bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping strategies and affect in rheumatoid and psoriatic arthritis relationship to pain and disability
Authors: Stewart Malcolm W. , Knight Robert G.
Published: February 2007

Affective state and utilization of coping strategies are factors that may be related to pain and disability in chronic disease, but may also be interrelated. The relationship of coping strategies and affect to both concurrent and 18‐month follow‐up pain and disability was studied in 60 women with rheumatoid or psoriatic arthritis of <8 years' duration. The type of coping strategy used was not associated with concurrent mood level. After accounting for physical variables, mood and strategy use were significantly, and largely independently, related to concurrent pain and disability measures. Future disability was not predicted by either mood or coping strategy use. These results show that mood and use of coping strategies are significantly related to concurrent function but, perhaps due to the variable nature of the disease process, are not predictive of future function. The clinical implications of this study are that interventions to promote better adjustment for people with rheumatoid or psoriatic arthritis should target both mood and coping strategies, as both may contribute independently to adjustment.
Aerobic capacity in juvenile rheumatoid arthritis patients and healthy children
Authors: Giannini Manuela Jasso , Protas Elizabeth J.
Published: February 2007

This study compared aerobic capacity and highest work load completed by children with juvenile rheumatoid arthritis (JRA) and healthy children during bicycle ergometer exercise. A secondary purpose was to determine the relationship between measures of disease severity and (a) aerobic capacity and (b) highest work load completed among the JRA patients. Aerobic capacity was measured using an open‐circuit computerized gas analysis system. Sixteen patients with JRA and 16 healthy children were matched for age, sex, and body surface area. The healthy children achieved a significantly higher aerobic capacity than their respective control (p < 0.001, paired test, two‐tailed). The healthy children were able to complete higher work loads than their respective control (p < 0.01, Wilcoxon matchedpairs signed‐rank test). There was no relationship between measures of articular disease severity and (a) aerobic capacity and (b) highest work load completed among the JRA patients. Results of this study provide specific direction to clinicians to initiate aerobic conditioning programs for children with JRA soon after diagnosis. Additionally, an individual's functional exercise capacity is not directly related to the severity of the articular disease.
Assessing the impact of self‐efficacy beliefs on adaptation to rheumatoid arthritis
Authors: Schiaffino Kathleen M. , Revenson Tracey A. , Gibofsky Allan
Published: February 2007

This article examines the influence of self‐efficacy beliefs on problem‐solving coping, functional disability, and psychological well‐being for 101 recently diagnosed adult patients with rheumatoid arthritis (RA). Data were drawn from a longitudinal study of psychosocial adaptation to the onset of RA. Self‐efficacy beliefs were associated with less functional disability assessed concurrently and 1 year later. Self‐efficacy beliefs were also associated with greater use of problem‐solving coping 1 year later. There was an interaction between pain and self‐efficacy beliefs in the prediction of depression 1 year later: at low pain, self‐efficacy beliefs were unrelated to depression, but at higher levels of pain, greater self‐efficacy was related to greater depression. Finally, problem‐solving coping mediated the relationship between disability and initial self‐efficacy beliefs. The distinct patterns that emerge for pain, self‐efficacy beliefs, and coping, with respect to functional status as compared to psychological status, are discussed.
Patterns of change over time in learned response to chronic illness among participants in a systemic lupus erythematosus self‐help course
Authors: Braden Carrie Jo
Published: February 2007

The findings of this descriptive study of learned response to chronic illness over time of 291 persons having a diagnosis of systemic lupus erythematosus (SLE) who had attended a series of self‐management classes demonstrated significant change in learned response over time. Self‐help model variables that significantly contributed to the change were uncertainty, depression, enabling skill, self‐efficacy, and self‐worth. Uncertainty and depression decreased over time while enabling skill, self‐efficacy, and self‐worth increased. Subjects also demonstrated significant increases in self‐help course tied variables of SLE knowledge and both the range and number of rest, relaxation, heat, and exercise activities.
Adolescents with chronic disease. Transition to adult health care
Authors: Rettig Patty , Athreya Balu H.
Published: February 2007

Older adolescents are in the midst of many life changes related to physical and emotional development, education and career choices, family and peer relationships. The presence of a chronic disease adds an additional burden. At this stage of development, transfer of care to an adult facility becomes a major challenge for the adolescent, parents, and pediatric and adult care providers. This article describes an interdisciplinary transition program from pediatric to adult health care for older adolescents with rheumatic diseases. Care is transferred to an internist‐rheumatologist who collaborates closely with the pediatric team. Scope of the program includes pretransitional assessments and interventions, including education, counseling, and referral around career, postsecondary education, sexuality, and other transitional issues. Benefits of and barriers to a structured transition program are discussed.

In broad terms the adult seeks care, the child receives care. The developmentally immature adult in the adult system of care is a victim since he or she is assumed to be autonomous.
Going beyond demographic characteristics in arthritis research: Reflections on process in the experience of arthritis
Authors: Fifield Judith , Reisine Susan
Published: February 2007

When the disease began I didn't know what it was. I was sitting at a sewing machine for forty hours a week. I was thinking of taking off some time and having it checked out but the kind of job I did have, there wasn't any coverage, no insurance or anything, so if I did leave I would lose the income. It wasn't a big‐paying job. I make $150 per week, and take home $130, so I have to be careful and take in the forty hours in order to come home with something. I was turned down for disability (1).
Gender and psychological well‐being of persons with rheumatoid arthritis
Authors: Dowdy Sharon W. , Dwyer Kathleen A. , Smith Craig A. , Wallston Kenneth A.
Published: February 2007

Objective.This study examined the relationship of gender and psychological well‐being (PWB) in community‐dwelling persons with rheumatoid arthritis (RA).

Method.Data from the first wave of two longitudinal panel studies of persons with RA were examined (93 men and 276 women in panel 1; 60 men and 147 women in panel 2). Subjects completed self‐report questionnaires on behavioral aspects of RA. Psychological well‐being was assessed in both panels by the Center for Epidemiologic Studies‐Depression Scale, using its 4 subcomponents, including positive and negative affect. Panel 2 had additional measures of PWB, namely the Positive and Negative Affect Schedule and the Satisfaction With Life Scale. Potential explanatory variables were then examined in an attempt to account for the observed gender differences.

Results.Gender differences were found for negative indicators of PWB, while positive indicators of PWB showed no significant differences by gender. As with other community samples, women reported higher levels of depressive symptoms and negative mood than men. Quality of emotional support, passive pain coping, and physical functional impairment could only partially explain the observed gender differences in this study.

Conclusion.The relationship of gender to negative indicators of PWB cannot easily be diminished or dismissed. The mechanisms by which gender differentially affects PWB need to be further explored in order to intervene appropriately to help men and women with RA achieve an optimal quality of life.
Formal education and five‐year mortality in rheumatoid arthritis: Mediation by helplessness scale scores
Authors: Callahan Leigh F. , Cordray David S. , Wells George , Pincus Theodore
Published: February 2007

Objective. To analyze scores on a scale designed to measure helplessness, a cognitive variable, as a possible mediator of the association between formal education level and mortality over 5 years in patients with rheumatoid arthritis (RA).

Methods. A cohort of 1,416 patients with RA from 15 private practices in 6 states and Washington, DC was monitored for over 5 years. Demographic, socioeconomic, therapy, functional status, and psychological variables were analyzed as possible predictors of mortality in univariable and multivariable Cox Proportional Hazards models.

Results. In a 5‐year followup, 1,384 patients were accounted for (97.3%), including 174 who died versus 111 expected (standardized mortality ratio = 1.54). Higher mortality was associated significantly with low formal education, high age, poor scores for activities of daily living (ADL) on a modified health assessment questionnaire (MHAQ), and poor scores on a helplessness scale (all P < 0.01) in univariable analyses. High age, few years of formal education, and poor MHAQ ADL scores were all significant independent predictors of mortality when analyzed simultaneously in a Cox Proportional Hazards model. When helplessness scale scores were included in a model, scores greater than 2.4 (on a scale of 1 to 4), higher age, male gender, and increased MHAQ ADL difficulty scores were all independently significantly predictive of 5‐year mortality (P < 0.05), while years of education was no longer a significant predictor.

Conclusion. Scores on a helplessness scale appear to mediate a component of the association between formal education level and 5‐year mortality in these patients with RA. Health professionals and policy makers might consider interventions directed at modification of helplessness as adjunctive to standard interventions to improve outcomes in RA.
Ethnic differences in self‐reported functional status in the rural south: The johnston county osteoarthritis project
Authors: Jordan Joanne M. , Luta Gheorghe , Renner Jordan B. , Dragomir Anca , Hochberg Marc C. , Fryer John G.
Published: February 2007

Objective. We examined ethnic differences in self‐reported functional status in a rural, population‐based sample in North Carolina.

Methods. Data from 1,197 African‐American and Caucasian participants, aged 45 and older, in the Johnston County Osteoarthritis Project were analyzed using multiple logistic regression to examine ethnic differences in difficulty performing tasks of the Health Assessment Questionnaire (HAQ) and in risk factor profiles associated with difficulty.

Results. Forty‐three percent reported difficulty in one or more HAQ tasks. African‐Americans were more likely than Caucasians to report difficulty performing 3 tasks (P < 0.04); these differences were minimal after adjustment for confounders. For some tasks, risk factor profiles included body mass index in African‐Americans only, and age and female gender more often in Caucasians. Low educational attainment was part of the risk factor profile for walking in African‐Americans.

Conclusions. Differences in proportions of African‐Americans and Caucasians reporting difficulty in performance of HAQ tasks were minimal, but risk factor profiles for difficulty appeared to vary by ethnicity.
Effects of exercise on knee joints with osteoarthritis: A pilot study of biologic markers
Authors: Bautch Judith C. , Malone Daniel G. , Vailas Arthur C.
Published: February 2007

Objective. To determine the effects of low intensity weight‐bearing exercise on osteoarthritis (OA) of the knee.

Methods. Synovial fluid keratan sulfate (KS) and hydroxyproline were measured as markers of cartilage degradation. The Arthritis Impact Measurement Scales (AIMS) were used to measure health status, and a visual analog scale for pain assessment was used before and after intervention. An exercise (EX) group (n = 15) received a thrice‐weekly 12‐week low intensity exercise program and a weekly educational program, and a minimal treatment (Min RX) group (n = 15) received only the education program.

Results. Pain levels declined in the EX group, and the Min RX group showed improvement on the AIMS. Synovial fluid was obtained in 11 subjects before and after the intervention. Levels of KS and hydroxyproline did not change.

Conclusion. Further study of exercise effects should include both clinical and biologic parameters to examine the outcome of exercise as a therapeutic intervention in OA of the knee.
Self‐efficacy for arthritis pain: Relationship to perception of thermal laboratory pain stimuli
Authors: Keefe Francis J. , Lefebvre John C. , Maixner William , Salley Alfred N. , Caldwell David S.
Published: February 2007

Objective. To examine how self‐efficacy for arthritis pain relates to the perception of controlled laboratory pain stimuli.

Methods. Forty patients with osteoarthritis completed self‐report measures of self‐efficacy for arthritis pain. They then participated in a single experimental session in which measures of thermal pain threshold and tolerance were collected, as well as measures of the perceived intensity and unpleasantness of a range of thermal pain stimuli.

Results. Correlational analyses revealed that patients reporting high self‐efficacy for arthritis pain rated the thermal pain stimuli as less unpleasant than those reporting low self‐efficacy. When subjects scoring very high and very low in self‐efficacy were compared, it was found that subjects scoring high on self‐efficacy for arthritis pain had significantly higher pain thresholds and pain tolerance than those scoring low on self‐efficacy.

Conclusions. These results in dicate that self‐efficacy for arthritis pain is related to judgments of thermal pain stimuli. Implications for the understanding of arthritis pain and for future laboratory research are discussed.
The experience of rheumatoid arthritis pain and fatigue: Examining momentary reports and correlates over one week
Authors: Stone Arthur A. , Broderick Joan E. , Porter Laura S. , Kaell Alan T.
Published: February 2007

Objective. To evaluate the daily experience of patients with rheumatoid arthritis (RA) in an ecologically valid manner; Ecological Momentary Assessment (EMA) was employed. Diurnal cycles and within‐day variation of self‐reported pain and fatigue were examined as were relationships between pain, fatigue, daily stressful events, and sleep.

Methods. Thirty‐five patients with RA were alerted with an electronic beep 7 times per day for 7 consecutive days. Assessments were recorded at each beep. Upon awakening each day, sleep information was reported.

Results. There were large individual differences in variation of pain and fatigue. Stressors were associated with increased pain but not fatigue. Subjects with poor sleep had higher levels of pain and fatigue. Diurnal cycles of pain and fatigue were found, yet were observed for only some patients (37% and 34%, respectively).

Conclusion. The use of EMA deepens our understanding of the pain and fatigue experienced by RA patients. This method may help identify subgroups of patients who are highly “psychoreactive” to environmental stimuli and/or who have diurnal patterns to their symptoms. It may also be used to improve existing instruments.
Measurement of depression in mexican patients with rheumatoid arthritis: Validity of the beck depression inventory
Authors: Suárez‐Mendoza Aldo A. , Cardiel Mario H. , Caballero‐Uribe Carlo V. , Ortega‐Soto Hector A. , Márquez‐Marin Mirella
Published: February 2007

Objective. To validate a Spanish version of the Beck Depression Inventory (BDI) in Mexican patients with rheumatoid arthritis (RA).

Methods. Thirty‐five patients with RA seen in our outpatient clinic were included. A semistructured psychiatric interview was applied, and the following instruments were administered: the BDI, the Hospital Anxiety and Depression Scale (HAD), and the Health Assessment Questionnaire Disability Index. Diagnostic properties of the BDI for both full‐length and smaller versions taking out somatic items were compared against a gold standard. The gold standard for comparison was the diagnosis of depression according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria.

Results. Thirty‐seven percent of RA patients had a diagnosis related to depression, most of which were major depression or dysthymia. The original BDI showed a high sensitivity (92%) and a high correlation with the HAD (r = 0.83). Exclusion of somatic items in modified versions of the BDI had a similar performance.

Conclusions. The original BDI is a suitable instrument to detect depression in Mexican RA patients. Nevertheless, shorter versions without some of the somatic items also show an adequate performance.
Off‐the‐shelf orthopedic footwear for people with rheumatoid arthritis
Authors: Fransen Marlene , Edmonds John
Published: February 2007

Objectives. To assess the effectiveness of off‐the‐shelf orthopedic footwear for people with rheumatoid arthritis (RA) reporting chronic foot pain, in terms of self‐reported pain and physical function, as well as objectively measured gait variables using an electric footswitch walkway.

Methods. A small, randomized, controlled trial followed by a larger repeated measures analysis was used.

Results. The control group (n = 15) demonstrated no significant changes over a 2‐month period in pain, physical function, or gait scores. In contrast, after supply of the footwear both the original footwear group (n = 15) and the control group demonstrated significant improvements, with small to large effect sizes, in weight‐bearing pain scores, physical function, gait velocity, and gait stride length without increases in use of arthritis medications or walking aids.

Conclusion. These data suggest that off‐the‐shelf orthopedic footwear is beneficial for people with RA even when subjects were unselected on basis of age, sex, disease duration, or disability as measured by the Stanford Health Assessment Questionnaire.
Users evaluate lupusline a telephone peer counseling service
Authors: Horton Roberta , Peterson Margaret G. E. , Powell Susan , Engelhard Enid , Paget Stephen A.
Published: February 2007

Objective. To assess the impact of LupusLine during its pilot phase of operation by determining patterns of utilization and user satisfaction. LupusLine is a peer counseling service designed to provide ongoing emotional support from home to home by telephone appointment.

Methods. One hundred fifty‐three respondents were surveyed, using a 72‐item structured questionnaire administered over the telephone by interviewers separately trained and hired specifically for this purpose. The questionnaire was pilot tested on 10 volunteers with systemic lupus erythematosus (SLE), and a panel of related health professionals reviewed the questionnaire for face validity.

Results. Most users were women (94.5%) who had SLE themselves (87.5%) and who called the service because of recent changes in their physical functioning and reported feelings of depression and anxiety about their illness. Forty‐one percent of respondents made 6 or more calls to their assigned peer counselor. Respondents reported high levels of satisfaction across 5 highly correlated measures, with 92% of callers reporting at least moderate satisfaction with the service. Over 60% of respondents who reported a change in 6 “feeling” categories attributed this change to using LupusLine. Fewer users reported a change in 4 specific behaviors since using the service, but more respondents attributed changes, when they occurred, to LupusLine.

Conclusions. Based on these initial findings, we believe that telephone networks similar to the LupusLine model maybe able to offer substantial benefit to people coping with the complex, ongoing psychosocial challenges of SLE. Further, the at‐home accessibility and low cost of such volunteer‐based interventions may play an ever more needed role in the present health care environment.
Comparison of general internists, family physicians, and rheumatologists managing patients with symptoms of osteoarthritis of the knee
Authors: Mazzuca Steven A. , Brandt Kenneth D. , Katz Barry P. , Dittus Robert S. , Freund Deborah A. , Lubitz Robert , Hawker Gillian , Eckert George
Published: February 2007

Objective. To evaluate the nature, risks, and benefits of osteoarthritis (OA) management by primary care physicians and rheumatologists.

Methods. Subjects were 419 patients followed for symptoms of knee OA by either a specialist in family medicine (FM) or general internal medicine (GIM) or by a rheumatologist (RH). Management practices were characterized by in‐home documentation by a visiting nurse of drugs taken to relieve OA pain or to prevent gastrointestinal side effects of nonsteroidal anti‐inflammatory drugs (NSAIDs) and by patient report (self‐administered survey) of nonpharmacologic treatments. Changes in outcomes (knee pain and physical function) over 6 months were measured with the Western Ontario and McMaster Universities Osteoarthritis Index.

Results. Patients of RHs were 2‐3 years older (P = 0.035) and tended to exhibit greater radiographic severity of OA (P = 0.064) and poorer physical function (P = 0.076) at baseline than the other 2 groups. In all 3 groups, knee pain and physical function improved slightly over 6 months; however, between‐group differences were not significant. Compared to drug management of knee pain by FMs or RHs, that by the GIMs was distinguished by greater utilization of acetaminophen and nonacetylated salicylates (P = 0.008), lower prescribed doses of NSAIDs (P = 0.007), and, therefore, lower risk of iatrogenic gastroenteropathy (P < 0.001). In contrast, patients of RHs were more likely than those of FMs and GIMs to report that they had been instructed in use of isometric quadriceps and range‐of‐motion exercises (P ≦ 0.001), application of heat (P = 0.051) and cold (P < 0.001) packs, and in the principles of joint protection (P = 0.016). Neither physician specialty nor specific management practices accounted for variations in patient outcomes.

Conclusion. This observational study identified specialty‐related variability in key aspects of the management of knee OA in the community (i.e., frequency and dosing of NSAIDs, use of nonpharmacologic modalities) that bear strong implications for long‐term safety and cost. However, changes in knee pain and function over 6 months were unrelated to variations in management practices.
Development and validation of an exercise performance support system for people with lower extremity impairment
Authors: Minor Marian A. , Reid John C. , Griffin Joyce Z. , Patrick Timothy B. , Pittman Cory B. , Cutts James H.
Published: February 2007

Objective. To identify innovative strategies to support appropriate, self‐directed exercise that increase physical activity levels of people with arthritis. This article reports on one interactive, multimedia exercise performance support system (PSS) for people with lower extremity impairments in strength or flexibility.

Methods. An interdisciplinary team developed the PSS using self‐report of lower extremity musculoskeletal impairments (flexibility and strength) to produce an individualized exercise program with video and print educational materials. Initial evaluation has investigated the validity and reliability of program assessments and recommendations.

Results. PSS self‐report and professional assessments were similar, with more impairments indicated by self‐report. PSS exercise recommendations were similar to those made by 3 expert physical therapists using the same exercise data base. Results of PSS impairment assessments were stable over a 1‐week period.

Conclusion. PSS exercise recommendations appear to be reliable and a valid reflection of current exercise knowledge in rheumatology. Furthermore, users were able to complete the computer‐based program with minimal assistance and reported it to be enjoyable and informative.
Positive impact of an intervention by arthritis educators on retention of information, confidence, and examination skills of medical students
Authors: Branch Valerie Klusas , Lipsky Peter E.
Published: February 2007

Objective. To determine whether an intervention by trained persons with arthritis could have a positive impact on retention of information, confidence, and examination skills of medical students.

Methods. Second‐year medical students were introduced to the musculoskeletal examination as part of their Introduction to Clinical Medicine course by viewing a video (n = 93) or were taught the joint examination by a trained arthritis educator after viewing the video (n = 88). Each group was tested before and after the intervention about arthritis information, confidence, and attitude about arthritis and also evaluated for the ability to carry out a musculoskeletal examination.

Results. Retention of information and confidence of both groups increased as a result of the intervention. However, students who received the arthritis educator intervention increased their scores significantly in comparison. Musculoskeletal examination skills of the students receiving the arthritis educator intervention were also significantly greater than the control group.

Conclusion. An intervention by arthritis educators improved the retention of information, confidence, and examination skills of second‐year medical students significantly compared with the standard educational approach. The impact of the intervention persisted for at least two weeks.
Joint hypermobility in patients with fibromyalgia syndrome
Authors: Acasuso‐Díaz Manuel , Collantes‐Estéez Eduardo
Published: February 2007

Objective. To test the hypothesis that joint hyperlaxity can play some role in the pathogenesis of pain in primary fibromyalgia.

Methods. A total of 66 women with fibromyalgia (according to the 1990 American College of Rheumatology criteria) and 70 women with other rheumatic diseases were examined for joint laxity based on 5 criteria (The Non‐Dominant Spanish modification). Individuals meeting 4 or 5 criteria were considered to be hyperlax.

Results. Joint hyperlaxity was detected in 18 (27.3%) of the patients with fibromyalgia and 8 (11.4%) of those with another rheumatic disorder. The statistical analysis revealed significant differences (p < 0.05) between both groups.

Conclusion. The results of this study suggest that joint hypermobility and fibromyalgia are associated. Joint hyperlaxity may play a prominent role in the pathogenesis of pain in fibromyalgia.
A standardized protocol for measurement of range of movement of the shoulder using the Plurimeter‐V inclinometer and assessment of its intrarater and interrater reliability
Authors: Green Sally , Forbes Andrew , Buchbinder Rachelle , Bellamy Nicholas
Published: February 2007

Objective. To develop a standardized protocol for measurement of shoulder movements using a gravity inclinometer designed for use in clinical trials, and to assess its intra‐ and interrater reliability in a group of manipulative physiotherapists.

Methods. After instruction, 6 manipulative physiotherapists independently assessed 8 movements of the shoulder, including total and glenohumeral flexion (TE GHF), total and glenohumeral abduction (TA, GHA), external rotation in neutral (ERN) and abduction (ERA), internal rotation in abduction (IRA), and hand behind back (HBB), in random order in 6 patients with shoulder pain and stiffness according to a 6 × 6 Latin square design using the standardized protocol. The assessments were then repeated. Analysis of variance was used to partition total variability into components of variance in order to calculate intraclass correlation coefficients (ICCs).

Results. The intra‐ and interrater reliability of the different movements varied widely Reliability was higher for TF and TA than for the corresponding glenohumeral movements (e.g., intmrater ICCs: TF = 0.80, GHF = 0.65, TA = 0.75, GHA = 0.62). Intererrater reliability was higher in the second round suggesting a practice effect (e.g., round 1,2 interrater ICCs TF = 0.62, 0.82; TA = 0.62, 0.88; ERN = 0.85, 0.95).

Conclusion. The measurement of the active range of TF, TA, ERN, and HBB, measured by manipulative physiotherapists following the standardized protocol, has intra‐ and interrater reliability acceptable for use as an outcome measure in clinical trials assessing interventions for shoulder pain.
A comparison of IgM rheumatoid nephelometry and latex methods: Clinical and laboratory significance
Authors: Wolfe Frederick
Published: February 2007

Objectives. To study the comparative performance characteristics of nephelometric and IgM latex rheumatoid factor [RF] with regard to diagnosis, to determine the level of test result that most accurately classifies patients as having rheumatoid arthritis [RA] versus noninflammatory rheumatic disorders, to develop mathematic and graphic conversion tools, and to determine the usefulness of serial nephelometric RF factors test in assessing change in clinical status.

Methods. Sera and clinical measurements were obtained from 576 rheumatic disease patients during routine clinic visits and were analyzed by latex and nephelometric methods.

Results. Nephelometric and latex methods were highly correlated (0.872) and generally equivalent in their ability to discriminate between RA and noninflammatory conditions. Serial measures of RF were correlated with changes in clinical activity, but were much less effective in this respect than erythrocyte sedimentation rate or C‐reactive protein.

Conclusion. Both tests yield equivalent results. Mathematic and graphic models will allow conversion between tests so that clinicians can use either or both methods effectively. RF is modestly correlated with changes in clinical activity and therefore is not a useful measure to follow clinical improvement or worsening.
Effect of satisfaction with one's abilities on positive and negative affect among individuals with recently diagnosed rheumatioid arthritis
Authors: Blalock Susan J. , Orlando Maria , Mutran Elizabeth J. , DeVellis Robert F. , Devellis Brenda M.
Published: February 2007

Objective. The purpose of this study was to examine the effect that self‐evaluation processes have on psychologic well‐being among individuals with rheumatoid arthritis (RA).

Methods. The study used a longitudinal research design with 4 data collection points. Participants were 227 adults with recently diagnosed RA. Data were collected via mailed questionnaire and telephone interview. Two dimensions of psychologic well‐being were assessed—positive affect and negative affect.

Results. We found that, among participants who viewed the abilities being evaluated as very important, greater satisfaction at time 1 was associated with less negative affect at time 2 and time 4. Satisfaction was not associated with positive affect at any of the time points, however.

Conclusion. Study findings indicate that dissatisfaction with illness‐related abilities can exacerbate psychologic distress. The findings also highlight the need for research examining the role that positive affect plays in adaptation to RA.
Arthritis health service utilization among the elderly: The role of urban‐rural residence and other utilization factors
Authors: Saag Kenneth G. , Doebbeling Bradley N. , Rohrer James E. , Kolluri Sheela , Mitchell Theresa A. , Wallace Robert B.
Published: February 2007

Objective. To compare the impact of urban‐rural residence and other factors on the utilization of any type of arthritis‐related physician care and on rheumatologist utilization.

Methods. A population‐based random sample of adults 65 years of age or older with self‐reported arthritis from 10 urban and 12 rural Iowa counties were surveyed by telephone interview. We estimated the arthritis prevalence and health service utilization in this sample and evaluated the effects of predisposing, enabling, and need factors on utilization and satisfaction. Health care utilization was defined as ever having visited specific types of providers for arthritis‐related care.

Results. A total of 488 individuals participated: 227 from urban counties and 261 rural respondents. Urban respondents more commonly reported having received a diagnosis of osteoarthritis from their physicians but were less likely to report rheumatoid arthritis. A greater proportion of urban versus rural respondents had utilized any physician for arthritis care (50.7% versus 41.0%, P = 0.032) and had more often seen an orthopedist (18.1% versus 9.6%, P = 0.006) or general internist (18.5% versus 8.8%, P = 0.002). A diagnosis of rheumatoid arthritis, younger age, living with another person, higher income, and further distance from an arthritis provider were significantly associated with prior rheumatologist utilization. The strongest adjusted predictor of any physician visit for arthritis care was whether older adults drove themselves to their provider. For rheumatologist utilization, a diagnosis of rheumatoid arthritis and age were independently associated.

Conclusions. The most striking finding was the consistent association of need factors (such as the desire for medical advice), joint swelling, and the presence of a diagnosis of rheumatoid arthritis with physician utilization. We identified significant urban‐rural variations in factors both enabling and predisposing to arthritis care, although urban‐rural status did not appear to independently influence arthritis physician utilization. In a rural state with a relatively small number of rheumatologists, deleterious enabling factors such as greater distance from the doctor and lack of supplemental insurance did not provide significant obstacles to either rheumatologist or generalist utilization.
Interdisciplinary treatment for fibromyalgia syndrome: Clinical and statistical significance
Authors: Turk Dennis C. , Okifuji Akiko , Sinclair J. David , Starz Terence W.
Published: February 2007

Objectives.The primary purposes of the study were to: evaluate the treatment efficacy of an outpatient, interdisciplinary treatment program for fibromyalgia syndrome (FMS); examine whether treatment gains would be sustained for 6 months following the treatment; assess whether improvements were clinically significant; and delineate the factors associated with clinically significant improvement in pain severity.

Methods.Sixty‐seven FMS patients completed a 4‐week outpatient program consisting of medical, physical, psychologic, and occupational therapies. Six‐month followup data were available for 66% of treated patients.

Results.Comparisons between pretreatment and posttreatment measures revealed significant improvements in pain severity, life interference, sense of control, affective distress, depression, perceived physical impairment, fatigue, and anxiety; however, there was no improvement in interpersonal relationships or general activities. Clinically significant improvement in pain severity, using the Reliable Change Index, was obtained by 42% of the sample and was predicted by the pretreatment levels of depression, activity, perceived disability, solicitous responses of significant others, and idiopathic onset. Pretreatment level of pain severity was not a significant predictor of the degree of pain improvement. Comparisons among pretreatment, posttreatment, and 6‐month followup data revealed that the patients maintained treatment gains in pain, life interference, sense of control, affective distress, and depression. However, the quadratic polynomial analysis revealed that relapse occurred in the subjective rating of fatigue.

Conclusions.The results suggest that, overall, an outpatient interdisciplinary treatment program was effective in reducing many FMS symptoms. Treatment gains tended to be maintained for at least 6 months. However, there were large individual differences in response to treatment. These results suggest that identification of subgroups of FMS patients and their specific clinical characteristics may be useful for maximizing treatment efficacy.
Using focus groups to understand arthritis patients' perceptions about unconventional therapy
Authors: Rao Jaya K. , Arick Rhonda , Mihaliak Kim , Weinberger Morris
Published: February 2007

Objective. To understand arthritis patients' use of unconventional therapies (UT).

Methods. Thirty‐three rheumatoid arthritis and osteoarthritis patients followed in university clinics participated in 5 focus groups to discuss: their beliefs about arthritis and UT; UT they have used; reasons for using UT; effectiveness of UT; sources of information on UT; and communication about UT with the physician. Two investigators analyzed focus group transcripts to identify common themes.

Results. All patients believed arthritis to be incurable by conventional regimens or UT. Over one‐half had used UT to relieve pain; cost was unimportant. Patients trusted information about UT from family, friends, and others with arthritis, but not supermarket tabloids or television commercials. Most discussed UT use with their physician, primarily to prevent interactions with prescribed treatments. Physicians' reactions ranged from ridicule to giving permission to continue using UT.

Conclusions. These results provide an understanding of arthritis patients' motives for using UT and for discussing this behavior with their physician.
The experience of knee arthritis in athletic young and middle‐aged adults: An heuristic study
Authors: Keysor Julie J. , Sparling Joyce W. , Riegger‐Krugh Cheryl
Published: February 2007

Objective. To gain a better understanding of the experience of living with tibiofemoral osteoarthritis (OA) as young and middle‐aged adults.

Methods. Heuristic qualitative research methods were used. Four informants between the ages of 25 and 45 years diagnosed with tibiofemoral OA were purposively sampled. Informants were white, college educated, middle class, and physically active. Informants were interviewed for 4 hours. Interviews were transcribed verbatim and analyzed according to a van Kaam method modified by Moustakas.

Results. Living with tibiofemoral OA involved pain, fear, isolation, helplessness, and loss of function, identity, and perceived control. The informants struggled with adapting to their pathology. Behavior change and activity modification were difficult and seemed to be related to the physical, sociologic, and psychologic aspects of pathology.

Conclusions. A biopsychosocial model of chronic pathology was developed that may guide health professionals in treating and developing interventions for younger adults with arthritis.
An examination of individual differences in the relationship between interpersonal stress and disease activity among women with rheumatoid arthritis
Authors: Zautra Alex J. , Hoffman Jeanne M. , Matt Kathleen S. , Yocum David , Potter Phillip T. , Castro William Lesley , Roth Sanford
Published: February 2007

Objective. The effects of interpersonal stress on disease activity were examined for married women with rheumatoid arthritis (RA) who differ in the quality of their relationships with their spouses.

Methods. Measures of interpersonal events were collected weekly for 12 weeks and related to disease activity through a comparison of clinician ratings and immune markers taken at baseline and during a highly stressful week for 20 RA patients. Individual differences in marital relationship variables and illness characteristics were used to predict group differences in how stress affected disease activity.

Results. Significant elevations in total T cell activation (DR + CD3 cells), soluble interleukin‐2 receptor (sIL‐2R), and clinician's global ratings of disease activity were found during a week of significant interpersonal stress. However, women with better spousal relationships did not show increases in disease activity following an episode of interpersonal stress. In addition, patients taking low‐dose prednisone showed greater reactivity to stress than patients not currently using glucocorticoid treatment.

Conclusion. The results are consistent with the hypothesis that disease activity in RA increases following increases in interpersonal stress and that women with stronger marital relationships were less vulnerable to those stressors.
Effects of epidural steroid injection on pain due to lumbar spinal stenosis or herniated disks: A prospective study
Authors: Rivest Charles , Katz Jeffrey N. , Ferrante F. Michael , Jamison Robert N.
Published: February 2007

Objectives. To describe the extent of pain relief two weeks after an epidural steroid injection in patients with herniated disks and lumbar spinal stenosis, and to identify predictors of changes in pain ratings in each population.

Methods. The study design was a prospective evaluation of patients with lumbar spinal stenosis (LSS) and herniated disks (HDs) referred to a hospital‐based pain clinic for an epidural steroid injection (ESI). A complete history, detailed physical examination, comprehensive pain questionnaire, and Brief Symptom Inventory were obtained for all patients. Pain was assessed at baseline and two weeks following a single ESI using a visual analog scale.

Results. Two hundred twelve patients (mean age 54 years) were enrolled, and 78 of these provided pain ratings before and two weeks after the injection. LSS patients improved less two weeks following the ESI than HD patients (P = 0.04). Just 38% of LSS patients reported improvement in pain score compared with 61 % of HD patients. In analyses that combined LSS and HD patients, predictors of worse response included a report of health problems and a diagnosis of LSS.

Conclusions. LSS patients have worse response to ESIs than HD patients. The poor response to ESI in patients with LSS underscores the need for randomized controlled trials of ESI in this population.
The social environment and health in rheumatoid arthritis: Marital quality predicts individual variability in pain severity
Authors: Waltz Millard , Kriegel Walter , Bosch Paul Van'T Pad
Published: February 2007

Objective. To examine prospective relations between a wide array of measures of social functioning and pain, while controlling for disease duration and activity and functional grade.

Methods. As part of a larger study on health care utilization, longitudinal data were collected from 136 Dutch and 98 German outpatients on clinical status and pain. Social data included information on sexual handicap, spouse behavior, loneliness, daily emotional support, and the maintenance of pleasurable life domains. Pain severity was assessed at baseline and 12 months later with standard measures of pain and analyzed with hierarchical regressions.

Results. Social measures obtained at baseline were consistently associated with pain at followup. Depression was a moderate correlate of pain in the Dutch and German samples. The regressions revealed that patient reports of negative spouse behavior (such as avoidance and critical remarks) and baseline depression predicted worse pain outcome, and this association remained significant in analyses controlling for baseline pain. The level of formal education was a weak correlate of disability, emotional support, and pain. Daily emotional support and social life domains associated with positive affect had an indirect influence on outcome. The absence of strong rather than weak social ties was the component of the loneliness construct linked to pain. These associations between social prognostic factors and pain severity, however, were mediated by psychological functioning at baseline.

Conclusion. The social environment was found to operate on the core health outcome, pain severity, via several pathways. Social functioning may be affected by rheumatoid arthritis (RA) progression, but it also appears to form a determinant of future health outcome. Not only the status of being married but also the quality of the relationship in terms of long‐term stress and emotional support may be useful prognostic factors in RA.
Arthritis self‐management program variations: Three studies
Authors: Lorig Kate , González Virginia M. , Laurent Diana D. , Morgan Lisa , Laris B. A.
Published: February 2007

Objectives. (1) Determine strengths and weaknesses of the Arthritis Self‐Management Program (ASMP). (2) Compare 3‐ and 6‐week ASMP. (3) Evaluate 1.5‐hour arthritis program.

Methods. Study 1: Qualitative methods incorporating incomplete block design. Study 2: Comparison of 3‐ and 6‐week outcomes. Study 3: Pretest/ posttest comparison.

Results. Study 1: Pain management, exercise, and sharing ranked as the most useful aspects of the ASMP. Nutrition, medications, and making decisions about nontraditional treatments ranked least useful. Study 2: Six‐week ASMP subjects improved pain, health distress, illness impact, exercise, cognitive pain management, self‐efficacy, and reduced visits to physicians (P < 0.05). Three‐week subjects improved health distress, cognitive pain management, and self‐efficacy (P < 0.05). Study 3: Improved knowledge, self‐efficacy, and pain (P < 0.05).

Conclusions. The traditional 6‐week ASMP is more effective than a 3‐week version. A 1.5‐hour community program is effective in increasing knowledge, self‐efficacy, and contact with the Arthritis Foundation.
Recruiting adults with osteoarthritis into an aquatic exercise class: Strategies for a statewide intervention
Authors: Spencer Anna C. , Kinne Susan , Belza Basia L. , Ramsey Scott , Patrikc Donald L.
Published: February 2007

Objective. Although research suggests that regular exercise can be helpful in reducing the dysfunction and discomfort of osteoarthritis, promoting exercise among older adults within this population is neither straightforward nor easily accomplished. This article describes the various methods, and their relative success rates, that were employed to recruit older adults throughout the state of Washington into an aquatic exercise program.

Methods. Strategies included a recruitment letter distributed to Arthritis Foundation (AF) members in Washington state, local media news coverage, physician referrals, and advertisements in local papers and newsletters.

Results. The most successful methods for enrolling participants were through the AF recruitment letters and local television coverage. The AF recruitment letter was the most expensive method of generating responses, while the television coverage was the least expensive.

Conclusions. Collaborating with a well‐reputed community‐based organization and capitalizing on available publicity resources are important strategies researchers can use to gain access to a difficult and geographically dispersed population.