bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of care for gout in the US needs improvement
Authors: Singh Jasvinder A. , Hodges James S. , Toscano John P. , Asch Steven M. 
Published: May 2007

AbstractObjectiveTo examine evidence‐based quality indicators (QIs) in US veterans with gout diagnosis, and to examine the effect of demographics, heath care utilization/access, comorbid conditions, or physican characteristics as predictors of quality of gout care.MethodsUsing the Minneapolis Veterans Affairs electronic medical record system, we identified a cohort of veterans receiving medication to treat gout between January 1, 1999 and December 31, 2003, and evaluated 3 recently published evidence‐based QIs for gout management: QI 1 = allopurinol dose <300 mg in gout patients with renal insufficiency, QI 2 = uric acid check within 6 months of starting a new allopurinol prescription, and QI 3 = complete blood count and creatine kinase check every 6 months for gout patients receiving prolonged colchicine therapy. We calculated the proportion of patients whose therapy adhered to each QI and to all applicable indicators (overall physician adherence). Logistic regression analysis examined association of overall physician adherence with sociodemographics, health care utilization, comorbidity, and provider characteristics.ResultsOf 3,658 patients with a diagnosis of gout, 663 patients qualified for examination of ≥1 QI. Of these 663 patients, therapy in only 144 (22%) adhered to all applicable QIs; 59 (78%) of 76 adhered to QI 1, 155 (24%) of 643 adhered to QI 2, and 18 (35%) of 52 adhered to QI 3. Overall physician adherence to QIs was significantly lower in older veterans and in those with more inpatient visits per year, but was higher in those with more primary care visits or more health care providers.ConclusionSuboptimal physician adherence to QIs was seen for all 3 QIs tested in this cohort of veterans with gout. These findings can guide quality improvement efforts.
Risk of tuberculosis in patients treated with tumor necrosis factor antagonists due to incomplete prevention of reactivation of latent infection
Authors: Gómez‐Reino Juan J. , Carmona Loreto , Ángel Descalzo Miguel 
Published: May 2007

AbstractObjectiveTo evaluate the causes of new cases of active tuberculosis (ATB) in patients treated with tumor necrosis factor (TNF) antagonists included in the national registry BIOBADASER (Base de Datos de Productos Biológicos de la Sociedad Española de Reumatología) after the dissemination of recommendations to prevent reactivation of latent tuberculosis infection (LTBI).MethodsIncidence rate of ATB per 100,000 patient‐years and 95% confidence intervals (95% CIs) were calculated in patients entering BIOBADASER after March 2002 and were stratified by compliance with recommendations (complete or incomplete). ATB rates in BIOBADASER were compared with the background rate and the rate in the rheumatoid arthritis cohort EMECAR (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide) not treated with TNF antagonists. In addition, rates of ATB among patients treated with adalimumab, etanercept, and infliximab were estimated and compared only for treatments started after September 2003, when all 3 drugs became fully available.ResultsFollowing March 2002, a total of 5,198 patients treated with a TNF antagonist were registered in BIOBADASER. Fifteen ATB cases were noted (rate 172 per 100,000 patient‐years, 95% CI 103–285). Recommendations were fully followed in 2,655 treatments. The probability of developing ATB was 7 times higher when recommendations were not followed (incidence rate ratio 7.09, 95% CI 1.60–64.69). Two‐step tuberculosis skin test for LTBI was the major failure in complying with recommendations.ConclusionNew cases of ATB still occur in patients treated with all available TNF antagonists due to lack of compliance with recommendations to prevent reactivation of LTBI. Continuous evaluation of recommendations is required to improve clinical practice.
Using Rasch analysis to compare the psychometric properties of the Short Form 36 physical function score and the Health Assessment Questionnaire disability index in patients with psoriatic arthritis and rheumatoid arthritis
Authors: Taylor William J. , McPherson Kathryn M. 
Published: May 2007

AbstractObjectiveItem‐response theory is increasingly used in the development of robust measurement tools. The extent to which the Health Assessment Questionnaire (HAQ) disability index (DI) and Short Form 36 (SF‐36) physical functioning subscale (PF) fit a Rasch model in psoriatic arthritis (PsA) is uncertain. Our objective was to compare the psychometric properties of the HAQ DI and SF‐36 PF in PsA and rheumatoid arthritis (RA) using Rasch analysis.MethodsPatients with RA (n = 142) and PsA (n = 134) were identified from a disease register based at a regional rheumatology service that serves a population of ∼400,000 individuals. Responses to the HAQ DI and SF‐36 PF were analyzed for item fit, differential item functioning (DIF), scale length (item separation), floor effects, and item difficulty by fitting the data to a Rasch model. The extent to which each instrument measured the same concept (disability) was also assessed in the PsA cohort using the Rasch model.ResultsItem separation was much better for the SF‐36 PF than the HAQ DI in PsA (9.12 logits versus 2.06 logits). There was evidence of marked DIF for the HAQ DI items activities, grip, and rising and relatively minor DIF for 4 items of the SF‐36 PF. The distribution of SF‐36 PF was better than HAQ DI in PsA, with floor effects of 3.1% versus 30.4%. Common person equating demonstrated that the 2 instruments measure the same construct in PsA.ConclusionThe SF‐36 PF has significant psychometric advantages over the HAQ DI in PsA.
The polymyalgia rheumatica activity score in daily use: Proposal for a definition of remission
Authors: Leeb Burkhard F. , Rintelen Bernhard , Sautner Judith , Fassl Christian , Bird Howard A. 
Published: May 2007

AbstractObjectiveTo confirm the reliability and applicability of the Polymyalgia Rheumatica Disease Activity Score (PMR‐AS), and to establish a threshold for remission.MethodsFirst, 78 patients with PMR (50 women/28 men, mean age 65.97 years) were enrolled in a cross‐sectional evaluation. The PMR‐AS, patient's satisfaction with disease status (PATSAT; range 1–5), erythrocyte sedimentation rate (ESR; first hour), and a visual analog scale of patients' general health assessment (VAS patient global; range 0–100) were recorded. Subsequently, another 39 PMR patients (24 women/15 men, mean age 68.12 years) were followed longitudinally. Relationships between the PMR‐AS, PATSAT, ESR, and VAS patient global were analyzed by the Kruskal‐Wallis test, Spearman's rank correlation, and kappa statistics. PMR‐AS values in patients with a PATSAT score of 1 and a VAS patient global <10 formed the basis to establish a remission threshold.ResultsPMR‐AS values were significantly related to PATSAT (P < 0.001), VAS patient global (P < 0.001), and ESR (P < 0.01). PATSAT and VAS patient global were reasonably different (κ = 0.226). The median PMR‐AS score in patients with PATSAT score 1 and VAS patient global <10 was 0.7 (range 0–3.3), and the respective 75th percentile was 1.3. To enhance applicability, a range from 0 to 1.5 was proposed to define remission in PMR. The median ESR in these patients was 10 mm/hour (range 3–28), indicating external validity.ConclusionWe demonstrated the reliability, validity, and applicability of the PMR‐AS in daily routine. Moreover, we proposed a remission threshold (0–1.5) founded on patient‐dependent parameters.
Measuring disease activity and functionality during pregnancy in patients with rheumatoid arthritis
Authors: de Man Yaël A. , Hazes Johanna M. W. , van de Geijn Fleur E. , Krommenhoek Catharina , Dolhain Radboud J. E. M. 
Published: May 2007

AbstractObjectivePregnancy has a favorable effect on the course of rheumatoid arthritis (RA), although the magnitude of this effect is equivocal because RA assessment tools have never been validated in pregnancy. The goal of this study was to assess how pregnancy influences the scoring of the Disease Activity Score in 28 joints (DAS28) and the Health Assessment Questionnaire (HAQ), and how both scores perform in pregnant patients with RA.MethodsThirty‐two healthy women and 30 pregnant patients with RA were prospectively studied during pregnancy and at postpartum. At each trimester and postpartum the components of the DAS28 (global health [GH], erythrocyte sedimentation rate [ESR], and C‐reactive protein level [CRP]) and HAQ scores were determined. Maximal influences of healthy pregnancy on each component of the DAS28 were calculated. The performances of different DAS28 scores and the HAQ were also determined in RA patients. Furthermore, variants of the HAQ were developed within the HAQ scoring rules.ResultsThe components of the DAS28 were influenced by healthy pregnancy, with average increases in DAS28 score of 0.22 (GH), 1.1 (ESR), and 0.25 (CRP). The DAS28 calculated with CRP (DAS28‐CRP) and without GH performed the best in pregnant RA patients. In healthy pregnancy, the median HAQ increased to 0.50 in the third trimester and was reduced by the HAQ variants to 0.25.ConclusionPregnancy considerably influences the scoring of the DAS28 and HAQ. RA disease activity in pregnant patients should preferably be calculated with DAS28‐CRP without GH. Even with HAQ variants, influences of pregnancy on the assessment of functionality cannot be precluded.
Clinical features and outcome of pediatric Wegener's granulomatosis
Authors: Akikusa J. D. , Schneider R. , Harvey E. A. , Hebert D. , Thorner P. S. , Laxer R. M. , Silverman E. D. 
Published: May 2007

AbstractObjectiveWegener's granulomatosis (WG) is a predominantly small‐vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). There are few reports describing its clinical features and outcome in children. We report on the experience at a single tertiary referral center over 21 years.MethodsWe conducted a retrospective chart review of all patients diagnosed with WG at The Hospital for Sick Children between 1984 and 2005.ResultsTwenty‐five patients were identified. Median age at diagnosis and median followup were 14.5 years and 32.7 months, respectively. Male‐to‐female ratio was 1:4. Median duration of symptoms before diagnosis was 2 months. Of 22 patients, 21 were ANCA positive during their disease course (classic ANCA 78.9%). Constitutional symptoms were the most common clinical feature at presentation (24 of 25). Glomerulonephritis was present in 22 patients at presentation. Only 1 of 11 patients who presented with or developed renal impairment had normalization of serum creatinine. Upper airway involvement occurred in 21 patients at presentation and 24 over followup; only 1 had subglottic stenosis. Twenty patients had initial pulmonary involvement, most commonly nodules (44%) and pulmonary hemorrhage (44%). Five patients required ventilation for pulmonary hemorrhage. Four patients (16%) had venous thrombotic events (VTEs). Treatment included prednisone (100%), cyclophosphamide (76%), azathioprine (40%), and methotrexate (32%).ConclusionPediatric WG typically presents in adolescence and has a female predominance. Glomerulonephritis and pulmonary disease are common at diagnosis and frequently present as a pulmonary‐renal syndrome. Loss of renal function is common and rarely completely reversible. As in adults, children with WG are at risk of VTEs.
Participation in patient self‐management programs
Authors: Bruce Bonnie , Lorig Kate , Laurent Diana 
Published: May 2007

AbstractObjectiveParticipation in evidenced‐based arthritis self‐management programs (SMPs) has not been well documented. The purpose of this study was to investigate the participation rate and participant characteristics in a closed cohort of subjects in a geographic region where arthritis SMPs have been offered multiple times and continuously for 2 decades.MethodsData were from osteoarthritis (OA) and rheumatoid arthritis subjects participating in the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) who resided in the San Francisco (SF) Bay area who had responded to questions about ever participating in an SMP. Differences between participants and nonparticipants were examined by t‐tests and chi‐square tests.ResultsQuestions added to the Health Assessment Questionnaire were returned by 1,176 patients; 618 resided in the SF Bay area. Of the SF Bay area sample, 41.9% had participated in an SMP. Small group SMPs, which had been offered multiple times, in diverse settings, continuously over the past 2 decades, were attended by the highest proportion (28%) of participants. Characteristics of participants and nonparticipants in the SF Bay area were similar (∼70 years old, 15 years of education, and the majority had OA [∼72%]). However, a higher proportion of participants were white (88% versus 82%; P = 0.046) and female (82% versus 73%; P < 0.05).ConclusionWhen arthritis SMPs were offered multiple times in diverse settings and continuously over many years, >40% of the cohort was reached. More research is needed with larger samples and different geographic regions to identify participation rates in more diverse populations.
Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica
Authors: Hutchings Andrew , Hollywood Jane , Lamping Donna L. , Pease Colin T. , Chakravarty Kuntal , Silverman Barbara , Choy Ernest H. S. , Scott David G. I. , Hazleman Brian L. , Bourke Brian , Gendi Nagui , Dasgupta Bhaskar 
Published: May 2007

AbstractObjectiveTo evaluate the impact of polymyalgia rheumatica (PMR) on clinical outcomes and quality of life (QOL); the relationship between laboratory measures and clinical outcomes, and changes in QOL; and agreement between rheumatologists in confirming the initial diagnosis.MethodsWe conducted a prospective study of 129 participants in 8 hospitals in England who met a modified version of the Jones and Hazleman criteria and had not started steroid therapy. The main outcome measures were response to steroids after 3 weeks (minimum 50% improvement in proximal pain, morning stiffness <30 minutes, acute‐phase response not elevated), relapses, QOL as measured by the Short Form 36 and Health Assessment Questionnaire, and diagnosis reassessment at 1 year.ResultsAt 3 weeks, 55% of participants failed to meet our definition of a complete response to steroid therapy. Both physical and mental QOL at presentation were substantially lower than general population norms and improved by 12.6 (95% confidence interval [95% CI] 10.8, 14.4) and 11.2 (95% CI 8.5, 13.8) points, respectively, at 1 year. Proximal pain and longer morning stiffness were significantly associated with lower physical QOL during followup, whereas erythrocyte sedimentation rate was most strongly associated with lower mental QOL during followup. There was moderate agreement between clinicians in confirming the PMR diagnosis (kappa coefficients 0.49–0.65).ConclusionPMR is a heterogeneous disease with a major impact on QOL. Ongoing monitoring should include disease activity based on symptoms, emergence of alternative diagnoses, and early referral of atypical and severe cases.
Responder criteria for operant and cognitive–behavioral treatment of fibromyalgia syndrome
Authors: Thieme Kati , Turk Dennis C. , Flor Herta 
Published: May 2007

AbstractObjectiveTo predict the effects of cognitive–behavioral therapy (CBT) and operant–behavioral therapy (OBT) in fibromyalgia syndrome (FMS).MethodsA total of 125 patients who fulfilled the American College of Rheumatology FMS criteria were randomly assigned to CBT (n = 42), OBT (n = 43), or attention placebo (AP; n = 40). The pretreatment to 12‐month followup reliability change index was used to determine clinically meaningful changes in pain intensity and physical impairment. Multinominal logistic regression analyses were used to determine the predictors of improvement in pain intensity and physical impairment for the entire sample. Analyses of variance were computed to compare the characteristics of responders and nonresponders in each of the 3 interventions.ResultsAt the 12‐month followup, 53.5%, 45.2%, and 5% of patients in the OBT, CBT, and AP groups, respectively, reported clinically meaningful improvements in pain intensity. Similarly, 58.1%, 38.1%, and 7.5% of patients treated with OBT, CBT, and AP, respectively, reported clinically significant improvements in physical impairment. Prior to treatment, the OBT physical impairment responders displayed significantly more pain behaviors, physical impairment, physician visits, solicitous spouse behaviors, and level of catastrophizing compared with nonresponders. The CBT physical impairment responders, compared with nonresponders, reported higher levels of affective distress, lower coping, less solicitous spouse behavior, and lower pain behaviors.ConclusionThe results of this study suggest that pretreatment patient characteristics are important predictors of treatment response and may serve as a basis for matching treatments to patient characteristics. Prospective outcome studies are needed to confirm whether the tailoring of treatment actually leads to better outcomes for patients with FMS.
Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee
Authors: van der Esch M. , Steultjens M. , Harlaar J. , Knol D. , Lems W. , Dekker J. 
Published: May 2007

AbstractObjectiveTo test the hypotheses that poor knee joint proprioception is related to limitations in functional ability, and poor proprioception aggravates the impact of muscle weakness on limitations in functional ability in osteoarthritis (OA) of the knee.MethodsSixty‐three patients with symptomatic OA of the knee were tested. Proprioceptive acuity was assessed by establishing the joint motion detection threshold (JMDT) in the anteroposterior direction. Muscle strength was measured using a computer‐driven isokinetic dynamometer. Functional ability was assessed by the 100‐meter walking test, the Get Up and Go (GUG) test, and the Western Ontario and McMaster Universities Osteoarthritis Index physical function (WOMAC‐PF) questionnaire. Correlation analyses were performed to assess the relationship between proprioception, muscle strength, and functional ability. Regression analyses were performed to assess the impact of proprioception on the relationship between muscle strength and functional ability.ResultsPoor proprioception (high JMDT) was related to more limitation in functional ability (walking time r = 0.30, P < 0.05; GUG time r = 0.30, P < 0.05; WOMAC‐PF r = 0.26, P <0.05). In regression analyses, the interaction between proprioception and muscle strength was significantly related to functional ability (walking time, P < 0.001 and GUG time, P < 0.001) but not to WOMAC‐PF score (P = 0.625). In patients with poor proprioception, reduction of muscle strength was associated with more severe deterioration of functional ability than in patients with accurate proprioception.ConclusionPatients with poor proprioception show more limitation in functional ability, but this relationship is rather weak. In patients with poor proprioception, muscle weakness has a stronger impact on limitations in functional ability than in patients with accurate proprioception.
Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis
Authors: Alexanderson Helene , Dastmalchi Maryam , Esbjörnsson‐Liljedahl Mona , Opava Christina H. , Lundberg Ingrid E. 
Published: May 2007

AbstractObjectiveTo investigate the benefits and safety of an intensive muscular training program in patients with chronic polymyositis (PM) and dermatomyositis (DM).MethodsNine patients with chronic PM or DM (median age 53 years, range 44–61) were included. Assessments of impairment (10–15 voluntary repetition maximum [VRM], the Functional Index 2 [FI‐2], the Grippit, and pain rated on the Borg CR‐10 scale), activity limitation (Myositis Activities Profile), and participation restriction (patients' disease impact on well‐being) were performed 4 weeks prior to baseline, at baseline, and after 7 weeks of exercise. A 6‐item core set of disease activity measures was administered and muscle biopsy samples of vastus lateralis were obtained at baseline and after 7 weeks of exercise. Response criteria at an individual level were set for disability and disease activity. The patients exercised 3 days per week for 7 weeks on loads allowing 10 VRM.ResultsOn a group level there were no significant differences between assessments at 4 weeks before baseline compared with baseline. The group improved significantly regarding 10–15 VRM and FI‐2 at 7 weeks compared with baseline (P < 0.05). All patients were responders with respect to impairment and 2 were activity limitation responders whereas participation restriction remained unchanged in all. Two patients were responders with reduced disease activity and no patient had signs of increased muscle inflammation in the muscle biopsy sample after 7 weeks of exercise.ConclusionPatients with chronic, stable PM and DM can perform this intensive resistive exercise program with beneficial effects on impairment and activity limitation without increased muscle inflammation.
Estimating the probability of radiographic osteoarthritis in the older patient with knee pain
Authors: Peat George , Thomas Elaine , Duncan Rachel , Wood Laurence , Wilkie Ross , Hill Jonathan , Hay Elaine M. , Croft Peter 
Published: May 2007

AbstractObjectiveTo determine whether clinical information can practically rule in or rule out the presence of radiographic osteoarthritis in older adults with knee pain.MethodsWe conducted a cross‐sectional diagnostic study involving 695 adults ages ≥50 years reporting knee pain within the last year identified by postal survey and attending a research clinic. Potential indicators of radiographic osteoarthritis were gathered by self‐complete questionnaires, clinical interview, and physical examination. Participants underwent plain radiography (posteroanterior, skyline, and lateral views). Radiographic osteoarthritis was defined as the presence of definite osteophytes in at least 1 joint compartment of the index knee.ResultsIndependent predictors of radiographic osteoarthritis were age, sex, body mass index, absence of whole leg pain, traumatic onset, difficulty descending stairs, palpable effusion, fixed‐flexion deformity, restricted‐flexion range of motion, and crepitus. Using this model, 245 participants had a predicted probability ≥80% (practical rule in), of whom 231 (94%) actually had radiographic osteoarthritis (specificity 93%). Twenty‐one participants had a predicted probability <20% (practical rule out), of whom only 2 (10%) had radiographic osteoarthritis (sensitivity 99.6%). The predicted probability of radiographic osteoarthritis for the remaining 429 participants fell into an intermediate category (20–79%).ConclusionSimple clinical information can be used to estimate the probability of radiographic osteoarthritis in individual patients. However, for the majority of community‐dwelling older adults with knee pain this method enables the presence of radiographic osteoarthritis to be neither confidently ruled in nor ruled out. Prospective validation and updating of these findings in an independent sample is required.