bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of col2a1 gene mutations in patients with chondrodysplasias and familial osteoarthritis
Authors: Ritvaniemi Pertti , Körkkö Jarmo , Bonaventure Jacky , Vikkula Miikka , Hyland James , Paassilta Petteri , Kaitila Ilkka , Kääriäinen Helena , Sokolov Boris P. , Hakala Markku , Mannismäki Pertti , Meerson Elena M. , Klemola Tero , Williams Charlene , Peltonen Leena , Kivirikko Kari I. , Prockop Darwin J. , Ala‐kokko Leena
Published: February 2007

Objective. To use a recently developed procedure for analysis of blood leukocyte DNA to detect mutations in the gene for type II procollagen (COL2A1) in patients with cartilage diseases ranging from early‐onset familial osteoarthritis (OA) to lethal chondrodysplasias.

Methods. The technique of denaturing gradient gel electrophoresis was used to scan polymerase chain reaction (PCR) products from 45 exons and exonflanking sequences of the COL2A1 gene in more than 70 patients with cartilage diseases whose severity ranged from mild to lethal. PCR products with abnormal migrations were then sequenced.

Results. Among the 3 patients with lethal hypochondrogenesis who were analyzed, all 3 were found to have a mutation in the COL2A1 gene. Among 17 patients with spondyloepiphyseal or spondyloepimetaphyseal dysplasia, 2 well‐defined and 2 probable mutations were found. Among 15 patients with the Wagner‐Stickler syndrome, 2 well‐defined and 2 probable mutations were found. Among 45 patients with early‐onset familial OA, 1 probable mutation was found.

Conclusion. Using the procedure developed for analysis of the COL2A1 gene, mutations were detected in >20% of patients with chondrodysplasias and up to 2% of patients with early‐onset familial OA. However, these percentages are only minimal estimates because all possible mutations in the gene cannot be detected with this procedure.
Increased susceptibility to oxidation of low‐density lipoproteins isolated from patients with systemic sclerosis
Authors: Bruckdorfer K. Richard , Hillary Janet B. , Bunce Tim , Vancheeswaran Rama , Black Carol M.
Published: February 2007

Objective. To examine the resistance to oxidation of low‐density lipoproteins (LDL) from patients with systemic sclerosis (SSc) and primary Raynaud's phenomenon (RP) compared with healthy controls.

Methods. Plasma LDL were isolated from patients with diffuse cutaneous and limited cutaneous SSc (dcSSc and lcSSc, respectively), patients with primary RP, and healthy control subjects. The lipoproteins were assessed for their resistance to oxidation in the presence of cupric ions, using spectrophotometric assays.

Results. LDL from patients with dcSSc and lcSSc were more susceptible to oxidation than were those from healthy control subjects or patients with RP.

Conclusion. Our findings suggest that free radicals may play a role in the pathology of SSc.
A human monoclonal antiphospholipid antibody that is representative of serum antibodies and is germline encoded
Authors: Harmer Ian J. , Loizou Sozos , Thompson Keith M. , So Alex K. L. , Walport Mark J. , Mackworth‐Young Charles
Published: February 2007

Objective. To investigate the origins of antiphospholipid antibodies associated with thrombosis and other disorders that are found in patients with systemic lupus erythematosus and primary antiphospholipid syndrome (APS).

Methods. Characterization, idiotypic study, and nucleotide sequencing of a human monoclonal antiphospholipid antibody generated from a patient with primary APS. Identification of the germline genes from which the antibody is derived.

Results. A human monoclonal antibody, BH1, was generated. This antibody has ligand‐binding properties that closely resemble those of the serum antiphospholipid antibodies found in our patient and in other individuals with APS: it recognizes negatively charged phospholipids, and has lupus anticoagulant activity; it does not bind to neutral phospholipids, or to singlestranded or double‐stranded DNA. The relevance of BH1 to the patient's serum antibodies is supported by our idiotypic studies. BH1 is encoded by a new germline VH gene, and by a λ light chain gene that displays >99% homology with the VλIII.1 germline gene.

Conclusion. Serum antiphospholipid antibodies associated with thrombosis may be encoded by either germline or only slightly mutated variable‐region genes.
A randomized, double‐blind, placebo‐controlled study of cd4 monoclonal antibody therapy in early rheumatoid arthritis
Authors: Van Der Lubbe Peter A. , Dijkmans Ben A. C. , Markusse Hendrik M. , Nässander Ulla , Breedveld Ferdinand C.
Published: February 2007

Objective. To assess the efficacy of the CD4 monoclonal antibody (MAb) cM‐T412 in the treatment of early rheumatoid arthritis (RA).

Methods. Sixty patients were enrolled in a 6‐week randomized, double‐blind, placebo‐controlled study investigating multiple dose regimens of cM‐T412. Thirty patients subsequently were enrolled in a 9‐month randomized, double‐blind, placebo‐controlled study investigating monthly single‐dose administrations of cM‐T412.

Results. Analysis of clinical parameters revealed no changes in arthritis activity in the groups that received CD4 MAb or the placebo group, and no difference between the groups, in either in the first or the second part of the study. The number of circulating CD4+ cells decreased substantially in the patients treated with CD4 MAb.

Conclusion. CD4 MAb treatment of patients with early RA induced no therapeutic effect.
Development of an observation method for assessing pain behaviors in children with juvenile rheumatoid arthritis
Authors: Jaworski Theresa M. , Bradley Laurence A. , Heck Louis W. , Roca Alex , Alarcön Graciela S.
Published: February 2007

Objective. To develop an observation method for assessing pain behaviors in children with juvenile rheumatoid arthritis (JRA).

Methods. Thirty children with JRA performed a standardized sequence of activities for video recording, and correlations between the pain behaviors observed on the videotapes and established measures of pain, depression, and functional disability were determined.

Results. Pain behaviors were reliably observed (kappa coefficients 0.53‐0.79). Total pain behaviors were significantly correlated with subjective reports of pain (r = 0.50) and disability levels (r = 0.64). These behaviors were not significantly associated with children's depression ratings (r = 23).

Conclusion. The results indicate that the behavioral observation method provides a reliable and valid measure of pain associated with JRA. Measurement of pain behaviors may be especially useful in treatment outcome studies because these behaviors are relatively independent of depression.
Lyme disease in a 74‐year‐old forest owner with symptoms of dermatomyositis
Authors: Hoffmann Jörg C. , Stichtenoth Dirk O. , Zeidler Henning , Follmann Markus , Brandis Almuth , Stanek Gerold , Wollenhaupt Jürgen
Published: February 2007

We describe a 73‐year‐old forest owner with widespread erythema, myalgia, and proximal muscle weakness. The clinical signs and the results of electro‐myography, magnetic resonance imaging, and a muscle biopsy were consistent with dermatomyositis. However, serology was positive for Borrelia burgdorferi. More importantly, B burgdorferi DNA was detected in skin by polymerase chain reaction techniques, and spirochete‐like organisms were detected in the muscle by silver staining. Lyme disease with muscle involvement can mimic or trigger dermatomyositis and should be considered in the differential diagnosis of dermatomyositis.
Degenerative lumbar spinal stenosis diagnostic value of the history and physical examination
Authors: Katz Jeffrey N. , Dalgas Marianne , Stucki Gerold , Katz Nathaniel P. , Bayley James , Fossel Anne H. , Chang Lily C. , Lipson Stephen J.
Published: February 2007

Objective. To assess the value of the history and physical examination findings in the diagnosis of symptomatic degenerative lumbar spinal stenosis (LSS).

Methods. The study was performed in 3 specialty clinics, and included patients with low back pain who were at least age 40. Findings from a standardized history and physical examination were compared with the diagnostic impression of expert attending clinicians. Imaging studies were available in 88% of those with LSS, and the findings further supported the diagnosis of LSS in each case. The sensitivity, specificity, and likelihood ratio associated with each history and physical examination finding were calculated in bivariate analyses, and independent correlates of LSS were identified with multivariate analyses.

Results. Ninety‐three patients were evaluated. History findings most strongly associated with the diagnosis of LSS (likelihood ratio ≥2) were greater age, severe lower‐extremity pain, and absence of pain when seated. Physical examination findings most strongly associated with the diagnosis were wide‐based gait, abnormal Romberg test result, thigh pain following 30 seconds of lumbar extension, and neuromuscular deficits. Independent correlates of LSS included advanced age (P = 0.0001), absence of pain when seated (P = 0.006), wide‐based gait (P = 0.013), and thigh pain following 30 seconds of lumbar extension (P = 0.002).

Conclusion. Specific history and physical examination findings are useful in the diagnosis of LSS and should be ascertained routinely in older patients with low back pain.
klebsiella pneumoniae‐reactive t cells in blood and synovial fluid of patients with ankylosing spondylitis comparison with hla–b27 + healthy control subjects in a limiting dilution study and determination of the specificity of synovial fluid t cell clones
Authors: Hermann Elisabeth , Sucké Bernd , Droste Ulf , zum Büschenfelde Karl‐Hermann Meyer
Published: February 2007

Objective. To study the frequency of Klebsiella pneumoniae–responsive T cells in the peripheral blood (PB) of ankylosing spondylitis (AS) patients compared with that in healthy HLA–B27+ donors, and to examine T lymphocyte clones (TLC) derived from AS patient synovial fluid (SF) for the presence of Klebsiella reactivity.

Methods. Limiting dilution analysis of PB T cells in 8 patients with active AS and in 8 HLA–B27+ healthy subjects was used to determine the frequency of PB T cells responsive to K pneumoniae and Escherichia coli GroEL. SF T cells from a patient with active AS were cloned, and 125 TLC were characterized in proliferation assays.

Results. There were fewer T cells in the PB of AS patients that reacted with K pneumoniae than in the PB of healthy HLA–B27+ subjects. The frequencies of E coli GroEL–responsive T cells were ∼5–10 times lower in all subjects tested (healthy donors and AS patients), but without significant differences between the 2 groups. Two CD4+ TLC that recognized K pneumoniae (1 cross‐reactive with E coli) as well as 3 TLC that recognized GroEL (2 CD4+, 1 T cell receptor γ/δ+) were isolated from the SF of a patient with active AS.

Conclusion. Our results indicate that there is a quantitative reduction of K pneumoniae‐responsive T cells in the PB of AS patients as compared with healthy controls. This may reflect a defective peripheral T cell defense in the immune response to Klebsiella and may allow bacterial antigens to reach the synovium, where they initiate specific T cell responses.
Quantitative bone scintigraphy in the management of monostotic paget's disease of bone
Authors: Patel Sanjeev , Pearson Derek , Hosking David J.
Published: February 2007

Objective. To assess the use of quantitative bone scanning (QBS) in the monitoring of patients with intravenous pamidronate–treated symptomatic mono‐stotic Paget's disease of bone in whom biochemical markers of bone turnover are relatively normal.

Methods. QBS was performed in 9 patients and the results were expressed as a ratio, obtained by comparing isotope uptake at an affected and a control (unaffected) site.

Results. Serum alkaline phosphatase levels were normal in 7 of the 9 patients and changed minimally with treatment. The median QBS ratio was 2.72 (range 1.69–24.6) at baseline and 1.49 (range 0.63–4.18) post‐ treatment (P = 0.008). The median symptom score decreased with treatment, but QBS ratios provided the only objective measure of disease activity by which response to pamidronate therapy could be judged.

Conclusion. QBS may be a useful technique for evaluating the effects of treatment in patients with Paget's disease of bone.
Adult respiratory distress syndrome in polymyositis patients with the anti–jo‐1 antibody
Authors: Clawson Kevin , Oddis Chester V.
Published: February 2007

We report 3 patients with polymyositis and the anti–Jo‐1 antibody who developed fatal adult respiratory distress syndrome (ARDS). Other than the presence of the anti–Jo‐1 antibody, there were no other consistent clinical features at the onset of disease that were predictive of ARDS development.
Campath‐1h, a humanized monoclonal antibody, in refractory rheumatoid arthritis
Authors: Weinblatt Michael E. , Maddison Peter J. , Bulpitt Ken J. , Hazleman Brian L. , Urowitz Murray B. , Sturrock Roger D. , Coblyn Jonathan S. , Maier Agnes L. , Spreen William R. , Manna Vasant K. , Johnston Jeffrey M.
Published: February 2007

Objective. To evaluate the biologic response, tolerability, and potential clinical effect of a humanized antilymphocyte monoclonal antibody, CAMPATH‐1H, in patients with rheumatoid arthritis (RA).

Methods. Forty adult patients with active, refractory RA were treated with CAMPATH‐1H, given intravenously, in a multicenter, open, single‐dose‐escalation study. Patients were assigned to dose groups of 1, 3, 10, 30, 60, and 100 mg CAMPATH‐1H.

Results. There was a profound, immediate, and sustained reduction of the peripheral lymphocyte count; the most susceptible were the levels of CD4+ and CD8+ cells, which remained depressed during the study period. Sixty‐three percent of patients developed antibodies to CAMPATH‐1H. Side effects occurred frequently throughout the first 24 hours following infusion, and included fever, headache, nausea, vomiting, and hypotension. All of the immediate drug toxicities resolved within the initial 24‐hour postdosing period. One patient developed a reactivation of Mycobacterium xenopi infection 10 weeks following infusion. Sixty‐five percent of patients developed a clinical response; the mean duration of response was 2 weeks.

Conclusion. CAMPATH‐1H is a lymphocytedepleting antibody that is biologically potent even after single‐dose therapy. There was no correlation between biologic effect and clinical response. Sustained lymphocyte suppression was observed. Acute infusion toxicities were observed in most patients. The role of depleting monoclonal antibodies in the treatment of RA should be reevaluated.
Oral 2‐chlorodeoxyadenosine in psoriatic
Authors: Eibschutz Barry , Baird Stephen M. , Weisman Michael H. , Amox Diane G. , Spellman Mary , Piacquadio Daniel , Carrera Carlos J. , Carson Dennis A.
Published: February 2007

Objective. To determine if weekly oral 2‐chlorodeoxyadenosine (2‐CdA) can induce selective lymphocytopenia, and reduce inflammation, in patients with refractory psoriatic arthritis.

Methods. Seven patients with psoriatic arthritis were treated with oral 2‐CdA at weekly dosages of 0.3 mg/kg to 0.45 mg/kg for 12 weeks, followed by monthly maintenance therapy. The patients were evaluated after 6 months.

Results. The drug treatment produced selective lymphocytopenia, and reduced lymphocyte infiltration into involved skin. One patient did not complete 12 weeks of therapy because of perceived lack of efficacy. Four of the 6 remaining patients had improved joint disease, and 5 of 6 had improved psoriasis.

Conclusion. Weekly oral 2‐CdA appears to be a well‐tolerated regimen for the inducement of peripheral lymphocytopenia in patients with psoriatic arthritis. Larger‐scale, controlled trials may be warranted.
In vivo effects of stromelysin on the composition and physical properties of rabbit articular cartilage in the presence and absence of a synthetic inhibitor
Authors: Bonassar Lawrence J. , Jeffries Kimberly A. , Frank Eliot H. , Moore Vernon L. , Lark Michael W. , Bayne Ellen K. , Mcdonnell Joseph , Olszewski Julie , Hagmann William , Chapman Kevin , Grodzinsky Alan J.
Published: February 2007

Objective. To characterize the effects of intra‐articular injection of recombinant human stromelysin (SLN) on the matrix composition and physical properties of cartilage from lapine stifle joints and the modulation of these effects by the systemic administration of an N‐carboxyalkyl synthetic matrix metalloproteinase inhibitor, L‐696,418.

Methods. Female 6–8‐week‐old New Zealand white rabbits received an intraarticular injection of 100 μg activated SLN in 1 stifle joint and buffer in the contralateral control knee; these animals were killed after 1 hour. A separate group of animals received an intravenous injection of either 30 mg/kg L‐696,418 or buffer prior to intraarticular injection of SLN. Joints were dissected and analyzed for proteoglycan (PG) loss into joint fluid, tissue biochemical composition, and histology by toluidine blue or anti‐VDIPEN antibody staining, or were frozen for physical property analysis. Disks of femoropatellar groove cartilage were harvested from the stifle joint and tested in uniaxially confined compression for determination of electromechanical and mechanical properties.

Results. Lapine stifle joints that received injection of SLN without systemic administration of L‐696,418 showed a 13‐fold increase in loss of PG into synovial fluid. Cartilage from these joints showed significant decreases in streaming potential at 1 Hz and electrokinetic coupling coefficient, but no change in equilibrium modulus, dynamic stiffness, or hydraulic permeability. Systemic treatment with L‐696,418 resulted in a significant decrease in loss of PG into joint fluid and elimination of changes in cartilage highfrequency streaming potential and coupling coefficient in joints that were injected with SLN.

Conclusion. The 1‐hour exposure to SLN in vivo resulted in loss of PG and exposure of the VDIPEN epitope of the aggrecan core protein in the superficial region of the tissue near the articular surface. This highly localized degradation resulted in electromechanical behavior changes, but little or no change occurred in mechanical properties. Systemic administration of L‐696,418 significantly decreased loss of PG from cartilage and prevented the highly localized tissue degradation and the resultant changes in electromechanical behavior caused by intraarticular SLN injection.
Somatostatin‐induced modulation of inflammation in experimental arthritis
Authors: Matucci‐Cerinic Marco , Borrelli Francesco , Generini Sergio , Cantelmo Alfredo , Marcucci Isabella , Martelli Fabrizio , Romagnoli Paolo , Bacci Stefano , Conz Angelo , Marinelli Paolo , Marabini Simone
Published: February 2007

Objective. To study the antiinflammatory effect of different doses of intraarticular somatostatin in experimental arthritis in rabbits.

Methods. Chronic arthritis was induced by a single injection of fibrin into the knee joint of rabbits previously sensitized to this antigen. The effects of sequential intraarticular injections of somatostatin into the rabbit knee, at doses of 500, 750, and 1,000 μg, were monitored by measuringknee joint circumferences and hematologic parameters. The measurements were compared with those obtained following use of triamcinolone acetonide and placebo. At the end of the experiments, the knee joints were examined histologically.

Results. Somatostatin treatment induced a statistically significant and dose‐related reduction of knee joint swelling. This effect was shorter than that produced by triamcinolone acetonide; however, the antiinflammatory activity elicited by successive doses of triamcinolone acetonide declined both in extent and duration, while the effects of somatostatin remained unchanged at each successive treatment. Histopatho‐logic observations showed that both somatostatin and triamcinolone acetonide reduced the inflammatory signs in the joint structures, although triamcinolone acetonide appeared to be more effective.

Conclusion. These findings suggest that somatostatin exerts an antiinflammatory effect in this model of experimental arthritis and may represent a valid and safer alternative to corticosteroids for intraarticular therapy of arthritis.
A patient with antineutrophil cytoplasmic antibody–negative pulmonary capillaritis and circulating primed neutrophils
Authors: Nierman David M. , Kalb Thomas H. , Ornstein Matthew H. , Gil Joan
Published: February 2007

We describe an antineutrophil cytoplasmic antibody–negative patient with capillaritis, acute respiratory failure, and primed neutrophils circulating systemically. Thoracoscopic lung biopsy showed capillary destruction, with neutrophils infiltrating the lung interstitium and air spaces but no alveolar damage or hemorrhage. We suggest that this atypical, limited form of pulmonary injury may occur when circulating neutrophils are primed, but, in the absence of an activating factor, not fully activated.
AI/learn/rheumatology. A computer‐assisted educational system for teaching about rheumatic diseases
Authors: Bridges Alan J. , Dansdill David , Anderson James , Reid John , Hazelwood Susan , Cutts James H. , Gall Eric P. , Sharp Gordon , Mitchell Joyce A.
Published: February 2007

Education of health professionals about the rheumatic diseases is in need of improvement. The computer is an instrument that can be used efficiently to educate large numbers of users. With specific educational principles in mind, we developed Al/LEARN/RHEUMATOLOGY, a computer‐assisted interactive videodisc system for teaching the rheumatic diseases. While interacting with the user, it conveys knowledge using visual and problem‐solving techniques. The system is efficient, enjoyable to use, and useful for small groups and independent study. It is applicable for teaching medical and allied health professional students, postgraduate trainees, and primary care physicians.
Changing patterns of hospital use for patients with musculoskeletal diseases in Michigan, 1980 to 1987
Authors: McMahon Laurence F. , Petroni Gina R. , Tedeschi Philip J. , McLaughlin Catherine G.
Published: February 2007

Over the past 10 years there have been dramatic changes in health care financing in the United States, such as Medicare's Prospective Payment System for hospitalized Medicare beneficiaries, and in health services delivery, such as the growth in health maintenance organizations and other forms of managed care. These changes have occurred largely in response to payors' concerns about the rising cost of health care. A study of such changes in financing and delivery, and how specific groups of patients are affected is necessary so that the effects of these changes on patients' health can be determined.

We examined the hospitalization rates for patients with musculoskeletal diseases in Michigan from 1980 through 1987. During this period, the overall ageadjusted hospitalization rates decreased 7.0% per year (p = 0.001). The decrease occurred less for surgical discharges (6.0% per year) than for medical discharges (8.6% per year) (p < 0.001). While these overall trends are of interest, they obscure disease‐specific trends that vary significantly from both the overall, and the medical and surgical trends. For example, while surgical discharges, in general declined, procedures related to major joint and limb reattachment (DRG # 209) increased at a rate of 6.3% per year. And while medical discharges in general decreased over this period, discharges for osteomyelitis increased 5.4% per year. The patterns of diseasespecific trends offers insight into the possible causes for these changes. Finally, it is important to understand the epidemiology of hospital use to evaluate the effects of new medical care delivery and payment systems on the care of subsets of patients.
Medical and psychosocial predictors of sexual outcome among women with systemic lupus Erythematosus
Authors: Curry Sandra L , Levine Stephen B. , Jones Paul K. , Kurit Doris M.
Published: February 2007

The influence of medical and psychosocial variables on sexual outcome in 100 women with systemic lupus erythematosus was examined. Subjects were administered a sexual adjustment interview and scales assessing depression, body image, and relationship qualilty. Medical data were obtained from patients and physicians. Key predictors of sexual outcome were disease severity (P < 0.001), premorbid sexual adjustment (P < 0.05), and relationship quality (P < 0.05). Results suggest that the impact of systemic lupus erythematosus on sexual response may best be understood by considering a combination of interpersonal, psychological, and medical conditions in a patient's life.
Cognitive‐behavioral approaches to pain management in rheumatoid arthritis
Authors: Parker Jerry C , Iverson Grant L , Smarr Karen L , Stucky‐ropp Renée C
Published: February 2007

The purpose of this article is to review the literature on the topic of cognitive‐behavioral approaches to pain management for persons with rheumatoid arthritis. Existing studies offer support for the usefulness of cognitive‐behavioral techniques, but methodologic limitations were identified. Although the core element in rheumatoid arthritis pain management is optimal rheumatologic care, an important role also exists for strategies that seek to reduce the cognitive‐evaluative aspects of arthritis pain.
Pain behavior of rheumatoid arthritis patients enrolled in experimental drug trials
Authors: Anderson Karen O. , Bradley Laurence A. , Turner Robert A. , Agudelo Carlos A. , Pisko Edward J.
Published: February 2007

Objective. This study examined the sensitivity of a behavioral observation method for the assessment of arthritis pain as an outcome measure in clinical drug trials.

Methods. The subjects were 33 rheumatoid arthritis patients who were receiving either an active experimental drug or a placebo. Disease activity measures, self‐reports of pain, and pain behavior observations were completed for each subject prior to drug initiation, 6 weeks after drug initiation, and 12 weeks after drug initiation.

Results. Significant reductions in measures of disease activity and self‐report of pain were found for the subjects who received an active drug, relative to those who received the placebo. The pain behavior scores produced by both groups of subjects remained relatively stable during the study.

Conclusion. The lack of change in pain behavior suggests that arthritis pain behavior may lack sensitivity to short‐term changes accompanying drug therapy.
Life activities of persons with rheumatoid arthritis with and without depressive symptoms
Authors: Katz Patricia P. , Yelin Edward H.
Published: February 2007

Objective. Persons with rheumatoid arthritis (RA) report more activity losses than persons without RA. Persons with RA who report depressive symptoms experience lower levels of functioning. We integrated these findings and examined the association of depressive symptoms with the activities in which persons with RA participate.

Methods. We surveyed 726 persons with RA and 192 matched controls. Within each group, we examined the perceived importance and actual performance of 65 life activities by individuals with and without depressive symptoms.

Results. Significantly more individuals with RA reported depressive symptoms. Among persons with RA, those who had depressive symptoms performed fewer activities, particularly fewer valued activities. In contrast, among controls, those who were depressed rated fewer activities as important, but exhibited few significant differences in the performance of activities.

Conclusions. Depressive symptoms and life activities are associated differently among persons with RA and controls. The higher rate of depression among persons with RA may be partially due to the inability to perform valued activities.
A tool for measuring functional outcomes after total hip arthroplasty
Authors: Kroll M. , Ganz S. , Backus S. , Benick R. , Mackenzie C. , Harris L.
Published: February 2007

Purpose. To describe a functional milestone scale (FMS) for measuring functional progression following total hip arthroplasty and to demonstrate that this scale meets accepted standards of scale construction.

Methods. Inter‐observer reliability of the scale was determined for 30 patients using a kappa coefficient of concordance (k) for ordinal data, representing 221 pairs of observations. There were 79, 54, 44, and 44 pairs of observations for transfer, walker, crutch, and stair ambulation, respectively.

Results. The k coefficient ranged from 0.82 to 0.91. Agreement between therapists was almost perfect according to the criteria of Feinstein.

Conclusions. The FMS exhibits substantial inter‐observer reliability and moderate to substantial validity. We have demonstrated its clinical applications as well as showing it to be a useful management and research tool.
Occupational therapy management of a patient with severe polymyositis
Authors: Deshaies Lisa D. , Yasuda Y. Lynn , Beardmore Thomas
Published: February 2007

The purpose of this article is to illustrate with a case study the process through which a patient with poly‐myositis taking part in an occupational therapy program achieved functional improvement in spite of persistent muscle weakness. Although the focus is on the occupational therapy program, close monitoring of patient improvement or regression by the total rehabilitation team was essential in order to adjust the patient's weekly activity level for maximum benefit.
An educational needs assessment of children with juvenile rheumatoid arthritis
Authors: Bartholomew L. Kay , Koenning Gaye , Dahlquist Lynnda , Barron Karyl
Published: February 2007

Objective. Our objective is to describe the use of the PRECEDE model (predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation) to organize needs assessment data in order to define self‐management behaviors and plan an educational intervention for children with juvenile rheumatoid arthritis (JRA) and their famihies.

Methods. Analysis was done of needs assessment data collected from several sources: 1) literature review, 2) survey of parents of 51 children with JRA, 3) group interview of seven parents of children with JRA, 4) results of pilot programs, and 5) clinical experience of an interdisciplinary pediatric rheumatology team.

Results. Two sets of interrelated behavioral factors were identified through the needs assessment: 1) those related to managing the school environment to facilitate optimal participation and to minimize schoolrelated disability, and 2) those related to treating pain and stiffness, intervening in the disease process, and preserving joint function.

Conclusion. Both of these sets of behavioral factors may be related to the optimization of children's mobility, joint function, and autonomy of activities of daily living and should be targets of an educational intervention.
Exercise tests as outcome measures
Authors: Burckhardt Carol S. , Moncur Carolee , Minor Marian A.
Published: February 2007

Outcome assessments of physical fitness attributes such as endurance, strength, and flexibility are not measured routinely in clinical trials or clinical practice in either adults or children with rheumatic diseases. Although physical fitness is not a measure of disease severity, it can be a critical indicator of capacity to function. Adequate fitness is necessary for the performance of positive health behaviors that enhance health status and wellness in spite of chronic disease. The purpose of this paper is to explore the conceptual, methodologic, and analytic issues related to the use of exercise tests as outcome measurements of physical functioning in persons with rheumatic disease.
The impact of fatigue on exercise performance
Authors: Belza Basia
Published: February 2007

The purpose of this paper is to discuss the impact of fatigue on exercise performance. First, fatigue will be defined and distinguished from similar constructs. Second, examples of instruments to measure fatigue in the rheumatic diseases are highlighted. Next, the social implications of fatigue are briefly mentioned. Fourth, methods in which fatigue impacts exercise performance are discussed. Fifth, the prevalence of fatigue in arthritis and its relationship to exercise will be presented. And last, areas of future research and roles of clinicians in managing fatigue relative to exercise performance are proposed.
Physical conditioning in children with arthritis. Assessment and guidelines for exercise prescription
Authors: Klepper Susan E. , Giannini Manuela Jasso
Published: February 2007

Objective. To review the literature in the area of physical fitness and conditioning programs for individuals with chronic illnesses, and increase the awareness of the need to include fitness testing and conditioning programs in the therapeutic management of children and adolescents with chronic arthritis.

Methods. This article provides a review of original research reports, information from principal texts, and review articles related to physical fitness testing and training in children.

Results. Several factors limit the exercise capacity of children with chronic arthritis, and studies report that these children have lower aerobic endurance and muscle performance than their peers. Preliminary studies suggest that fitness testing is safe for most children with arthritis, and physical conditioning programs, which appear to benefit adults with arthritis and children with other chronic illnesses, may also benefit children with arthritis. Easily administered, inexpensive field tests of fitness are available. Guidelines for prescribing physical conditioning programs are provided. The risks and benefits of increased exercise are discussed.

Conclusions. Assessment of exercise capacity and muscle function and individualized prescription of physical conditioning programs are indicated for children with chronic arthritis, soon after diagnosis.
Evaluation of a community arthritis program in Australia: Dissemination of a developed program
Authors: Simeoni Edda , Bauman Adrian , Stenmark Judith , O'Brien Jane
Published: February 2007

Objective. To evaluate the effectiveness of a community‐based arthritis education program conducted in a number of locations throughout the Sydney, Australia, metropolitan area.

Methods. The program, based on earlier work, comprised 6 weekly sessions of 2.5 hours' duration. The study sample included 175 men and women with different types of arthritis, divided into intervention (n = 104) and control (n = 71) groups. Five outcome measures were selected to evaluate effectiveness of the program: pain perception, knowledge level, self‐efficacy, disability index, and self‐management behavior.

Results. The results indicated that the program was effective in increasing knowledge level ( F[1,222] = 10.3, P = 0.001 at 6 weeks; F[1,108] = 7.8, P = 0.006 at 6 months), and a statistically significant difference was found in disability satisfaction 6 months after intervention ([F 1,98] = 5.9, P = 0.01), but no statistically significant difference was found in pain perception, self‐efficacy, and disability index.

Conclusion. This research supports some of the successful outcomes which follow an arthritis edu‐cation program: increased knowledge level and increased disability satisfaction.
Physical activity in children with juvenile rheumatoid arthritis: Quantification and evaluation
Authors: Henderson Carol J. , Lovell Daniel J. , Specker Bonny L. , Campaigne Barbara N.
Published: February 2007

Objective. To measure daily physical activity in patients with juvenile rheumatoid arthritis (JRA) and in healthy controls, and to identify variables that may influence physical activity in JRA patients.

Methods. Twenty‐three prepubertal children, ages 5‐11 years, with mild to moderate JRA and no prior exposure to systemic glucocorticosteroids, were compared to 23 healthy children of similar age. Physical activity was measured for 3 days (minimum of one weekend day) using 3 standardized methods simultaneously. Total body movement was assessed by the Caltrac accelerometer and the University of Cincinnati Motion Sensor (UCMS). The Caltrac measured movement in the vertical plane; the UCMS measured movement of 10° or more from the horizontal plane. The type and intensity of daily physical activity was measured by the 3‐day activity record, which also recorded the number of hours of daily sleep. Participation and duration of involvement in organized sports was ascertained by questionnaire.

Results. The mean physical activity was significantly lower in JRA patients than in controls for the activity diary (P = 0.05). However, daily body movement measured by the Caltrac and UCMS were similar for both groups. Differences were seen in the number of hours of sleep per day (P = 0.02) and participation in strenuous activities (P < 0.01). JRA patients had significantly less participation in organized sports (P = 0.01).

Conclusion. There was less daily physical activity by this group of JRA patients than for healthy age‐and sex‐matched control subjects.
Parents of children with rheumatic disease as peer counselors
Authors: DeNardo Bethany A. , Stebulis Judith A. , Tucker Lori B. , Schaller Jane G.
Published: February 2007

Objective. A parent consultant program was established to promote active family involvement in the health care process and to provide parent‐to‐parent support, education, and training.

Methods. Parents of children with rheumatic disease were hired by 7 pediatric rheumatology centers to serve as role models and advocates for other parents whose children attended the clinics. In the clinic, the parent consultants provided support, advocacy, and education regarding specific nonmedical issues. At the local level, they assisted parents in obtaining community‐based services, such as individual educational plans at school, local physical therapy, or access to recreational resources.

Results. Program impact was evaluated by an anonymous, mail‐response questionnaire sent to parents who met with a parent consultant during a clinic visit for their child. Surveys were sent within 6 months of the initial parent consultant meeting; 257 questionnaires were mailed, 33% were returned. The majority of respondents (87%) felt their interaction with the parent consultant was helpful. The general support received and the specific information and/or assis‐tance received were found to be equally useful by respondents. The majority of respondents (98%) stated they would recommend that other parents meet with the parent consultant.

Conclusion. Parents of children with rheumatic disease are effective peer counselors, providing general support and specific assistance to enhance family involvement in care.
The short form‐36 is preferable to the SIP as a generic health status measure in patients undergoing elective total hip arthroplasty
Authors: Stucki Gerold , Liang Matthew H. , Phillips Charlotte , Katz Jeffrey N.
Published: February 2007

Objective. To assess the comparative usefulness of the Short Form‐36 (SF‐36) and the Sickness Impact Profile (SIP) as generic health status measures in total hip arthroplasty.

Methods. Analysis of preoperative and 3‐month data of 54 consecutive patients undergoing total hip replacement for osteoarthritis or rheumatoid arthritis. Instruments were mailed to patients preoperatively and 3 months postoperatively.

Results. In 10 of the 12 SIP subscales, but just 1 of the 8 SF‐36 subscales, more than 40% of the patients had scores of zero. On α 100‐point scale, the median global SIP was 12 (range 0–40) whereas the median global SF‐36 was 50 (range 10–85). This indicates that many items of the SIP were not germane to patients undergoing joint arthroplasty. The global and, particularly, the physical dimensions of the SF‐36 were more responsive than their SIP counterparts, as measured both by the standardized response mean (1.26 and 0.88, respectively) and the correlation with self‐perceived improvement in quality of life (r = 0.37 and 0.26, respectively). The SF‐36, but not the SIP, discriminated between patients with relatively good physical performance at 3 months with respect to their ability to work, to play sports, or to garden.

Conclusion. The SF‐36 is briefer, more relevant, and more responsive than the SIP and is preferable as a generic health status measure in patients undergoing elective hip arthroplasty. The SF‐36 should be tested in other populations as well as other conditions to determine whether it is a superior generic health status instrument for evaluative research in orthopedic surgery.
Shoulder range of motion in patients with osteoporosis
Authors: Pearlmutter Lori L. , Bode Barbara Y. , Wilkinson William E. , Maricic Michael J.
Published: February 2007

Objective. To determine the degree of loss of shoulder flexion in patients with osteoporosis, and to determine whether this was correlated with functional disability and pain as measured by the modified Health Assessment Questionnaire.

Methods. Two different exercise regimens, one using traditional extension exercises of the spine (group A) and the other using both the extension exercises and exercises to stretch and strengthen scapular musculature (group B), were compared to determine their effects on range of motion, pain, and disability in 33 women with osteoporosis.

Results. A significant improvement in shoulder flexion occurred in both exercise groups compared to controls; however, there were no statistically significant differences either within or between exercise groups from baseline to study end. A decrease in pain correlated with an increase in shoulder flexion in group A (r = 0.56), while an improvement in functional disability scores correlated with an increase in shoulder flexion in group B (r = 0.46).

Conclusion. Traditional spinal exercises along with exercises that target scapular mobility help to improve shoulder flexion, pain, and function in women with osteoporosis.
Arthritis and other rheumatic conditions: Who is affected now, who will be affected later?
Authors: Helmick Charles G. , Lawrence Reva C. , Pollard Robert A. , Lloyd Elizabeth , Heyse Stephen P.
Published: February 2007

Objective. We present national and state estimates for 1990 and projections for the year 2020 of the prevalence of self‐reported arthritis and other rheumatic diseases and related activity limitations. We further suggest a research and policy agenda to address this important and growing public health problem.

Methods. Estimates and projections were derived from household interviews conducted for the 1989–1991 National Health Interview Survey, and were applied to United States census population estimates for 1990 and projections for 2020.

Results. The prevalence rate of self‐reported arthritis and other rheumatic conditions in the United States is projected to increase from 15.0% (37.4 million) of the 1990 population to 18.2% (59.4 million) of the estimated 2020 population. Activity limitation attributed to these conditions is projected to increase from 2.8% (7.0 million) of the 1990 population to 3.6% (11.6 million) of the 2020 population. Prevalence rates were higher for older persons, women, residents of nonmetropolitan areas, and those with less education or lower income.

Conclusions. Arthritis and other rheumatic conditions are frequent and disabling public health problems now, and are projected to become even more so by 2020. Implementing the suggested research and public health agenda could reduce the occurrence and impact of these conditions.
The impact of disabling arthritis
Authors: Badley Elizabeth M.
Published: February 2007

Objective. To use the WHO International Classification of Impairments, Disabilities, and Handicaps (ICIDH) as a framework to conceptualize how arthritis affects people and how the effects might be minimized.

Methods. The ICIDH framework emphasizes that the impact of arthritis in terms of handicap is a product of an interaction between a person's social and environmental setting and his or her level of impairment and disability. Data from the Canadian Health and Activity Limitation Survey are used to illustrate the impact for the handicap dimensions.

Results. Among persons who have arthritis, 25% cannot leave their residence or can leave only with help (mobility dimension), 45% have at least some level of physical dependence (physical independence dimension), 18% never participate in social activities (social integration dimension), 51% of those under age 65 are not in the labor force and 76% never go out to events such as sports or movies (occupation dimension), and 42% have out‐of‐pocket expenses because of disability (economic self‐sufficiency dimension).

Conclusion. Policies for the control of handicap require not only medical and rehabilitation interventions to reduce disability, but also consideration of environmental and other social factors.
The prevalence and impact of arthritis in older persons
Authors: Hughes Susan L. , Dunlop Dorothy
Published: February 2007

Objective. To review what is known about the prevalence and impact of arthritis on disability and health care expenditures incurred by older persons.

Methods. The current prevalence estimates of osteoarthritis and osteoporosis in the US are examined, and what is known about the relationship of arthritis, broadly defined to disability, and the impact of arthritis‐specific disability on home care and nursing home use by older persons are reviewed.

Results. Arthritis is a major contributor to disability among older people and is especially disabling for older women, who have higher prevalence rates and greater disability than their male counterparts. Studies of the relationship of arthritis to long‐term care use indicate that arthritis can be a risk factor insofar as it can cause disability that results in homeboundedness, which, in turn is a risk factor for nursing home use. It is possible that previous analyses that included arthritis and disability as competing risk factors for nursing home use underestimate the contribution of arthritis because arthritis is a risk factor for disability; thus, the two variables may be strongly correlated.

Conclusions. More study is needed to understand the contribution of sex to prevalence of arthritis and severity of arthritis‐specific disability. The route through which arthritis affects long‐term care use also needs careful longitudinal study. If arthritis is confirmed to be a major risk factor for disability that leads to long‐term care use, the development and testing of interventions to prevent/minimize arthritis‐specific disability should be a major research priority.
lpp deletion as a permeabilization method
Authors: Ni Ye , Reye John , Chen Rachel R.
Published: February 2007

Our earlier studies with outer membrane permeability in E. coli showed that an insertion mutation in lpp gene (encoding Braun's lipoprotein) drastically changed the outer membrane permeability, resulting in significant acceleration of whole‐cell catalyzed reactions. In order to gain a mechanistic understanding of the nature of permeability change, the lpp region was sequenced. The results revealed that Lpp was not expressed in the insertion mutant, suggesting that the absence, rather than the alteration, of Lpp is responsible for the observed permeability change. This surprising result prompts us to investigate the possibility of establishing lpp deletion as a general permeabilization method. Two lpp deletion mutants were generated from strains with different genetic background and the effect of lpp deletion on cell physiology was investigated. While lpp deletion had no significant effect on cell growth, carbon metabolism, and fatty acid compositions, it enhanced permeability of various small molecules, consistent with the results with the insertion mutant. This phenotype is useful in a wide range of biotechnological applications. We illustrate here the use of the mutant with organophosphate hydrolysis and L‐carnitine synthesis, where permeability is known to be a limiting factor. Both processes were significantly improved with the mutant because of enhanced permeability through the outer membrane. Therefore, this study has established an easy yet generally applicable method for permeabilizing E. coli cells without significant adverse effects. Further, as lpp homolog is known to exist in gram‐negative bacteria, we expect that this method will be applicable to other gram‐negative bacteria. Biotechnol. Bioneg. 2007;97: 1347–1356. © 2007 Wiley Periodicals, Inc.