predictor of a lower initial CS dose.

Conclusion. The use of CS and NSAIDs in the treatment of PMR is associated with important longterm morbidity.
Criteria for the diagnosis of familial mediterranean fever
Authors: Livneh Avi , Langevitz Pnina , Zemer Deborah , Zaks Nurit , Kees Salim , Lidar Tzvi , Migdal Amiel , Padeh Shai , Pras Mordechai
Published: February 2007

Objective. To establish a new set of criteria for the diagnosis of familial Mediterranean fever (FMF).

Methods. Twenty‐seven features and manifestations typical of FMF were studied to determine their prevalence in 105 patients with FMF and 106 controls. Diagnosis of FMF in the study group was based on clinical judgment. Controls were patients with a variety of other diseases who presented to the emergency room or outpatient clinics with recurrent episodes of pain in body sites usually involved in FMF attacks. Manifestations observed to be significantly more common in FMF patients than in controls were incorporated into the rule proposed for diagnosis of FMF, based on a model of major, minor, and supportive criteria.

Results. Two sets of diagnostic criteria were established. A conservative criteria set for diagnosis of FMF was based on the presence of 1 major or 2 minor criteria, or 1 minor plus 5 supportive criteria, and a simple criteria set for diagnosis of FMF required 1 major or 2 minor criteria. The sensitivity and specificity of these 2 criteria sets were >95% and >97%, respectively.

Conclusion. The proposed new sets of criteria were highly sensitive and specific, and could be used to readily diagnose FMF and to distinguish FMF from other periodic febrile diseases.
Symptomatic spinal calcinosis in systemic sclerosis (scleroderma)
Authors: Ward Mark , Curé Joel , Schabel Stephen , Smith Edwin A. , Schumacher H. Ralph , Silver Richard M.
Published: February 2007

Two patients with diffuse cutaneous systemic sclerosis and spinal calcification, involving the lumbar spine in one and the cervical spine in the other, are described. Computed tomography‐guided aspiration of the calcific masses was performed, and material aspirated from one patient was shown to be apatite, Ca5(PO4)3OH. One patient showed improvement following lumbar laminotomy, hemilaminectomy, and diskectomy.
Juvenile rheumatoid arthritis in affected sibpairs
Authors: Moroldo Marta B. , Tague B. Link , Shear Edith S. , Glass David N. , Giannini Edward H.
Published: February 2007

Objective. To describe the demographics and clinical disease in affected sibpairs (ASPs) with juvenile rheumatoid arthritis (JRA), and to compare JRA as it occurs in ASPs with that from non‐ASP JRA populations described in the literature.

Methods. A rare disease research registry was established with a focus on JRA ASPs to facilitate accrual of patients for genetic, epidemiologic, and clinical studies. Physicians likely to care for patients with JRA were made aware of the registry and its goals by a variety of methods and asked to refer patients for entry.

Results. To date, 71 ASPs have been registered and complete information has been obtained. These affected sibs differed in age by a mean of 4.1 years (SD 3.4) and in age at disease onset by 2.8 years (SD 3.0). The actual time difference between onset in sib 1 versus sib 2 averaged 4.4 years (SD 4.2). Sixty‐three percent of the sibpairs were concordant for sex, and 76% for JRA.Onset type within sibpairs did not appear to be random, based upon comparisons with non‐ASP populations. Greater than expected concordance was seen among those with pauciarticular‐onset and polyarticular‐onset JRA. Seventy‐nine percent of the pairs were concordant for course type. Seven sets of twins were included (∼10% of the total), all were concordant for onset and course type (6 sets with pauciarticular, 1 set with polyarticular), and disease onset was separated by a mean of only 3.3 months. Within the onset and course types, the clinical disease, such as the female:male ratio, age at onset, and serologic findings, in ASPs resembled that which has been described in the literature.

Conclusion. A higher than expected degree of concordance for onset type of JRA exists between sibpairs, indicating that genetic influences play a role. Affected sibs do not tend to develop their disease at approximately the same point in time, except for the twin sets. Clinical features of the disease within the various subtypes appear similar to those in non‐ASP populations.
HLA‐B27‐derived peptides as autoantigens for T lymphocytes in ankylosing spondylitis
Authors: Märker‐Hermann Elisabeth , Büschenfelde Karl‐Hermann Meyer Zum , Wildner Gerhild
Published: February 2007

Objective.To study whether peptides derived from the HLA‐B27 molecule sequence can stimulate peripheral blood T lymphocytes (PBL) from patients with HLA‐B27‐associated spondylarthropathies.

Methods.PBL from 55 HLA‐B27+ patients with ankylosing spondylitis (AS), 28 HLA‐B27+ patients with other spondylarthropathies, 7 rheumatoid arthritis patients, and 30 HLA‐B27+ and 22 HLA‐B27‐ healthy controls were tested in lymphocyte proliferation assays with 4 synthetic peptides derived from the HLA‐B*2705 molecule.

Results. A 13‐mer peptide (B27PA) induced significant proliferative responses in 17 of the 55 AS patients (stimulation index [SI] 2.5–17.5), as well as in 3 of the HLA‐B27+ healthy controls (SI 2.5–9.8). Another 13‐mer peptide (B27PC) induced PBL proliferation (SI 2.7–5.5) in 10 AS patients and in some donors of the control groups. In B27PA‐specific T cell lines, an expansion of cells positive for the γ/δ T cell receptor could be demonstrated.

Conclusion. These results indicate that HLA‐B27‐derived peptides can be recognized as autoantigens by PBL of HLA‐B27+ AS patients and B27+ healthy controls. Recent infections preceding the manifestation of AS may be involved in this process of anti‐self major histocompatibility complex reactivity.
Effects of pulse methylprednisolone on bone and marrow tissues. Corticosteroid‐induced osteonecrosis in rabbits
Authors: Yamamoto Takuaki , Irisa Takahiko , Sugioka Yoichi , Sueishi Katsuo , Yamamoto Takuaki , Irisa Takahiko , Sugioka Yoichi , Sueishi Katsuo
Published: February 2007

Objective. To investigate the effects of pulse methylprednisolone acetate on bone and bone marrow tissues and to clarify the causal factors of corticosteroidinduced osteonecrosis (ON) by using an experimental animal model.

Methods. Male adult Japanese white rabbits were injected once with 20 mg/kg of methylprednisolone into the right gluteus medius muscle. Seven rabbits were killed at 4 weeks, 4 at 6 weeks, 4 at 8 weeks, and 6 at 10 weeks. Both histopathologic and hematologic studies were performed every week.

Results. By 4 weeks after the steroid injection, 43% of the rabbits studied had developed multifocal ON lesions in the femur and/or humerus. In 1 rabbit, a thrombus was detected in an arteriole adjacent to the necrotic area at 4 weeks. After 6 weeks, there was also progressive histologic evidence of revascularization, with granulation tissue, and osteoblastic repair, with appositional bone formation. Hyperlipemia, fatty liver, and intraosseous fat embolism were observed in conjunction with thrombocytopenia and hypofibrinogenemia.

Conclusion. A single injection of high‐dose corticosteroids was found to be capable of inducing thrombocytopenia, hypofibrinogenemia, and hyperlipemia with multifocal ON in several bones.
Circulating plasma levels of nucleosomes in patients with systemic lupus erythematosus. Correlation with serum antinucleosome antibody titers and absence of clear association with disease activity
Authors: Amoura Zahir , Piette Jean‐Charles , Chabre Henri , Cacoub Patrice , Papo Thomas , Wechsler Bertrand , Bach Jean‐François , Koutouzov Sophie
Published: February 2007

Objective. To assess nucleosome plasma levels in patients with systemic lupus erythematosus (SLE) and to study the correlations with serum antinucleosome, anti‐double‐stranded DNA (anti‐dsDNA), and antihistone antibody activities, as well as with disease activity (by the SLE Disease Activity Index [SLEDAI]).

Methods. In a cross‐sectional study, we assessed 58 SLE patients for their plasma nucleosome levels. Plasma nucleosome levels as well as serum antinucleosome, anti‐double‐stranded DNA, and antihistone antibody activities were assessed by enzyme‐linked immunosorbent assay. SLE activity was evaluated using the SLEDAI.

Results. The mean (± SD) plasma nucleosome concentration in SLE patients was 52 ± 159 ng/ml (range 5–1,180), and was significantly higher than that of the controls (16 ± 8.8 ng/ml, range 8–52; P = 0.03). Thirteen of the 58 lupus patients had levels over the range of normal (defined as the control mean + 3 SD, or 42 ng/ml). An inverse correlation was found between nucleosome plasma levels and serum antinucleosome antibody activity in the entire group of SLE patients, those with active disease, and those with inactive disease, respectively. No correlation was found between the SLEDAI and nucleosome plasma concentrations.

Conclusion. Nucleosome plasma levels may be normal or increased in SLE, and found in patients with active or inactive SLE. Longitudinal studies are needed to further establish whether high levels of circulating nucleosomes may predict the occurrence of an SLE flare.
Esophageal dysfunction in scleroderma. Relationship with disease subsets
Authors: Bassotti Gabrio , Battaglia Edda , Debernardi Valeria , Quiriconi Fabrizio , Dughera Luca , Buonafede Giuseppina , Puiatti Paolo , Mioli Pier Roberto , Emanuelli Giorgio , Germani Ugo , Morelli Antonio , Spinozzi Fabrizio
Published: February 2007

Objective. To investigate the relationship between esophageal function and the extent of disease in a nonselected group of scleroderma patients, and to study gastric and small bowel motility in a group of scleroderma patients with more severe clinical manifestations.

Methods. Esophageal function in 125 scleroderma patients was investigated by radiologic, endoscopic, manometric, and pH‐metric techniques. Ten patients also underwent gastrointestinal (GI) manometric recording, both during fasting and after a standard meal.

Results. Radiologic abnormalities of the esophagus were found in 55 of 81 patients (68%) and esophagitis in 45 of 125 (36%). No significant relationship was disclosed between GI symptoms, radiologic abnormalities, esophagitis grade, and the various disease subsets. However, the overall incidence of endoscopic esophagitis (irrespective of the degree) was significantly (P < 0.05) correlated with the patient subgroups, with 100% incidence of esophagitis in those having the more severe cutaneous involvement (type III). Manometric abnormalities were documented in 80% of patients, and pathologic reflux in 78%. The severity of esophageal abnormalities on manometry significantly correlated with the severity of the disease, whereas no correlations were found with pH‐metric data. Ninety percent of the 10 female patients undergoing antroduodenal manometry displayed abnormal findings; of these, 60% showed neuropathic, and 30% myopathic, patterns. The latter were recorded in patients with a more severe stage of the disease (type III).

Conclusion. A direct relationship was observed between scleroderma subsets and the severity of esophageal (and, probably, more distal gut) motor involvement. Since no correlation was found between esophageal symptoms and the severity of manometric abnormalities, manometry should be considered the single most important GI test to document the severity of the “esophageal” disease. Gastric and small bowel manometry may also offer evidence of widespread gut involvement, and provide a rationale for a more targeted therapeutic approach.
A case of spontaneous femoral neck fracture associated with multicentric reticulohistiocytosis. Oversecretion of interleukin‐1β, interleukin‐6, and tumor necrosis factor α by affected synovial cells
Authors: Nakamura Hiroshi , Yoshino Shinichi , Shiga Hiroo , Tanaka Hidekazu , Katsumata Shinichi
Published: February 2007

We describe a case of left femoral neck fracture associated with multicentric reticulohistiocytosis (MR). Biopsy specimens from a skin nodule and from synovial tissue showed histiocytic multinucleated giant cells (MR cells) that are characteristic of MR. A surgical specimen from the resected femoral head revealed that multinucleated giant cells and mononuclear cells invaded the marginal subchondral bone, without evident pannus. These cells also infiltrated into the fracture site, with bone resorption by activated osteoclasts. Immunohistochemical studies of synovium from the left hip joint showed positive staining for interleukin‐1β (IL‐1β), IL‐6, and tumor necrosis factor α, and abundant cytokine production by cultured synovial cells was demonstrated. These findings suggest that the subchondral invasion and intramedullary infiltration by MR cells caused articular destruction and/or fracture as a result of oversecretion of the cytokines.
Functional ability and work status in patients with fibromyalgia
Authors: Cathey Mary Ann , Wolfe Frederick , Kleinheksel Sue M.
Published: February 2007

To assess functional ability in fibromyalgia patients, we examined 28 patients during the performance of five standardized work tasks (SWT), and compared their performance to 26 RA patients and 11 healthy community controls. Fibromyalgia patients performed 58.6% and RA patients 62.1% of the work done by normals. Work performance was strongly associated with pretest Stanford Health Assessment Disability Index (HAQ) scores (r = 0.705), but also with pain, global severity, and psychologic status in both RA and fibromyalgia groups. We also examined work status in 176 fibromyalgia patients. Sixty percent were employed, 9.6% considered themselves disabled, but only 6.2% received disability payments (none for the specific diagnosis of fibromyalgia). Thirty percent of patients had changed jobs because of this illness. Functional ability is impaired in Fibromyalgia. SWT and the HAQ disability instrument may be effective in the clinical assessment of fibromyalgia.
Static wrist splint: Its effect on hand function in three women with rheumatoid arthritis
Authors: Backman Catherine L. , Deitz Jean C.
Published: February 2007

The effect of a static wrist splint on strength (grip and pinch), applied strength (pouring water, lifting groceries), and applied dexterity (writing, manipulating coins) was examined using a single‐subject, alternating‐treatments design. A aseline phase was followed by an intervention phase in which splint and no‐splint conditions were alternated and counterbalanced. Three women with rheumatoid arthritis (RA) entered the study. Data for each subject on each measure of hand function were plotted on graphs and analyzed visually for changes in level, trend, and variability. The results suggested that for women with RA a static wrist splint is useful in improving hand strength, but may hinder the wearer's ability to perform some fine motor tasks.
Effect of iontophoretically delivered dexamethasone on muscle performance in a rheumatoid arthritic joint. A case study
Authors: Hasson Scott M. , English Susan E. , Daniels Jerry C. , Reich Miles
Published: February 2007

Dexamethasone is a corticosteroid that has been used to decrease inflammation and pain in inflammed joints. The method of delivery has conventionally been through joint injection. The subject (female, age 36) in this investigation, has a 2‐year history of rheumatoid arthritis in the wrists, knees, ankles, and feet. The joints treated in this study were the knees, and a double‐blind procedure was utilized to determine the experimental (E) (dexamethasone and lidocaine) left; versus the control (C) (lidocaine only) right. Treatment consisted of iontophoresis onto the knee joint; and then repeated on the other knee joint, three times a week over an 8‐week period. Prior to the initial treatment session baseline data were collected for peak torque (knee extension [KE] at high omnikinetic resistance (PT); KE angular velocity at low resistance (AV); and total KE work at low resistance (20 repetitions). The subject was subsequently reassessed at 2 weeks, 4 weeks, 6 weeks and 8 weeks. The results, (E vs. C, percentage change from baseline to 8 weeks): PT (20.8% vs. −6.7%); AV (22.3% vs. 13.4%); and TW (54.0% vs. 17.2%). The results indicate that delivery of dexamethasone via electrical current may be effective in improving muscle/joint performance in a patient with rheumatoid arthritis.
Rheumatoid arthritis patients and clinical drug trials A case‐control study
Authors: Austin Janet S. , Ambros Richard F. , Young Peggy K. , Moreland Larry W. , Anthony Saway P. , Alarcón Graciela S.
Published: February 2007

In order to understand better why patients do or do not participate in clinical drug trials, we sent questionnaires to 100 patients with rheumatoid arthritis (RA) who participated in clinical drug trials at our center and to 100 RA patients with similar disease durations who did not participate in clinical drug trials at our center. We compared demographic, so‐cioeconomic, and clinical characteristics of respondents. Those who participated and those who did not participate in clinical drug trials selected similar rank‐order preferences of potential reasons for doing so. The most frequent reasons cited by participants and nonparticipants were physician recommendation (50% and 56%) and benefit to society (25% and 17%). Participants and nonparticipants were similar in reference to their age, sex, educational level, reported income per household, employment status, distance from the medical center, disease duration, number of tender joints, American Rheumatism Association functional class, and mean erythrocyte sedimentation rate variables. There were two differences between the groups: participants included a lower percentage of blacks and had a greater number of swollen joints. Even with those exceptions, we concluded that participants in clinical trials appear to be comparable to the general population of RA patients followed at our outpatient department.
Hip fracture in older persons does self‐efficacy‐based intervention have a role in rehabilitation?
Authors: Allegrante John P. , Ronald MacKenzie C. , Robbins Laura , Cornell Charles N.
Published: February 2007

Over 250,000 patients are hospitalized each year in the United States for treatment of a fractured hip, resulting in considerable medical, social, and economic costs to society. Most hip fractures occur among older persons who have fallen. The consequences of hip fractures due to falls by older persons include loss of confidence and the accompanying deterioration in global functional capacity for independent living. This article reviews the problem of hip fracture in the elderly and suggests that intervention approaches designed to enhance personal self‐efficacy through patient education may have an important role to play in rehabilitation after hip fracture.
Psychosocial effects of juvenile rheumatic disease the family and peer systems as a context for coping
Authors: Harris Jennifer A. , Newcomb Andrew F. , Gewanter Harry L.
Published: February 2007

The psychosocial effects of juvenile rheumatic diseases and disease activity were examined among 24 children and their families (12 children with a rheumatic disease and 12 children with no chronic illness). Each child with rheumatic illness was paired with a healthy control child nominated by their classroom teacher. Family and child functioning was assessed through measures of competence, coping, and adjustment and through direct observation of social functioning with peers at school. Multivariate and univariate analyses were performed to examine scores on the assessment measures, percentages of time spent in peer activities, and frequency scores for types of peer interactions. The results of these analyses indicated that juvenile rheumatic disease (JRD) is not associated with detrimental psychosocial outcomes. Instead, the results indicated that JRD children and their families actively utilize multiple coping strategies. These findings stress the importance of including and examining the family and peer systems as contexts for coping in future research.
Immediate and short‐term effects of three commercial wrist extensor orthoses on grip strength and function in patients with rheumatoid arthritis
Authors: Stern Erica B. , Ytterberg Steven R. , Krug Hollis E. , Mullin Gerald T. , Mahowald Maren L.
Published: February 2007

Objective. To investigate the immediate and shortterm effects of 3 commercial wrist orthoses on grip strength and function.

Methods. Thirty‐six patients with definite rheumatoid arthritis participated in the randomized, controlled, cross‐over design study of 3 commercial wrist extensor orthoses. Dominant‐hand dynamometric grip strength was assessed at both initial and followup sessions while splinted and nonsplinted. Functional impact was assessed using a written questionnaire.

Results. All 3 commercial orthoses reduced grip strength when first donned. After a 1‐week adjustment period, one orthosis, the Smith and Nephew Roylan D‐Ring® (Roylan), afforded splinted grip strength equal to that of the nonsplinted grip strength. The other 2 orthoses continued to reduce grip strength, and afforded splinted grip strength significantly below that of the Roylan. The Roylan was deemed comfortable by more subjects than the other orthoses.

Conclusions. The belief that commercial orthotic use increases grip strength, either immediately or after 1 week, is not supported by this study's data. Different styles of commercial wrist orthoses appear to have differing influence on splinted grip strength.
The effect of person‐centered counseling on the psychological status of persons with systemic lupus erythematosus or rheumatoid arthritis. A randomized, controlled trial
Authors: Maisiak Richard , Austin Janet , West Susan , Heck Louis
Published: February 2007

Objective. We tested the effectiveness of a 6‐month person‐centered (PC), nondirective, telephone‐based counseling intervention for improving the psychological status of persons with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA).

Methods. The design was a parallel‐group, randomized, controlled study comparing a PC counseling intervention (8 SLE, 28 RA patients) with usual care (7 SLE, 30 RA patients). The Arthritis Impact Measurement Scales was used to measure psychological dysfunction, physical dysfunction, and pain at baseline and at followup.

Results. The main finding was that the PC counseling intervention significantly improved the psychological status of the SLE patients (P < 0.05, effect size = 1.13, responsiveness = 0.77) in comparison to usual care. There was no evidence of a benefit for persons with RA or of improvements in physical function or pain for persons with either disease.

Conclusions. PC counseling may be an effective intervention for improving the psychological status of persons with SLE, but may not be for those with RA.
Differences in symptom reports between men and women with rheumatoid arthritis
Authors: Katz Patricia P. , Criswell Lindsey A.
Published: February 2007

Objective. To determine if differences exist between men and women in their reports and evaluations of rheumatoid arthritis (RA) symptoms, and, if so, to identify explanations for those differences.

Method. Data from a longitudinal panel study of persons with RA were used. Symptom reports were defined as individuals' evaluations of body states, e.g., evaluations of the severity of pain. Analyses were controlled for sociodemographic, clinical, and psychological characteristics.

Results. In unadjusted analyses, women were more likely to evaluate their symptoms as severe. Adjustment for sociodemographic and clinical characteristics changed these results very little. Controlling for depressive symptoms decreased the magnitude of associations somewhat. Analyses controlling for additional respondent‐reported clinical characteristics (Health Assessment Questionnaire score, number of painful joints) yielded dramatically different results; in no case did women evaluate their symptoms significantly more severely than men.

Conclusion. Our analyses suggest that women reported more severe symptoms, but that these differences may be due to more severe disease rather than a tendency by women to over‐report symptoms or overrate symptom severity. Future research should examine whether physicians respond to reports or prescribe treatments differently for men and women.
Racial aspects of comorbidity in systemic lupus erythematosus
Authors: Walsh Stephen J. , Algert Charles , Rothfield Naomi F.
Published: February 2007

Objective. To investigate racial differences in the expression of systemic lupus erythematosus (SLE) by comparing comorbidity at death among individuals with SLE.

Methods. Proportional mortality rates were estimated for common contributing causes of death among white and black females in the United States, 1989–1991, whose death certificates listed SLE as an underlying or contributing cause. Logistic regression analysis was used to assess the effects of SLE and race on variation in proportional mortality using rates from non SLE deaths as a comparison baseline.

Results. Common contributing causes of death listed with SLE included conditions that are known sequelae of the disease. Proportional mortality rates for these conditions varied with race and age. However, among black deaths that listed SLE, the rates of renal disease surpassed those of all other conditions regardless of age. When rates of renal disease among black SLE deaths or among white SLE deaths in any age group were compared to those among white non‐SLE deaths, proportional mortality ratios were significantly greater than 1. This also held when rates of renal disease among black non‐SLE deaths were compared to rates among white non‐SLE deaths. However, across all ages, the proportional mortality ratios for renal disease in black SLE deaths significantly exceeded corresponding ratios for white SLE deaths and for black non‐SLE deaths.

Conclusion. Black females who die with SLE appear to experience a combination of the excess renal disease reported for persons with SLE and for all blacks. This combination may be a source of the elevated SLE mortality rates observed among US blacks.
Nutrient intake patterns, body mass index, and vitamin levels in patients with rheumatoid arthritis
Authors: Morgan Sarah L. , Anderson Ashley M. , Hood Sara M. , Matthews Patricia A. , Lee Jeannette Y. , Alarcón Graciela S.
Published: February 2007

Objective. To assess nutrient intakes and vitamin levels in 79 patients with rheumatoid arthritis participating in a trial and to determine whether changes in body mass index were associated with changes in disease activity.

Methods. This study evaluated baseline vitamin levels, 1‐day dietary intakes, and weight every 3 months for 1 year. Linear regression analysis was used to evaluate the relationship of time to body mass index. Analysis of covariance was used to determine if body mass index, time, or treatment had an effect on disease activity.

Results. Deficient vitamin levels and poor nutrient intake patterns were prevalent in the study population. Changes in body mass index over time did not correlate with changes in disease activity.

Conclusions. Rheumatoid arthritis patients are at high risk of obesity, abnormal vitamin levels, and poor nutrient intakes. Changes in body mass index failed to correlate with changes in disease activity.
The importance of enhancing self‐efficacy in rheumatoid arthritis
Authors: Smarr Karen L. , Parker Jerry C. , Wright Gail E. , Stucky‐Ropp Renée C. , Buckelew Susan P. , Hoffman Robert W. , O'Sullivan Frank X. , Hewett John E.
Published: February 2007

Objective. To examine relationships among changes in self‐efficacy and changes in other clinically relevant outcome measures.

Method. Subjects (n = 44) were participants in a prospective, randomized stress‐management study followed over 15 months. Outcome measures included self‐efficacy, depression, pain, health status, and disease activity.

Results. Correlational analyses revealed significant associations between changes in self‐efficacy (particularly total self‐efficacy) and changes in selected measures of depression, pain, health status, and disease activity. The observed associations were not due to changes in medication regimen or to nonadherence to the stress‐management program.

Conclusions. Evidence is provided that induced changes in self‐efficacy following a stress‐management program were significantly related to other clinically important outcome measures.
Correlates of fear of falling and activity limitation among persons with rheumatoid arthritis
Authors: Fessel Karen D. , Nevitt Michael C.
Published: February 2007

Objectives. To examine factors associated with fear of falling, activity limitation due to fear of falling, and how persons modified their activities in response to fear of falling, among older persons with rheumatoid arthritis (RA).

Methods. Participants in a panel study of RA who were over age 50 (n = 570) were questioned about whether they experienced fear of falling and whether and how they limited activities due to fear of falling.

Results. Fifty percent reported fear of falling, and 38% modified activities due to fear of falling. Correlates of fear of falling included female gender, depressive symptoms, poor physical functioning, minor fall‐related injuries, and a greater number of painful joints. Correlates of limiting activities due to fear of falling included worse self‐rated health, poor physical functioning, and high painful joint count. Activities commonly affected included stair climbing, walking, and outings.

Conclusions. Fear of falling and limiting activities are common problems for persons with RA. Persons at risk should be targeted for appropriate interventions.
Illness behavior in rheumatoid arthritis
Authors: Sakalys Jurate A.
Published: February 2007

Objective. To explore prediagnostic illness behavior in rheumatoid arthritis (RA).

Method. In this descriptive study, interview and medical records data from 50 female patients were analyzed using quantitative and qualitative techniques.

Results. Findings revealed a high incidence of symptom normalization, self‐treatment, symptom comparison, and prolonged time to diagnosis with multiple misdiagnoses and physicians consulted. Most subjects reported invalidation of initial symptoms, multifaceted emotional distress, and relief upon accurate diagnosis. Significant associations were found between (a) illness‐related symptom attributions and fewer physicians consulted (P < 0.05) and less invalidation (P < 0.05); (b) life stress events and fewer physicians consulted (P < 0.05) and shorter time to diagnosis (P < 0.05); (c) remissions and time to diagnosis (P < 0.05), number of physicians consulted (P < 0.001), and number of misdiagnoses (P < 0.001).

Conclusion. Illness behavior in RA is prolonged, convoluted, and accompanied by personal and social stress. Invalidation of reported symptoms and relief upon definitive diagnosis are prominent features of the process.
Coordinated individual education with an arthritis passport for patients with rheumatoid arthritis
Authors: Riemsma Robert P. , Taal Erik , Brus Herman L. M. , Rasker Johannes J. , Wiegman Oene
Published: February 2007

Objective. To evaluate the effects of a program for individual education in combination with the use of an arthritis passport.

Methods. We studied 3 groups of patients with rheumatoid arthritis. The first experimental group received educational materials and followed the program under the guidance of their regular providers of health care whose activities were coordinated through arthritis passports. The second experimental group only received education materials; the control group received only usual care.

Results. There were no effects on self‐efficacy expectations, knowledge, health status, or behavior in either experimental group. Opinions of general practitioners, physiotherapists, and visiting nurses concerning the arthritis passport were very positive, but rheumatologists' opinions were not. Opinions on coordination of care were more positive among the physiotherapists of the experimental group.

Conclusions. Individual education for patients with rheumatoid arthritis by health care providers during routine consultations, as implemented in this program, had no effect on self‐efficacy expectations, knowledge, health status, or health behavior. Likewise, the distribution of educational materials by itself without the involvement of health care providers had no effect. The use of the arthritis passport improved coordination of care, especially for physiotherapists.
Measures of activity and damage in rheumatoid arthritis: Depiction of changes and prediction of mortality over five years
Authors: Callahan Leigh F. , Pincus Theodore , Huston Joseph W. , Brooks Raye H. , Nance E. Paul , Kaye Jeremy J.
Published: February 2007

Objective. To analyze various quantitative measures of inflammatory activity and joint damage, including articular, radiographic, laboratory, questionnaire, and physical function measures, in regard to changes in status in surviving patients and prediction of mortality in non‐survivors over 5 years in a cohort of patients with rheumatoid arthritis (RA) monitored in the mid‐1980s and early 1990s.

Methods. A comprehensive evaluation, which included a complete joint count, radiograph, laboratory tests, physical measures of function, and self‐report questionnaire scales, was performed at baseline and 5 years later in 210 consecutive patients with RA.

Results. Five years after baseline, 206 of the 210 patients were accounted for: 37 had died, 130 had a comprehensive repeat assessment, and 39 had a more limited repeat assessment. In surviving patients, most measures of activity were generally unchanged or somewhat better, including joint tenderness, pain on motion, and swelling; erythrocyte sedimentation rate and rheumatoid factor; as well as questionnaire scores for pain, global status, helplessness, and difficulty in performing 8 activities of daily living (ADL) according to a modified Health Assessment Questionnaire (MHAQ). By contrast, measures of damage, including joint deformity, grip strength, walk time, and radiographic scores, indicated worse status. Mortality over 5 years was predicted significantly in univariable analyses by American College of Rheumatology (formerly the American Rheumatism Association) Functional Class, limited joint motion, scores for MHAQ, global status, helplessness, grip strength, walk time, button time, and number of comorbidities and duration of diseases, as well as the sociodemographic measures of age and formal education. In multivariable Cox regressions, age, comorbidities, MHAQ, and other measures of functional status were the most effective predictors of 5‐year mortality.

Conclusion. In patients with RA, most measures of inflammatory activity were unchanged and sometimes better, while measures of damage indicated worse status in the same patients over 5 years. Measures indicating functional disability, as well as age and comorbidities, predict 5‐year mortality more effectively than radiographic and laboratory data. Measures of inflammatory activity may underestimate long‐term outcomes in RA, and long‐term studies should include measures of damage.
The stresses of rheumatoid arthritis: Appraisals of perceived impact and coping efficacy
Authors: Katz Partricia P.
Published: February 2007

Objective. This study examined appraisals of the impact of 7 stressors associated with rheumatoid arthritis (RA) and the perceived ability to cope With those stressors.

Methods. Subjects were 446 participants in a panel study of persons with RA. Data were derived from the 1994 annual interview.

Results. There were significant differences among mean ratings of the stressors. Taking care of RA, fatigue, pain, and functional impairment were rated as having the greatest impact; perceived coping efficacy was highest for medication side effects and taking care of RA. Appraisals of impact and coping efficacy were negatively correlated. Clinical factors were the strongest predictors of both appraisals. Depressive symptoms and instrumental support were also independently associated with both appraisals for most stressors.

Conclusions. All of the stressors were problematic to some degree, suggesting that coping research should include stressors other than pain and function. Most subjects rated the effects of these stressors as moderate, however. Future examination of the coping responses of these individuals may shed light on adaptation to RA.
Treating disability in knee osteoarthritis with exercise therapy: A central role for self‐efficacy and pain
Authors: Rejeski W Jack , Martin Kathleen , Ettinger Walter H. , Morgan Timothy
Published: February 2007

Objective. To examine the effects of aerobic and resistance exercise on self‐efficacy beliefs in older adults with knee osteoarthritis [OA] and to determine whether self‐efficacy and knee pain mediated the effects of the treatments on stair time performance and health perceptions.

Methods. Measures of self‐efficacy knee pain, stair climbing performance, and health perceptions were collected prior to randomization and again at an 18‐month follow up in older adults with knee OA who were assigned to 1 of 3 treatment conditions: aerobic exercise, resistance training, or health education control. All analyses were conducted on the intention‐to‐treat principle.

Results. Both exercise treatments increased self‐efficacy for stair climbing in comparison to the health education control group. Both knee pain and self‐efficacy mediated the effect of the treatments on stair climb time, whereas only knee pain mediated health perceptions.

Conclusions. The findings suggest that control beliefs and changes in physical symptoms such as knee pain are important outcomes in physical activity programs with patients who have OA of the knee. Moreover, these variables mediate the effects that such programs have on disability and health perceptions.