bluuebunny/crossref_metadata_2025 huggingface dataset:
A reexamination of the relationship between active rheumatoid arthritis and the acquired immunodeficiency syndrome
Authors: Ornstein Matthew H. , Kerr Leslie Dubin , Spiera Harry
Published: February 2007

Three patients with rheumatoid arthritis (RA) that remitted with the development of the human immunodeficiency virus (HIV) infection have been described in the literature, and this has contributed to the belief that RA and HIV infection or the acquired immunodeficiency syndrome (AIDS) cannot coexist. However, a computerized MEDLINE literature search revealed reports of 4 patients who did have active RA and AIDS or HIV infection, as well as other case reports of symmetric polyarthritis compatible with RA in patients with HIV infection. Each of the patients whose RA remitted had received standard disease‐modifying antirheumatic drug therapy, and 1 of the 3 had a normal T helper: T suppressor ratio at the time of remission. Of the 4 previously reported patients with active RA and AIDS or HIV infection, all had decreased numbers of T helper lymphocytes. The present report describes a fifth patient with both RA and AIDS and reviews the data concerning the coexistence of these 2 diseases. It appears that active RA may indeed coexist with AIDS. It remains to be seen under what settings HIV may have a diseasemodifying effect in RA. These issues have important implications regarding the pathogenesis and therapy of RA, especially in terms of the role of CD4+ lymphocytes and anti‐CD4 monoclonal antibody therapy.
Levels of soluble fas/APO‐1 /CD95 in systemic lupus erythematosus and juvenile rheumatoid arthritis
Authors: Knipping Eckart , Krammer Peter H. , Onel Karen B. , Lehman Thomas J. A. , Mysler Eduardo , Elkon Keith B.
Published: February 2007

Objective. To quantify soluble Fas/APO‐1 (sFas/APO‐1 ) protein in the serum of patients with systemic lupus erythematosus (SLE) and juvenile rheumatoid arthritis (JRA).

Methods. Soluble Fas/APO‐1 was quantified using a sandwich enzyme‐linked immunosorbent assay. Disease activity in SLE patients was assessed by the SLE Disease Activity Index.

Results. Increased serum sFas/APO‐1 levels were observed in only 1 of the 27 SLE patients (4%) and 3 of the 10 JRA patients (30%).

Conclusion. Increased levels of sFas/APO‐1 occurred infrequently in SLE, and the levels were lower than 10 ng/ml. Increased levels of sFas/APO‐1 are not specific for SLE. Soluble Fas/APO‐1 is unlikely to be of major pathogenetic significance in SLE.
Lack of correlation between serum soluble fas/APO‐1 levels and autoimmune disease
Authors: Goel Niti , William Clair E. S. T. , Fleming Judith A. , Ulrich Dawn T. , Lynch David H. , Seldin Michael F.
Published: February 2007

Objective. To determine whether elevated soluble Fas/APO‐1 (sFas/APO‐1 ) levels are associated with either autoimmune disease or evidence of flares in autoimmune disease.

Methods. Thirty‐seven serum samples were retrospectively obtained from normal controls and patients with laboratory evidence of autoimmune disease activity. These samples were assayed for sFas/APO‐1 levels by an enzyme‐linked immunosorbent assay, and hospital medical records were retrospectively reviewed for clinical and laboratory characteristics of the patients.

Results. Soluble Fas/APO‐1 levels did not correlate with clinical diagnoses or laboratory abnormalities. The mean and range of sFas/APO‐1 levels were similar in systemic lupus erythematosus patients (including those with active disease), patients with other autoimmune diseases, and normal controls.

Conclusion. These data strongly suggest that measurement of sFas/APO‐1 levels is unlikely to hold clinical value or play a role in the pathogenesis of autoimmune disease.
Negatively charged residues interacting with the p4 pocket confer binding specificity to DRB1*0401
Authors: Woulfe Susan L. , Bono Christine P. , Zacheis Michelle L. , Kirschmann Dawn A. , Baudino Troy A. , Swearingen Craig , Karr Robert W. , Schwartz Benjamin D.
Published: February 2007

Objective. To identify critical residues involved in the binding of a selective peptide to DRB1*0401.

Methods. The binding of peptides to native or site‐directed mutant DR molecules was evaluated using enzyme‐linked immunosorbent assay and flow cytometry.

Results. Amino acid substitutions at DR and peptide residues, which were predicted to contribute to interactions within the DR p4 pocket, had the greatest effects on the specificity of binding.

Conclusion. Differences in the peptide‐binding repertoires of DR molecules may contribute to associations with autoimmune diseases.
The genotypic distribution of shared‐epitope DRB1 alleles suggests a recessive mode of inheritance of the rheumatoid arthritis disease‐susceptibility gene
Authors: Evans Toni I. , Han Jinfeng , Singh Rovinder , Moxley George
Published: February 2007

Objective. To test whether the genotypic distribution of rheumatoid arthritis (RA)–associated DRB1 alleles suggests that the DRB1‐a ssociated disease‐susceptibility gene has a recessive or additive (dominant) mode of inheritance.

Methods. Caucasian patients with RA and control subjects were recruited from a faculty outpatient practice. DRB1 typing was done by several DNA‐based techniques: polymerase chain reaction (PCR), followed by dot‐blot hybridization with sequence‐specific oligonucleotides, conventional and PCR‐based restriction fragment length polymorphisms (RFLPs), and a multiplex amplification–refractory mutation RFLP system. The genotypic distribution of shared‐epitope DRB1 alleles was analyzed by antigen genotype frequency among patients. The analytical method postulates a linkage‐disequilibrium model with a disease locus close to a marker locus and a marker allele in linkage disequilibrium with the disease‐susceptibility allele. In this instance, the marker allele was defined alternatively by any DR4‐g roup allele, by any DR4‐g roup or DR1‐g roup allele, by any DR4‐g roup shared‐epitope allele, by any DRC‐group shared‐epitope allele plus DRB1*0101, or by any shared‐epitope DRB1 allele. Observed numbers were compared with those predicted for recessive mode or additive (dominant) mode of inheritance of the DRB1‐a ssociated RA disease‐susceptibility gene.

Results. The genotypic distribution of shared‐epitope DRB1 alleles (DRB1*0401, *0404, *0405, *0408, *0101, *0102, or *1001) fit that predicted for a recessive mode of inheritance and was significantly different from that predicted for an additive (dominant) mode. When the analysis was restricted to shared‐epitope DR4 alleles alone (DRB1*0401, *0404, *0405, or *0408), the observed genotype numbers fit the recessive mode best. When DR1‐g roup alleles were added to DR4‐g roup alleles, or alternatively, when the major shared‐epitope DR1 allele (*0101) was added to DR4‐g roup shared‐epitope alleles, there was a less significant deviation from the additive mode of inheritance. The reason for this was derived by comparison of observed genotype frequencies to those expected under Hardy‐Weinberg equilibrium; there was a deficit of persons with DRB1*0401,*0101 and an excess of *0101,X.

Conclusion. The genotypic distribution of shared‐epitope DRB1 marker alleles suggests that the mode of inheritance of the DRB1‐a ssociated disease susceptibility gene must be recessive and not additive (dominant).
Nuclear factor–kB in rheumatoid synovium. Localization of P50 and P65
Authors: Handel Malcolm L. , Mcmorrow Linda B. , Gravallese Ellen M.
Published: February 2007

Objective. To identify the cells that express transcription factor NF‐kB subunits p50 and p65 in synovial tissue from patients with rheumatoid arthritis (RA) and to correlate the distribution of p50 and p65 with CD14 (macrophage lipopolysaccharide receptor) and members of the AP‐1 transcription factor family, Jun and Fos.

Methods. Immunohistochemistry was used to identify p50, p65, Jun and Fos in sections of synovial tissue from 13 patients with RA and 4 ‘normal’ control subjects. Double staining for CD14 and each of the transcription factor subunits was performed.

Results. Subunits p50 and p65 were present in the nuclei of synovial cells in all 13 RA patients, with expression varying from rare cells to more than half of all cells. In most cases, nuclear p50 and p65 were present in approximately one‐third of synovial lining cells and in a variable proportion of cells scattered throughout the sublining region, including the endothelium. The distributions of p50 and p65 were similar. Jun and Fos were present in the nuclei of a large proportion of synovial lining cells with significantly less expression elsewhere. In each case the Jun/Fos distribution was clearly different from the p50/p65 distribution, although there was significant overlap in many cases. Cells expressing CD14 were mostly Jun/Fos negative and were predominantly p50/p65 positive. There was negligible staining for p50 or p65 in the 4 normal control synovium samples.

Conclusion. In most RA patients, the p50 and p65 subunits of NF‐kB were present in the majority of CD14‐p ositive cells within the lining and sublining regions and in a proportion of other cells throughout the synovium, including endothelial cells. NF‐kB is likely to play an important role in the expression of macrophage‐derived cytokines in rheumatoid synovium. Different but overlapping distributions of nuclear p50 and p65 versus Jun and Fos indicate separate or divergent mechanisms for the activation of NF‐kB and the expression of AP‐1 proteins in rheumatoid synovium.
Terminal differentiation of spontaneous rheumatoid factor–secreting B cells from rheumatoid arthritis patients depends on endogenous interleukin‐1 0
Authors: Perez Lisardo , Orte Javier , A. Brieva José
Published: February 2007

Objective. The presence of serum rheumatoid factor (RF) and spontaneous RF‐secreting B cells is a common feature in most patients with rheumatoid arthritis (RA). This study analyzed the cytokine(s) that controls the final maturation of B cells capable of spontaneous IgM‐RF secretion in vitro.

Methods. RA patients' peripheral blood mononuclear cells (PBMC), as well as adherent and nonadherent cell fractions, were cultured, and spontaneous IgM‐RF and interleukin‐1 0 (IL‐1 0) secretion were determined by enzyme‐linked immunosorbent assay.

Results. The RF+ RA PBMC, but not PBMC from RF– RA patients or healthy controls, actively produced IgM‐RF in a linear manner for 14 days. This activity depended on the presence of fetal calf serum and did not require cellular DNA synthesis. Spontaneous IgM‐RF secretion depended on IL‐1 0, as deduced from the following findings: 1) IL‐1 0, but not a variety of cytokines including IL‐6, restored missing IgM‐RF secretion by PBMC in serum‐free supplemented cultures; 2) the addition of anti–IL‐1 0, but not anti–IL‐6, blocking antibodies inhibited PBMC IgM‐RF secretion, and this effect could be reversed by exogenous IL‐1 0; and 3) RA PBMC actively produced IL‐1 0 in vitro. The cells responsible for endogenous IL‐1 0 production were found in the adherent cell fraction. Finally, IL‐1 0 induced IgM‐RF, but not total IgM, secretion by RA PBMC.

Conclusion. In patients with RA, circulating B cells capable of spontaneous IgM‐RF secretion require IL‐1 0 production by adherent cells to reach terminal maturation.
Long‐term amelioration of rat adjuvant arthritis following systemic elimination of macrophages by clodronate‐containing liposomes
Authors: Kinne Raimund W. , Schmidt‐Weber Carsten B. , Hoppe Ralph , Buchner Eberhard , Palombo‐Kinne Ernesta , Nürnberg Eberhard , Emmrich Frank
Published: February 2007

Objective. To determine whether systemic elimination of macrophages by means of clodronate‐containing liposomes counteracts inflammation and joint destruction in rats with established adjuvant arthritis (AA).

Methods. Rats with AA received a total of 2.7 mg of clodronate encapsulated in liposomes in 3 intravenous doses on days 10, 11, and 12 of arthritis. Phosphate buffered saline (PBS), PBS‐laden liposomes, or free clodronate were used as negative controls. Clinical, hematologic, and histopathologic signs of AA were monitored, and depletion of macrophages by clodronate‐liposomes was evaluated both in the synovial membrane (SM) and in organs of the mononuclear phagocyte system (MPS).

Results. Clodronate‐laden liposomes led to significant, long‐term amelioration of the clinical signs of AA, a reduction in the erythrocyte sedimentation rate (ESR), and counteraction of joint destruction, not only immediately after treatment, but also for 2 weeks thereafter. Free clodronate induced moderate clinical improvement and a significant decrease in the ESR, but only during the late phase of AA. Drug‐free vesicles even aggravated the joint destruction. Clodronate‐laden liposomes did not induce significant depletion of resident macrophages in the SM, but rather, in the paracortical region of popliteal lymph nodes, in the liver, and in the marginal zone and periarteriolar lymphatic sheaths of the spleen.

Conclusion. Clodronate‐laden liposomes induce long‐term amelioration of AA, even if administered for a brief period during the florid phase of the disease. The amelioration is paralleled by the elimination of macrophages in immunocompetent areas of the spleen and draining lymph nodes, but not locally in the SM. This suggests an influence of the treatment on the immunoregulatory rather than effector, functions of macrophages.
The tight skin 2 mouse
Authors: Christner Paul J. , Peters Josephine , Hawkins David , Siracusa Linda D. , Jiménez Sergio A.
Published: February 2007

Objective. To describe the histopathologic and biochemical characteristics of skin from the Tsk2/ + mouse, a mutation with phenotypic features resembling those of systemic sclerosis (SSc), and to report the initial genetic mapping of the Tsk2 locus.

Methods. Histologic examination was performed and collagen content and type I collagen messenger RNA (mRNA) levels were determined in skin biopsy specimens from Tsk2/+ mice and normal mice. An intersubspecific backcross was conducted as a first step toward identifying the position of the Tsk2 locus on mouse chromosome 1.

Results. Histologic examination of Tsk2/+ mouse skin revealed marked accumulation of collagen and infiltration with mononuclear cells in the dermis and adipose tissue. Biochemical studies of Tsk2/+ mouse skin showed increased collagen content and elevated steady‐state levels of α1(I) procollagen mRNA. Tsk2 was mapped to a 15.3‐c entimorgan interval on mouse chromosome 1.

Conclusion. Tsk2 is a novel mutation which displays histopathologic and biochemical abnormalities similar to those present in the skin of patients with SSc, including increased collagen content and expression of type I collagen genes. This mutation has been mapped to a 15.3‐c M region on mouse chromosome 1. Further study of this novel mutation will allow the identification of previously undescribed mechanisms involved in the regulation of normal and pathologic collagen gene expression.
Comparison of azathioprine, methotrexate, and the combination of the two in the treatment of rheumatoid arthritis
Authors: Willkens Robert F. , Sharp John T. , Stablein Donald , Marks Carolly , Wortmann Robert
Published: February 2007

Objective. To assess the relative efficacy of methotrexate (MTX), azathioprine (AZA), and their combination in the treatment of rheumatoid arthritis (RA) in a double‐blind, prospective, multicenter, controlled trial.

Methods. Two hundred nine patients with active RA were treated with escalating doses of MTX (5–15 mg/week), AZA (50–150 mg/day), or combination (5 mg MTX/week plus 50 mg AZA/day–7.5 mg MTX/week plus 100 mg AZA/day), with opportunity to increase the dosage at 6‐w eek intervals. The patients were evaluated for significant clinical and laboratory improvement and assessed for radiologic progression at 48 weeks.

Results. One hundred ten patients remained on the initial, randomly assigned therapeutic regimen. The percentage of patients who were responders, defined as those who had 30% or greater improvement in at least 3 of 4 variables, was 38% for the combination treatment, 26% for AZA, and 45% for MTX (P = 0.06). A trend toward decreased radiologic progression was seen in the MTX‐treated patients. Termination of treatment due to adverse experience occurred more frequently with combination and AZA treatments than with MTX treatment. Lack of effectiveness, adverse gastrointestinal effects, and liver enzyme elevation were the most frequent causes of treatment discontinuation.

Conclusion. This study establishes that the combination of MTX and AZA in the dosages utilized is not associated with more toxicity than treatment with single agents; however, enhanced efficacy is also not seen. There is a trend toward decreased radiologic progression in patients treated with MTX.
Risk factors for septic arthritis in patients with joint disease
Authors: Kaandorp Carola J. E. , Schaardenburg Dirkjan Van , Krijnen Pieta , Habbema J. Dik F. , Van De Laar Mart A. F. J.
Published: February 2007

Objective. To quantify potential risk factors for septic arthritis, in order to identify a basis for prevention.

Methods. The occurrence of potential risk factors for septic arthritis in patients with joint diseases attending a rheumatic disease clinic was prospectively monitored at 3‐m onth intervals over a period of 3 years. Potential risk factors investigated were type of joint disease, comorbidity, medication, joint prosthesis, infections, and invasive procedures. The frequencies of risk factors in patients with and those without septic arthritis were compared using multiple logistic regression analysis.

Results. There were 37 patients with and 4,870 without septic arthritis. Risk factors for developing septic arthritis were age ≥80 years (odds ratio [OR] = 3.5, 95% confidence interval [95% CI] 1.4–8.6), diabetes mellitus (OR = 3.3, 95% CI 1.1–10.1), rheumatoid arthritis (OR = 4.0, 95% CI 1.9–8.3), hip and/or knee prosthesis (OR = 15, 95% CI 4.1–54.3), joint surgery (OR = 5.1, 95% CI 2.2–11.9), and skin infection (OR = 27.2, 95% CI 7.6–97.1)

Conclusion. These findings indicate that preventive measures against septic arthritis in patients with joint diseases should mainly be directed at those with joint prostheses and/or skin infection.
Dehydroepiandrosterone in systemic lupus erythematosus
Authors: Van Vollenhoven Ronald F. , Engleman Edgar G. , Mcguire James L.
Published: February 2007

Objective. To determine if dehydroepiandrosterone (DHEA) is beneficial in the treatment of systemic lupus erythematosus (SLE).

Methods. In a double‐blind, placebo‐controlled, randomized trial, 28 female patients with mild to moderate SLE were given DHEA 200 mg/day or placebo for 3 months. Outcomes included the SLE Disease Activity Index (SLEDAI) score, patient's and physician's overall assessments of disease activity, and concurrent corticosteroid dosages (which were adjusted as clinically indicated).

Results. In the patients who were receiving DHEA, the SLEDAI score, patient's and physician's overall assessment of disease activity, and concurrent prednisone dosage decreased, while in the patients taking placebo, small increases were seen. The difference in patient's assessment between the groups was statistically significant (P = 0.022, adjusted). Lupus flares occurred more frequently in the placebo group (P = 0.053). Mild acne was a frequent side effect of DHEA.

Conclusion. DHEA may be useful as a therapeutic agent for the treatment of mild to moderate SLE. Further studies of DHEA in the treatment of SLE are warranted.
Skewed distribution of IGG FC receptor iia (CD32) polymorphism is associated with renal disease in systemic lupus erythematosus patients
Authors: Duits Ashley J. , Bootsma Hendrika , Derksen Ronald H. W. M. , Spronk Peter E. , Kater Louis , Kallenberg Cees G. M. , Capel Peter J. A. , Westerdaal Nomdo A. C. , Spierenburg Gerrit T. H. , Gmelig‐Meyling Frits H. J. , Van De Winkel Jan G. J.
Published: February 2007

Objective. Fcγ receptors of class IIa (FcγRIIa) occur in 2 allelic forms, with either a low (IIa‐R131) or a high (IIa‐H131) affinity for complexed IgG2 and IgG3. This polymorphism might have implications for the handling of immune complexes. Therefore, we determined the distribution of the Fc γRIIa allotypes in patients with systemic lupus erythematosus (SLE), with or without a history of lupus nephritis.

Methods. We studied 95 unrelated white European patients with SLE, as defined by the American College of Rheumatology criteria, 50 of whom had a history of lupus nephritis, and 69 healthy white European control subjects. Fc γRIIa allotypes were determined by immunophenotyping of blood monocytes.

Results. It was found that lupus nephritis was significantly associated with the ‘low affinity’ FcγRIIa R/R131 allotype and with the R131 allele, compared with healthy controls. No significant association was found upon comparison of groups with and without nephritis.

Conclusion. SLE patients with a history of lupus nephritis have an abnormal distribution of FcγRIIa allotypes. FcγRIIa may well play a role in the pathogenesis of lupus nephritis, since IIa‐R/R131 SLE patients seem to have a higher incidence of developing this complication.
Analysis of anti–u1 RNA antibodies in patients with connective tissue disease
Authors: Hoffman Robert W. , Sharp Gordon C. , Deutscher Susan L.
Published: February 2007

Objective. To determine the prevalence of anti–U1 RNA antibodies in connective tissue disease (CTD) patients and evaluate immunogenetic and clinical features of patients possessing these antibodies.

Methods. RNA immunoprecipitation was used to analyze patient and healthy control sera for the presence of anti–U1 RNA antibodies. Enzyme‐linked immunosorbent assay and immunoblotting were used to determine small nuclear RNP (snRNP) polypeptide antibodies. HLA polymorphisms were determined by microcytotoxicity and DNA typing.

Results. Anti–U1 RNA IgM and IgG antibodies were found in 60% of anti‐RNP positive patients. All of the anti–U1 RNA positive patients had anti‐7 0K, and most had anti‐A, (U1)snRNP polypeptide antibodies. HLA–DR2/DR4, as well as Raynaud's phenomenon and synovitis, were significantly increased in the anti–U1 RNA positive group.

Conclusion. The presence of anti–U1 RNA anti‐bodies correlates with anti‐7 0K and anti‐A polypeptide antibodies. In addition, the anti–U1 RNA positive CTD patient group is immunogenetically and clinically distinctive from the anti–U1 RNA negative patient group.
Segregation of autoantibodies with disease in monozygotic twin pairs discordant for systemic sclerosis
Authors: Mchugh Neil J. , Harvey Georgina R. , Whyte Jean , Dorsey J. Kevin
Published: February 2007

Objective. To study the serologic status of 3 previously unreported monozygotic twin pairs discordant for systemic sclerosis (SSc).

Methods. Autoantibodies were measured by indirect immunofluorescence, immunodiffusion, and immunoprecipitation of 35S‐labeled cell lines. Major histocompatibility complex (MHC) class II allele typing and DNA fingerprinting were used to confirm monozygosity.

Results. Anti–PM‐Scl, anti–threonyl transfer RNA synthetase, and anti–topoisomerase I antibodies, respectively, were found in each of the twins with SSc. None of the unaffected twin siblings had an identifiable autoantibody, although serum from 1 unaffected twin precipitated several unknown proteins. The MHC class II genotype in each twin was the genotype expected for the autoantibody that was present.

Conclusion. Autoantibodies of certain defined specificities are intimately linked with the development of SSc, because they segregate with SSc in individuals who start life with identical germline genes.
Self‐administered patient questionnaire for assessing knowledge about joint arthroplasty prior to surgery
Authors: Reisine Susan , Lewis Courtland , Tibbles Lillian , Donald Mary , Rippey Robert
Published: February 2007

This article assesses the discriminant validity of a questionnaire designed to test patients' knowledge about total joint arthroplasty prior to preoperative educationai intervention. The method employed was to compare responses on the test by surgeons, health care workers, and patients and to evaluate whether the test could discriminate among groups. A total of 148 patients, 59 health care workers and 28 orthopedic surgeons completed the questionnaire. The results show that patients are knowledgeable about the benefits of surgery, but are in need of information about surgical risks and complications. The test was able to discriminate between surgeons and the other two groups, but there were few differences between health care workers and patients. Item analysis also demonstrates that the test is reliable. Although the test exhibits acceptable psychometric properties, a major problem in using this test in evaluating educational interventions is the relatively high average score and the potential ceiling effect that prevents measurement of further gains in knowledge. More work is needed on expanding the test to include more items where knowledge of total joint arthroplasy is limited.
Comparison of literacy level of patients in a VA arthritis center with the reading level required by educational materials
Authors: Larson Ingegerd , Schumacher H. Ralph
Published: February 2007

Low literacy is a problem in a large segment of our population. We tested the reading levels of a group of 100 randomly chosen clinic and hospitalized patients seen in an urban Veterans Administration Arthritis and Immunology Center. The standardized Jastak Wide Range Achievement Test, revised level 2 (WRAT‐R2), was utilized to determine the reading level appropriateness of Arthritis Foundation literature for this population. Arthritis Foundation literature by our testing with the McLaughlin's SMOG grading readability formula was found to be at the 8th‐ to 13th‐grade level. Nearly 51% of our patients read below the 10th‐grade level and 31% below the 7th‐grade level. The Arthritis Foundation literature reading level may be too advanced for a significant number of our patients. These results may also have implications for other patient education literature and other written materials such as instructions on prescriptions.
Differential muscle strength decline in osteoarthritis of the knee. A developing hypothesis
Authors: Hayes Karen W. , Falconer Judith
Published: February 2007

The ratio of quadriceps to hamstrings muscle strength (Q/H ratio) is important for the stability of the knee and for protection from excessive stress. The purpose of this study was to explore whether the Q/H ratio is altered in patients with osteoarthritis (OA). Subjects were 43 patients with physician‐diagnosed OA of the knee (mean age, 65.61 years; SD, 12.74). Isometric knee flexor and extensor strength was measured with a hand‐held dynamometer. Both muscle groups were weak, with relatively greater weakness in the quadriceps muscles. The mean Q/H ratio of 1.43 (SD, 0.39) was below ratios reported for young healthy adults (2.0). The low Q/H ratio might be caused by the inability to correct the measurement for gravity, but a liberal estimate of gravity correction raised the ratio only to 1.71 (SD, 0.47). The low Q/H ratio was probably not caused by physiologic changes due to aging, because the correlation between the ratio and age was low (−0.04). Since the correlation of the Q/H ratio with the usual level of pain (measured by a visual analogue scale) was negative (−0.26), the low ratio might be explained by reflex inhibition due to pain associated with disease.
Effect of ultrasound on mobility in osteoarthritis of the knee. A randomized clinical trial
Authors: Falconer Judith , Hayes Karen W. , Chang Rowland W.
Published: February 2007

Ultrasound increases soft tissue extensibility and may be an effective adjunct in the treatment of knee contractures secondary to connective tissue shortening. A randomized clinical trial was conducted to determine the effectiveness of ultrasound in relieving stiffness and pain in patients (age x = 67.5 years, SD = 13.0) who had osteoarthritis (OA) and a chronic knee contracture. Subjects received 12 treatments of exercise preceded by either ultrasound (n = 34) or sham ultrasound (n = 35) and a blinded evaluation at baseline, after treatment, and 2 months after treatment. MANCOVA controlling for baseline scores showed that there were no significant differences in knee active range of motion (ROM) (goniometry) or pain (visual analogue scale) between experimental and control groups. Possible explanations for the no difference finding involve dosage issues, muscle shortening, transiency of effects, and the effects of exercise. Paired t‐tests revealed that both groups significantly improved (p < 0.05) in active ROM, pain, and gait velocity, and maintained improvement for at least 2 months. Although ultrasound may not contribute to the management of patients with chronic knee stiffness and OA, benefits of the exercise program and increased activity secondary to program participation probably influenced the overall improvement.
Joint exercises in elderly persons with symptomatic osteoarthritis of the hip or knee. Performance patterns, medical support patterns, and the relationship between exercising and medical care
Authors: Dexter Phyllis A.
Published: February 2007

A total of 110 community‐living elderly persons with chronic hip and/or knee pain, all of whom met American College of Rheumatology classification criteria for osteoarthritis (OA), were interviewed to obtain information about their performance of therapeutic joint exercises and exercise‐related medical care. Although exercises are considered standard treatment for OA and 96% of subjects had seen a physician for the problem, fewer than half had received medical advice to exercise and very few had received thorough exercise‐related teaching and monitoring. Arthritis specialists provided significantly more support for exercising than primary care physicians. Forty percent of the total sample and 63% of those advised by a physician to exercise were making some attempt to do so; however, only 10% were exercising in a manner that might be expected to achieve maximum therapeutic benefit. Supportive medical care was highly related to frequency of exercising.
Observation of pain behavior in rheumatoid arthritis patients during physical examination. Relationship to disease activity and psychological variables
Authors: Anderson Karen O. , Bradley Laurence A. , Turner Robert A. , Agudelo Carlos A. , Pisko Edward J. , Salley Alfred N. , Fletcher Kenneth E.
Published: February 2007

This study examined the reliability and validity of a behavioral observation method for the assessment of arthritis pain in a clinical practice setting. Trained observers measured the occurrence of seven pain behaviors in a group of 61 rheumatoid arthritis patients undergoing physical examinations. These observations were compared with videotaped observations of the patients in a laboratory setting. Significant differences were found between the pain behavior frequencies observed during the examinations and those observed during videotaped sessions. Total pain behavior scores obtained in both settings were significantly correlated with patients' self‐reports of pain and with disease activity measures. Pain behavior observed during the exams was significantly associated with patients' self‐reports of anxiety and depression.
Validation of the NIH activity record. A quantitative measure of life activities
Authors: Gerber Lynn H. , Furst Gloria P.
Published: February 2007

This article reports the results of the validation of a life activity record. We devised a self‐administered daily log [the NIH Activity Record, ACTRE], for persons with rheumatoid arthritis (RA), which recorded specific daily activities over a 24‐hour period and identified the level of physical effort for each task. In addition, each activity was assigned a level of pain, fatigue, difficulty, competence, meaningful‐ness and enjoyment. Twenty‐one persons with RA completed the log. They underwent an articular examination (AI) (Ritchie Articular Index) as well as completed the following self‐reports: Psychosocial Adjustment to Illness Scale (PAIS); The Feeling Tone Checklist (FTC), a measure of fatigue; The Modified Health Assessment Questionnaire (ALL); and the Pain and Disability Index (PDI). Significant correlations were found between fatigue measured by ACTRE and FTC (p= 0.028); pain measured by ACTRE, PDI (p = 0.002), and AI (p = 0.01) and the visual analog scale in the ALI (p = 0.0002). Pain experienced while performing self‐care measured by ACTRE correlated with AI (p = 0.001) and ALI (p= 0.0013). Difficulty with self‐care activities on the ACTRE correlated with difficulty (p = 0.007) and pain (p = 0.012) on the ALI. The ACTRE is a valid measure of symptoms and perceptions that can be quantified, and is unique in that it identifies specific daily activities likely to produce them.
Effect of active hand exercise and wax bath treatment in rheumatoid arthritis patients
Authors: Dellhag Berit , Wollersjö Ingrid , Bjelle Anders
Published: February 2007

The effect of active hand exercise and warm wax treatment was evaluated in 52 rheumatoid arthritis patients randomized into four groups: (1) both exercise and wax bath, (2) exercise only, (3) wax bath only, and (4) controls. Treatment was given three times a week for 4 weeks. Deficits in flexion and extension in digits II–V bilaterally, grip function, grip strength, pain, and stiffness were measured before and after the treatment period. The control group was measured at corresponding times. Wax bath treatment followed by active hand exercise resulted in significant improvements of range of motion (ROM) and grip function. Active hand exercise alone reduced stiffness and pain with nonresisted motion and increased ROM. Wax bath alone had no significant effect.
Physical fitness levels in children with polyarticular juvenile rheumatoid arthritis
Authors: Klepper Susan E. , Darbee Joan , Effgen Susan K. , Singsen Bernhard H.
Published: February 2007

Children with juvenile rheumatoid arthritis (JRA) often exhibit fatigue and prolonged exercise recovery. Improved fitness through physical conditioning has not been a goal of standard medical or physical treatment regimens for JRA, and fitness levels of children with JRA have rarely been studied. We compared physical fitness in 20 6 to 11‐year‐old patients with polyarticular JRA with sex‐, age‐, and size‐matched controls, using the Health Related Physical Fitness Test (HRPFT), a national, standardized, norm‐referenced test. We correlated fitness scores with summary joint counts, and with an articular severity index (sum of joint swelling, tenderness, pain, and limited range for each child). The results showed that children with polyarticular JRA were less physically fit than normally active (noncompetitively athletic) children of the same sex, age, and size. There was no statistically significant relationship between increased joint counts, and/or disease severity scores, and reduced fitness scores. This suggests that physical fitness levels are less related to degree of “disease activity” than is often thought. We conclude that (1) a readily available, nationally standardized fitness test can be used to assess children with JRA: and (2) fitness levels and measures of disease activity do not correlate. We believe that multiple factors, perhaps including family, physician, and school concerns about potential disease exacerbation following exercise, may account for the low fitness levels observed in children with JRA.
Evaluation of a psychological treatment package for treating pain in juvenile rheumatoid arthritis
Authors: Lavigne John V. , Ross Caroline K. , Berry Sharon L. , Hayford Jennifer R. , Pachman Lauren M.
Published: February 2007

We examined the utility of psychological treatment procedures for children with high levels of pain associated with juvenile rheumatoid arthritis (JRA). By the use of a multiple baseline across subjects design, four children were assigned to an immediate treatment group, and four children to a delayed treatment group. The six‐session treatment included relaxation training, electromyogram, and thermal biofeedback for the child; mothers were trained in the use of behavioral techniques for managing physical therapy and school attendance. Visual inspection of the data indicates small changes on children's self‐reported pain diary scores for mean pain and ratings of high (greater than 5 on a 10‐point visual analogue scale) pain periods, with 50% to 62% showing at least a 25% reduction in pain immediately after treatment, and 62% to 88% showing a 25% reduction by 6‐month follow‐up. Maternal reports of changes paralleled those of the children. Comparisons of Mann‐Whitney U‐tests conducted pre‐ and posttreatment indicated no differences for children's ratings of mean pain or + 5 pain ratings between the immediate and delayed treatment groups; greater improvement for the immediate treatment group was noted on maternal reports of both mean pain (p < 0.05) and +5 pain (p < 0.5) ratings. The reduction of pain reports from pretreatment to follow‐up was significant for children's mean pain (p = 0.02), +5 pain ratings (p = 0.02), and mother's reports of mean pain (p = 0.03) and +5 pain periods (p = 0.01). Maternal reports of the number of pain‐related behaviors that the child exhibited also declined (p < 0.05). No reduction in physical therapist's ratings of pain during evaluation were noted. No increases in maternal reports of child's psychological adjustment problems were reported following treatment. Results provide modest support for the use of psychological interventions with patients with JRA.
The health assessment questionnaire 1992. Status and review
Authors: Ramey Dena R. , Raynauld Jean‐Pierre , Fries James F.
Published: February 2007

Over 100 papers describing and utilizing the Stanford Health Assessment Questionnaire (HAQ) have been published since 1980. A brief overview of the HAQ is presented along with a guide to the accumulated literature. The topics covered include: studies using the disability, pain, economic, and drug side effect dimensions of the HAQ; reliability and validity studies; applications to various rheumatic diseases; language adaptations; modifications and derivative scales; studies correlating the HAQ with sociodemographic, health status, laboratory, and physical measures; and randomized controlled trials and observational studies using the HAQ. A few comments regarding future directions for research are also presented.
Sensitivity to change of the Health Assessment Questionnaire (HAQ) and other clinical and health status measures in rheumatoid arthritis results of short‐term clinical trials and observational studies versus long‐term observational studies
Authors: Hawley Donna J. , Wolfe Frederick
Published: February 2007

To obtain evidence concerning short‐term and longterm efficacy of clinical and health status measures in rheumatoid arthritis (RA), we conducted two observational studies—a 6‐month study of 233 patients receiving methotrexate and a 10‐year study of 157 patients receiving multiple treatments in a rheumatic disease clinic. Results of the 6‐month study yielded effect sizes for treatment similar to the metaanalyses reported by Weinblatt et al. (Arthritis Rheum 33:1449–1461, 1990) and the controlled trials of methotrexate reported by Weinblatt et al. (Arthritis Rheum 33:330–338, 1990), suggesting that observational studies provide valid measurements of treatment effect. The effect size for the Health Assessment Questionnaire (HAQ) was 0.5. By contrast, the 10‐year study suggested that standard clinical variables changed little and were not useful in assessing RA outcome, while the effect size of the HAQ was − 2.39. These data continue to underscore the differences between short‐term trials and the long‐term outcome of RA, and suggest an important place for the HAQ or similar instruments in all phases of RA evaluation and assessment.
Does musculoskeletal function deteriorate in a predictable sequence in the elderly?
Authors: Daltroy Lawren H. , Logigian Martha , Iversen Maura D. , Lian Matthew H.
Published: February 2007

A variety of functions decline with aging, but whether losses occur in a predictable sequence is unknown. Improved understanding might facilitate the early detection and possible prevention of functional deterioration. We assessed self‐reported difficulty with functional tasks in 288 community‐dwelling elderly aged 65 to 97. We hypothesized that the ability to perform tasks involving strength, skill, and endurance (run errands, shop, yardwork or housework) would be lost first, followed by activities requiring less strength or mobility (rise from a chair with no hands, walk), followed by easier, but essential tasks (pick up clothes, rise from bed, lift a cup to the mouth). The patterns of decline were evaluated with Guttman scalograms. Picking up clothes and walking were reversed from the predicted order. Scale reliability was 0.92, indicating that functional decline is ordered; 75% of subjects fell into one of the modal sequence types. Analysis by self‐reported presence of arthritis showed that 83% of nonarthritic subjects fit the predicted patterns (reliability = 0.95) versus 65% of arthritic subjects (reliability = 0.86), who tended to lose hand ability out of sequence.

Sequential functional loss scales may tell more than the typical simple summation of functional loss, and may have predictive value to the clinician monitoring an elderly patient. If the sequence is accelerated or out of order, such as was seen in patients with arthritis, it may indicate the need for intervention. Examination of sequences of loss may help characterize adaptations to impairment and differences among subgroups.
Scoring methods and application of the activity record (ACTRE) for patients with musculoskeletal disorders
Authors: Gerber Lynn H. , Furst Gloria P.
Published: February 2007

The National Institutes of Health (NIH) Activity Record (ACTRE) has been used to document daily activities in patients with musculoskeletal disorders. Quantification of the amount of time spent resting and physically active, the intensity of pain and fatigue associated with patterns of activities, and motivational considerations are possible with the ACTRE. Scoring has been streamlined to permit identification of the amount of pain, fatigue, and motivational factors as they relate to activity patterns (e.g., rest and physical activity). The ACTRE provides a performance‐based, quantifiable measure of daily activity.
Arthritis problem indicator preliminary report on a new tool for use in the primary care setting
Authors: Sotosky Judy R. , McGrory Carolyn H. , Metzger David S. , Dehoratius Raphael J.
Published: February 2007

Improving the quality of life for people with rheumatic disease involves timely identification of problem areas and application of appropriate interventions. In response to a 1987 Commonwealth of Pennsylvania study, which reported a wide variety of unmet needs in arthritis patients and their families, the Arthritis Problem Indicator (API) was developed. It is a single‐page, self‐report, low‐cost tool. A mixed rheumatology population (n = 50) and their primary care physicians participated in a pilot study. The study revealed that the seven most common areas of patient concern were pain, weight control, sleep, mobility/walking, activities of daily living, community access, and depression/anxiety. The physicians reported that the patient's answers on the API led them to initiate new treatment or referral for 32% of the patients. The physicians also stated that for 80% of the patients, the API was helpful in providing information about the patient. The API is easily interpreted by health professionals and designed to be an indicator of problem areas frequently associated with arthritis.
Do self‐reported arthritis symptom (RADAR) and health status (AIMS2) data provide duplicative or complementary information?
Authors: Mason John Hayes , Meenan Robert F. , Anderson Jennifer J.
Published: February 2007

This study assessed whether self‐report measures of symptoms and functional health status provide unique outcome information, or whether functional status assessments primarily serve as a proxy for self‐reported arthritis symptoms. Symptom scores of 138 individuals with rheumatoid arthritis (RA) collected with the Rapid Assessment of Disease Activity in Rheumatology (RADAR) measure were compared with same‐day functional health scores collected with the recently revised Arthritis Impact Measurement Scales (AIMS2). Correlational and factor analyses revealed that self‐assessed arthritis symptoms, physical function and work impact, psychological status, and social health each made independent contributions to outcome. Satisfaction with health status was shown not to be independent of symptoms, functional capacity, or psychological status. It is important to document that self‐reported symptom and health status information, when collected concurrently, provides complementary rather than duplicative information.
Quality of life and policy analysis in arthritis
Authors: Kaplan Robert M. , Coons Stephen Joel , Anderson John P.
Published: February 2007

Problems in the American health care system have stimulated interest in cost‐effectiveness methodologies. However, there is little consensus on how to define a common unit of health outcome. Many measures used in policy studies consider only mortality and do not fully capture the significant impact of disease‐related dysfunction. The impact of conditions, such as osteoarthritis, that have little impact on mortality rates but substantial impact on functioning and well‐being may be underestimated in these analyses. In this article, we propose a measurement and policy model that is based on a theoretical conceptualization of health outcome. The model considers the impact of disease and its treatment in terms of both morbidity and mortality. The value of the model for clinical trials, population assessments, and policy analysis is reviewed. A public policy application of the model in Oregon is briefly described.
Characterizing the meaning of psychological distress in rheumatoid arthritis
Authors: Fifield Judith , Reisine Susan
Published: February 2007

Symptoms of depression are frequently reported by people with rheumatoid arthritis (RA). To advance our understanding of how best to assess and treat these symptoms, their meaning must be elucidated. This article explores two possible meanings for the emotional distress of RA patients reported on the Center for Epidemiological Studies Depression (CESD) scale: (1) Certain CES‐D scale items may inflate actual depressive symptom scores. (2) Depressive symptoms are experienced and/or expressed in unique ways in an RA population due to the presence of chronic physical symptoms. In this study of 988 people with RA, it was found that there is some modest inflation of the CES‐D scale due to the items of “having difficulty getting going” and “everything was an effort.” However, irrespective of the modest inflation of the scale, there is evidence that distress in RA is not a static concept. Distress in this RA population was expressed differently from that of a community population, and within the RA population, distress was expressed differently over time.
Psychological factors, immunologic activation, and disease activity in rheumatoid arthritis
Authors: Parker Jerry C. , Smarr Karen L. , Angelone Edgar O. , Mothersead Philip K. , Lee Byung S. , Walker Sara E. , Bridges Alan J. , Caldwell C. William
Published: February 2007

The purpose of this study was to use structural equation modeling techniques to examine potential interrelationships among psychological factors, im‐munologic activation, and disease activity in rheumatoid arthritis (RA). The subjects were 80 male patients with a diagnosis of classic or definite RA. Measures included the Beck Depression Inventory, the Arthritis Helplessness Index, and the Arthritis Impact Measurement Scales (AIMS) pain score. Joint counts and immunophenotypic analyses of peripheral blood lyMPHocytes also were collected. Path analysis showed that percentage of HLA‐DR+ cells in the peripheral blood and helplessness were related to join count. In addition, joint count had an effect upon depression. Depression had an effect upon pain, but there was no reciprocal effect of pain upon depression. This study describes a preliminary path model of interrelationships among psychological factors, immunologic activation, and disease activity in RA.