bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness
Authors: Englund M. , Niu J. , Guermazi A. , Roemer F. W. , Hunter D. J. , Lynch J. A. , Lewis C. E. , Torner J. , Nevitt M. C. , Zhang Y. Q. , Felson D. T. 
Published: November 2007

AbstractObjectiveTo evaluate the effect of meniscal damage on the development of frequent knee pain, aching, or stiffness in middle‐aged and older adults.MethodsThe Multicenter Osteoarthritis Study is a prospective study of 3,026 individuals 50 years of age or older who have or are at high risk of developing knee osteoarthritis (OA). We investigated knees at baseline and at 15 months. Case knees (n = 110) were those with no pain, aching, or stiffness on most days at baseline, but that had developed frequent pain, aching, or stiffness at 15 months. Control knees (n = 220) were drawn randomly from knees with no frequent symptoms at baseline that did not become case knees. Using 1.0T magnetic resonance imaging performed at baseline and at followup, 2 musculoskeletal radiologists blinded to the case–control status assessed the meniscal damage using the following scale: 0 = intact, 1 = minor tear, 2 = nondisplaced tear or prior surgical repair, and 3 = displaced tear, resection, maceration, or destruction. The effect of meniscal damage was analyzed by contingency tables and logistic regression.ResultsMeniscal damage was common at baseline both in case knees (38%) and in control knees (29%). Although there was a modest association between the meniscal damage score (range 0–3) and the development of frequent knee pain, aching, or stiffness (odds ratio [OR] 1.21, 95% confidence interval [95% CI] 0.96–1.51, adjusted for age, sex, and body mass index), meniscal damage was mostly present in knees with OA. When considering the co‐occurrence of OA, we found no independent association between meniscal damage and the development of frequent knee symptoms (OR 1.05, 95% CI 0.80–1.37).ConclusionIn middle‐aged and older adults, any association between meniscal damage and the development of frequent knee pain seems to be present because both pain and meniscal damage are related to OA and not because of a direct link between the two.
Persistence of abnormal bronchoalveolar lavage findings after cyclophosphamide treatment in scleroderma patients with interstitial lung disease
Authors: Mittoo Shikha , Wigley Fredrick M. , Wise Robert , Xiao Huiqing , Hummers Laura 
Published: November 2007

AbstractObjectiveBronchoalveolar lavage (BAL) is a procedure for sampling the terminal airspace cell population to diagnose alveolitis, a condition that predicts changes in lung function in scleroderma patients. Cyclophosphamide (CYC) stabilizes the progression of lung disease in some, but not all, patients with active alveolitis. However, it is unknown whether the BAL fluid cell count obtained after CYC treatment of alveolitis predicts long‐term lung function outcomes and can therefore be used to assist in therapeutic decision‐making. The purpose of this study was to determine whether CYC therapy for active lung disease alters BAL fluid neutrophil and eosinophil counts and whether the persistence of abnormal BAL findings after CYC therapy predicts a decline in lung function in patients with scleroderma and interstitial lung disease (ILD).MethodsWe systematically reviewed the records of scleroderma patients who had active ILD, as evidenced by neutrophilia or eosinophilia on BAL fluid analysis before CYC therapy and on repeat analysis after completion of CYC. Pulmonary function tests (PFTs) were performed before initiation of therapy, at completion of therapy, and during long‐term followup (mean ± SD 3.6 ± 1.94 years).ResultsOf the 25 study patients, in only 6 did the BAL fluid cell counts normalize after CYC therapy. No significant differences were observed between the proportions of patients who had a ≥10% decline in the % predicted DLCO or FVC on the second set of PFTs and had abnormal findings on followup BAL fluid analysis. During long‐term followup, patients with persistent alveolitis had a decline in lung function (mean ± SD change in % predicted FVC −0.6 ± 10.8 liters and mean ± SD change in % predicted DLCO −4.7 ± 21.43 ml/minute/mm Hg), but their lung function did not significantly differ from that in patients whose BAL fluid cell counts had normalized (P = 0.70 and P = 0.62, respectively).ConclusionPersistently abnormal results on BAL fluid analysis following CYC treatment is a common finding and does not predict a subsequent decline in lung function.
Case management of arthritis patients in primary care: A cluster‐randomized controlled trial
Authors: Rosemann Thomas , Joos Stefanie , Laux Gunter , Gensichen Jochen , Szecsenyi Joachim 
Published: November 2007

AbstractObjectiveTo assess whether providing information on arthritis self‐management through general practitioners (GPs) increases the quality of life in patients with osteoarthritis and whether additional case management provided by practice nurses shows better results.MethodsWe conducted a pragmatic, cluster‐randomized, controlled, 3‐arm trial that included 1,021 patients from 75 primary care practices in Germany. GPs were randomized to intervention group I, group II, or a control group. GPs of both intervention groups participated in 2 peer group meetings. In intervention group II, additional case management was conducted via telephone by a practice nurse. The primary outcome was change in quality of life, assessed by the German version of the Arthritis Impact Measurement Scales Short Form (AIMS2‐SF). Secondary outcomes were health service utilization, prescriptions, and physical activity. Data were controlled for depression using the Patient Health Questionnaire 9 as a potential confounder.ResultsOf 1,125 administered questionnaires, 1,021 were analyzed. Compared with the control group, no significant changes occurred in intervention group I with respect to the primary outcome. Performed radiographs decreased significantly (P = 0.050), whereas prescriptions of acetaminophen increased significantly (P < 0.001). In intervention group II, significant changes in the AIMS2‐SF dimensions social (P < 0.001), symptom (P = 0.048), and lower body (P = 0.049) were identified. Radiographs (P = 0.031) and orthopedic referrals (P = 0.044) decreased whereas prescriptions of pain relievers increased significantly.ConclusionImproving the quality of life in patients with arthritis using arthritis self‐management seems challenging. Simply providing this information through GPs is not sufficient but combining it with case management seems to be a promising approach.
Delay in consultation with specialists for persons with suspected new‐onset rheumatoid arthritis: A population‐based study
Authors: Feldman Debbie Ehrmann , Bernatsky Sasha , Haggerty Jeannie , Leffondré Karen , Tousignant Pierre , Roy Yves , Xiao Yongling , Zummer Michel , Abrahamowicz Michal 
Published: November 2007

AbstractObjectiveCare in rheumatoid arthritis (RA) is optimized by involvement of rheumatologists. We wished to determine whether patients suspected of having new‐onset RA in Québec consulted with a rheumatologist, to document any delay in these consultations, and to determine factors associated with prompt consultation.MethodsPhysician reimbursement administrative data were obtained for all adults in Québec. Suspected new‐onset cases of RA in the year 2000 were defined operationally as a physician visit for RA (based on the International Classification of Diseases, Ninth Revision diagnostic codes), where there had been no prior visit code to any physician for RA in the preceding 3 years. For those patients who were first diagnosed by a nonrheumatologist, Cox regression modeling was used to identify patient and physician characteristics associated with time to consultation with a rheumatologist.ResultsOf the 10,001 persons coded as incident RA by a nonrheumatologist, only 27.3% consulted a rheumatologist within the next 2.5–3.5 years. Of those who consulted, the median time from initial visit to a physician for RA to consultation with a rheumatologist was 79 days. The strongest predictors of shorter time to consultation were female sex, younger age, being in a higher socioeconomic class, and having greater comorbidity.ConclusionOur data suggest that the vast majority of patients suspected of having new‐onset RA do not receive rheumatology care. Further action should focus on this issue so that outcomes in RA may be optimized.
Reliability of exercise testing and functional activity questionnaires in children with juvenile arthritis
Authors: Stephens Samantha , Singh‐Grewal Davinder , Bar‐Or Oded , Beyene Joseph , Cameron Bonnie , Leblanc Claire M. A. , Schneider Rayfel , Schneiderman‐Walker Jane , Selvadurai Hiran , Silverman Earl , Spiegel Lynn , Tse Shirley M. L. , Wright Virginia , Feldman Brian M. 
Published: November 2007

AbstractObjectiveTo determine the reliability of formal exercise testing and the reliability of functional and activity questionnaires in children with juvenile idiopathic arthritis (JIA).MethodsChildren with JIA of any subtype ages 8–16 years who were recruited to a randomized trial comparing different exercise therapies participated in 2 preintervention sessions of exercise testing 2–6 weeks apart. Exercise testing included 1) submaximal oxygen uptake (VO2submax), 2) peak VO2 (VO2peak), and 3) anaerobic power using modified Wingate tests (Want). Two physical function questionnaires (the Childhood Health Assessment Questionnaire [C‐HAQ] and Revised Activity Scale for Kids [ASK]) and 1 daily physical activity questionnaire (the Habitual Activity Estimation Scale [HAES]) were also completed at these times. Test–retest reliability was assessed using type 3, intrarater intraclass correlation coefficient (ICC3,1) and Bland and Altman plots were used to determine limits of agreement.ResultsData were available for 74 patients (58 girls). VO2submax, VO2peak, and Want demonstrated high reliability (ICC3,1 0.82, 0.91, and 0.94, respectively). C‐HAQ and ASK questionnaires also had very high reliability (ICC3,1 0.82 and 0.91, respectively). The HAES demonstrated low reliability for total activity score (ICC3,1 0.15) and moderate reliability when the number of very active hours was analyzed separately (ICC3,1 0.59).ConclusionResults of this investigation suggest that exercise testing and functional questionnaires in children with JIA are consistent and reliable. Reliability of the HAES total score was poor, but moderate when the very active hours subscale score was used.
Osteoporosis disease management for fragility fracture patients: New understandings based on three years' experience with an osteoporosis care service
Authors: Harrington J. Timothy , Lease JoEllen 
Published: November 2007

AbstractObjectiveTo review the 3‐year performance of an established osteoporosis care service and consider further improvements in an effort to reduce fragility fractures.MethodsOsteoporosis care has been coordinated for all willing and able patients with orthopedic fragility fractures in our health system by a nurse and medical director since 2003, using a guideline‐based care algorithm and task management software. Patients were followed by telephone for 2 years to monitor their status and optimize adherence to treatment. Demographics, management recommendations, clinical data, and adherence to treatment were reviewed for the 2003–2005 patient population.ResultsOf 1,019 patients with fragility fractures, 61% underwent osteoporosis evaluation and treatment. The remainder included 15% who refused to participate and 24% who were unable to participate for various logistical and health reasons. More patients age >80 years were unwilling or unable to participate. Bone densities (dual x‐ray absorptiometry [DXA]) were normal, low, or osteoporotic in 24%, 55%, and 21% of patients, respectively, and 60% of the osteoporotic group had ≥1 abnormal metabolic bone laboratory result. Only 17% of the total reported a previous fracture, and 47% had ever undergone DXA. Few experienced bone loss, a new fracture, or bisphosphonate intolerance during treatment.ConclusionAn osteoporosis care service has coordinated care for every willing and able fragility fracture patient with positive outcomes. In addition, the results suggest a high priority for earlier proactive diagnosis and intervention of the at‐risk population if fractures are to be reduced.
Treatment of refractory polymyalgia rheumatica with etanercept: An open pilot study
Authors: Catanoso Maria Grazia , Macchioni Pierluigi , Boiardi Luigi , Pipitone Nicolò , Salvarani Carlo 
Published: November 2007

AbstractObjectiveTo investigate whether etanercept has a steroid‐sparing effect in the treatment of patients with relapsing polymyalgia rheumatica (PMR).MethodsThe study group comprised patients with relapsing PMR who were not able to reduce their prednisone dosage below 7.5–10 mg/day and who had experienced corticosteroid‐related side effects. Patients received injections of etanercept 25 mg twice weekly for 24 weeks, and were followed up for 3 additional months after treatment withdrawal. Patients regularly underwent clinical assessment, measurement of erythrocyte sedimentation rate and C‐reactive protein level, and ultrasound (US) examination of the shoulders during the 9 months of the followup period.ResultsAll 6 enrolled patients responded to etanercept with sustained remission (improvement of at least 70% according to European League Against Rheumatism response criteria for PMR in 4 patients and at least 50% in 2 patients) and were able to significantly reduce their median prednisone daily dosage without experiencing a disease relapse (8.75 mg versus 2.5 mg; P = 0.026) at the end of the 9‐month study period. US shoulder examination performed at the end of followup demonstrated a parallel reduction of glenohumeral and periarticular inflammation. A significant reduction in the cumulative prednisone dose 9 months before versus the 9‐month study period was observed (mean ± SD 1,767 ± 524 mg versus 730 ± 182 mg; P = 0.028). Three patients developed nonsevere side effects: bacterial cystitis in 2 and influenza in 1.ConclusionThese results, which should be confirmed in a controlled study, suggest that etanercept may be a safe and useful corticosteroid‐sparing agent in relapsing PMR.
General and specific factors associated with severity of cognitive impairment in systemic lupus erythematosus
Authors: Tomietto P. , Annese V. , D'agostini S. , Venturini P. , La Torre G. , De Vita S. , Ferraccioli G. F. 
Published: November 2007

AbstractObjectiveTo determine factors affecting the severity of cognitive impairment in systemic lupus erythematosus (SLE) and to analyze its anatomic location.MethodsFifteen cognitive functions grouped into 8 domains were evaluated in 52 patients with SLE and 20 with rheumatoid arthritis. Patients were classified according to severity of impairment as normal, mild, or moderate/severe. Multivariate analysis was performed to identify the main factors affecting severity of cognitive deficits. The most likely anatomic site of damage according to neuropsychological performance was compared with the lesion's location on magnetic resonance imaging (MRI).ResultsIn SLE patients, a stepwise regression analysis showed that the number of impaired functions (dependent variable) was associated with antiphospholipid antibody positivity (aPL+; P = 0.04), the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI; P = 0.001), hypertension (P = 0.032), and was inversely related to educational level (P = 0.021). Including MRI, the number of impaired functions was associated with severity of MRI (P < 0.001), the SDI (P = 0.013), and the presence of Raynaud's phenomenon (P = 0.04). The contemporary presence of aPL+ and Raynaud's phenomenon resulted in a higher probability to develop moderate/severe cognitive deficits (P = 0.015). Two logistic multiple regression analyses identified hypertension (P < 0.05), the SDI (P < 0.01), and moderate/severe MRI findings as main predictors of moderate/severe impairment (dependent variable). The damage site hypothesized through neuropsychological testing corresponded with MRI findings in 71.7% of SLE patients K = 0.42, P = 0.005).ConclusionHypertension, aPL+, accumulated damage, and MRI lesions are the main factors affecting severity of cognitive impairment in SLE. The hypothesized sites of central nervous system involvement according to neuropsychological testing correlated with MRI findings in most patients.
Measurement of fatigue in systemic lupus erythematosus: A systematic review
Authors:   Ad Hoc Committee on Systemic Lupus Erythematosus Response Criteria for Fatigue
Published: November 2007

AbstractObjectiveTo systematically review fatigue instruments used in patients with systemic lupus erythematosus (SLE) and to seek consensus on which instruments should be recommended for future studies and which data on comorbid conditions should be reported when evaluating fatigue in patients with SLE.MethodsWe used data from Medline and EMBase databases (from January 1970 to June 2006), clinical experts, and bibliographies. Data were extracted independently by 4 authors and reviewed by a working group and larger expert panel to produce a recommendation. Instruments were examined for construct validity, reliability, and responsiveness to change. Correlations between fatigue and some components of the Medical Outcomes Study Short Form 36 (SF‐36), disease activity, and comorbidities were reviewed.ResultsWe identified 34 studies that used 15 fatigue instruments in patients with SLE. The Fatigue Severity Scale (FSS) was used in 56% of the studies. The Systemic Lupus Activity Measure was significantly correlated with fatigue, but the Systemic Lupus Erythematosus Disease Activity Index was not. Fatigue was also correlated with pain, poor quality of sleep, depression, and with each subscale of the SF‐36.ConclusionThe working group and expert panel recommend the 9‐item FSS for evaluating fatigue in SLE patients. Responsiveness to change of fatigue instruments has not been well established in SLE and needs further study. The panel suggested that an important improvement or response could be a 15% decrease in the FSS. The effect of several important confounding factors of fatigue such as sleep disorders, depression, fibromyalgia, and anemia needs to be collected and reported.
Atherosclerosis in patients with biopsy‐proven giant cell arteritis
Authors: Gonzalez‐Juanatey Carlos , Lopez‐Diaz Maria J. , Martin Javier , Llorca Javier , Gonzalez‐Gay Miguel A. 
Published: November 2007

AbstractObjectiveTo examine the presence of atherosclerosis in a series of giant cell arteritis (GCA) patients attended to in a community hospital and to determine whether clinical features or steroid therapy might be associated with the development of atherosclerotic disease.MethodsForty consecutive patients diagnosed with biopsy‐proven GCA, periodically followed at the rheumatology outpatient clinic of Hospital Xeral‐Calde, Lugo (Spain), who had ended steroid therapy and had at least 3 years of followup were assessed for the presence of atherosclerosis by determination of the carotid intima‐media thickness (IMT) and carotid plaques using high‐resolution B‐mode ultrasound. Forty matched controls were also studied.ResultsGCA patients exhibited less carotid artery IMT than did matched controls (mean ± SD 1.01 ± 0.16 mm versus 1.13 ± 0.20 mm; P = 0.005; difference in means 0.12, 95% confidence interval 0.04–0.20). Patients who required steroid therapy for >2 years had greater mean ± SD carotid IMT (1.04 ± 0.17 mm versus 0.95 ± 0.15 mm) but the difference was not statistically significant (P = 0.10). A positive correlation between age at the time of the study and the carotid artery IMT in GCA patients was observed (r = 0.673, P < 0.001). However, adjusting for age, sex, and classic atherosclerosis risk factors, no significant correlation between carotid IMT and the routine laboratory markers of inflammation assessed at the time of disease diagnosis, disease duration, or cumulative prednisone dose was found.ConclusionThe present study demonstrates that atherosclerotic macrovascular disease is not increased in patients with GCA.
Antibody responses to Borrelia burgdorferi in patients with antibiotic‐refractory, antibiotic‐responsive, or non–antibiotic‐treated lyme arthritis
Authors: Kannian Priya , McHugh Gail , Johnson Barbara J. B. , Bacon Rendi M. , Glickstein Lisa J. , Steere Allen C. 
Published: November 2007

AbstractObjectiveTo compare the pattern of antibody responses to Borrelia burgdorferi in patients with antibiotic‐refractory, antibiotic‐responsive, or non–antibiotic‐treated Lyme arthritis as an indirect measure of spirochetal persistence or eradication.MethodsAt least 3 serial serum samples from 41 patients with antibiotic‐refractory arthritis and 23 patients with antibiotic‐responsive arthritis, and samples from 10 non–antibiotic‐treated, historical control patients were tested for IgG reactivity with B burgdorferi sonicate and 4 differentially expressed outer surface lipoproteins of the spirochete, by enzyme‐linked immunosorbent assay.ResultsAmong non–antibiotic‐treated patients, antibody titers to B burgdorferi antigens remained high throughout a 2–5‐year period of arthritis. In contrast, in patients with antibiotic‐responsive arthritis, in whom joint swelling usually resolved during a 1‐month course of oral antibiotic therapy, the median antibody titers to most of the spirochetal antigens remained steady or decreased during the first 1–3 months after starting antibiotic therapy. In patients with antibiotic‐refractory arthritis, who had persistent joint swelling for a median duration of 10 months despite 2–3 months of oral or intravenous antibiotics, the median titers to most antigens increased slightly during the first 1–3 months. However, by 4–6 months after starting antibiotic therapy, reactivity with all antigens declined similarly in both antibiotic‐treated groups.ConclusionWhereas the antibody titers to B burgdorferi remained high in non–antibiotic‐treated patients, the titers declined similarly 4–6 months after starting therapy in patients with antibiotic‐responsive or antibiotic‐refractory arthritis, suggesting that synovial inflammation persisted in patients with antibiotic‐refractory arthritis after the period of infection.