Wiley
0893-7524
1529-0123
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A 73‐year‐old woman with rheumatoid arthritis and shortness of breath
Tập 59 Số 6 - Trang 892-899 - 2008
Detection of coronary artery lesions and myocardial necrosis by magnetic resonance in systemic necrotizing vasculitides Abstract Objective Myocardium and coronary arteries can occasionally be affected in patients with systemic necrotizing vasculitides; however, such involvement has not been systematically assessed using cardiovascular magnetic resonance imaging (MRI). Methods Magnetic resonance angiography and contrast‐enhanced MRI were applied for the assessment of coronary arteries (the left anterior descending [LAD], left circumflex [LCx], and right coronary artery [RCA]) and myocardium, respectively, in 39 patients with vasculitis who were asymptomatic for cardiac disease (16 with microscopic polyangiitis [MPA], 11 with Wegener's granulomatosis [WG], 9 with Churg‐Strauss syndrome [CSS], and 3 with polyarteritis nodosa [PAN]). Data were compared with age‐matched disease‐control patients with rheumatoid arthritis (n = 20) or systemic lupus erythematosus (n = 13), and with healthy control individuals with normal coronaries (n = 40). Results Patients with MPA, WG, and PAN (but not with CSS) were found to display significantly increased maximal diameters of coronary arteries compared with healthy controls (for MPA and WG; P < 0.001 for LAD and RCA, and P < 0.01 for LCx) and with both disease‐control groups (for only MPA; P < 0.01 for LAD and RCA, and P < 0.05 for LCx). Fusiform coronary aneurysms were detected in patients with MPA (4/16) and PAN (2/3), whereas coronary ectasias were evident in patients with MPA (14/16) and WG (2/11). The presence of myocardial necrosis (by assessment of late gadolinium‐enhanced images) was identified only in patients with MPA (2/16) and CSS (3/8 studied). Conclusion Cardiovascular MRI assessment of patients with systemic vasculitis revealed coronary ectatic disease in the majority of patients with MPA and PAN, as well as in several patients with WG. Myocardial necrosis can be detected in MPA and CSS.
Tập 61 Số 8 - Trang 1121-1129 - 2009
Differences in the incidence of flares or new onset of inflammatory bowel diseases in patients with ankylosing spondylitis exposed to therapy with anti–tumor necrosis factor α agents Abstract Objective Ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) are clinically and pathologically linked. Anti–tumor necrosis factor (anti‐TNF) agents are efficacious in treating AS, but not all are equally effective in treating IBD (Crohn's disease [CD] and ulcerative colitis [UC]). The purpose our study was to analyze the incidence of flares and new onset of IBD in patients with AS treated with anti‐TNF agents. Methods Data from 9 trials, 7 placebo‐controlled trials and 2 open studies, were analyzed. Results Data were available on 419 AS patients exposed to etanercept (625 patient‐years), 366 exposed to infliximab (618 patient‐years), 295 exposed to adalimumab (132 patient‐years), and 434 placebo patients (150 patient‐years). A history of IBD was reported in 76 of 1,130 patients (6.7%). There were 2 reports of IBD while receiving placebo (1.3 per 100 patient‐years), 1 while receiving infliximab, and 3 while receiving adalimumab. Among the 14 IBD cases receiving etanercept (2.2 per 100 patient‐years) there were 8 CD and 6 UC cases, significantly different from infliximab (P = 0.01) but not from placebo. Patients with a history of IBD had an IBD flare odds ratio of 18.0 (95% confidence interval [95% CI] 2–154) while taking etanercept and 4.2 (95% CI 0.4–44) while taking adalimumab, in comparison with infliximab. The incidence rates of new onset of IBD showed no significant difference between etanercept (0.8 per 100 patient‐years) and placebo (0.5 per 100 patient‐years). Conclusion New onset and flare of IBD are infrequent events in AS patients receiving anti‐TNF therapy. Infliximab (but not etanercept) largely prevents IBD activity. More data are required for adalimumab. The incidence of new onset of IBD was statistically not different from placebo for all anti‐TNF agents.
Tập 57 Số 4 - Trang 639-647 - 2007
Health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus Abstract Objective To estimate health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus (SLE) in the US. Methods Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants provided information on their health care resource use and employment. Cost estimates were derived for both direct health care costs and costs related to changes in work productivity. Direct health care costs included costs for hospitalizations, emergency department services, physician visits, outpatient surgical procedures, dialysis, and medications. Productivity costs were estimated by measuring changes in hours of work productivity since diagnosis of SLE; these estimates were also compared with normal US population data. Results For the total population of participants, the mean annual direct cost was $12,643 (2004 US dollars). The mean annual productivity cost for subjects of employment age (≥18 and <65 years) was $8,659. The mean annual total cost (direct and productivity) for subjects of employment age was $20,924. Regression results showed that greater disease activity, longer disease duration, and worse physical and mental health were significant predictors of higher direct costs; older age predicted lower direct costs. Older age, greater disease activity, and worse physical and mental health status were significant predictors of higher costs due to changes in work productivity. Conclusion Both direct health care costs and costs associated with changes in work productivity are substantial and both represent important contributors to the total costs associated with SLE.
Tập 59 Số 12 - Trang 1788-1795 - 2008
Prognostic factors of progression of osteoarthritis of the knee: A systematic review of observational studies Abstract Objective To provide an overview of prognostic factors of knee osteoarthritis (OA) progression. Methods We searched Medline and Embase up to December 2003 according to a specified search strategy (keywords for disease, location, and study design). Studies that fulfilled predefined criteria were assessed for methodologic quality. Study characteristics and associations were extracted and the results were summarized according to a best evidence synthesis. Results Of the 1,004 studies found, 37 met the inclusion criteria. Methodologic quality was assessed and only high‐quality studies were included (n = 36). The best evidence synthesis yielded strong evidence that hyaluronic acid serum levels and generalized OA are predictive for progression of knee OA. Sex, knee pain, radiologic severity, knee injury, quadriceps strength, and regular sport activities were not predictive. Conflicting evidence for associations was found for several factors including body mass index and age. Limited evidence for an association with progression of knee OA was found for several factors, including the alignment (varus/valgus) of the joint. Limited evidence for no association with progression of OA was also found for several factors, including meniscectomy, several markers of bone or cartilage turnover, and the clinical diagnosis of localized OA. Conclusion Generalized OA and level of hyaluronic acid seem to be associated with the radiologic progression of knee OA. Knee pain, radiologic severity at baseline, sex, quadriceps strength, knee injury, and regular sport activities seem not to be related. For other factors, the evidence was limited or conflicting.
Tập 57 Số 1 - Trang 13-26 - 2007
Effect of thigh strength on incident radiographic and symptomatic knee osteoarthritis in a longitudinal cohort Abstract Objective To assess whether knee extensor strength or hamstring:quadriceps (H:Q) ratio predicts risk for incident radiographic tibiofemoral and incident symptomatic whole knee osteoarthritis (OA) in adults ages 50–79 years. Methods We followed 1,617 participants (2,519 knees) who, at the baseline visit of the Multicenter Osteoarthritis (MOST) Study, did not have radiographic tibiofemoral OA and 2,078 participants (3,392 knees) who did not have symptomatic whole knee OA (i.e., did not have the combination of radiographic OA and frequent knee symptoms). Isokinetic strength was measured at baseline, and participants were followed for development of incident radiographic tibiofemoral OA, or incident symptomatic whole knee OA at 30 months. Generalized estimating equations accounted for 2 knees per subject, and multivariable models adjusted for age, body mass index (BMI), hip bone mineral density, knee surgery or pain, and physical activity score. Results In the studies of incident radiographic and incident symptomatic knee OA, mean ± SD ages were 62.4 ± 8.0 years and 62.3 ± 8.0 years, respectively, and mean ± SD BMI scores were 30.6 ± 5.8 kg/m2 and 30.2 ± 5.5 kg/m2 , respectively. Knee extensor strength and H:Q ratio at baseline significantly differed between men and women. Neither knee extensor strength nor the H:Q ratio was predictive of incident radiographic tibiofemoral OA. Compared with the lowest tertile, the highest tertile of knee extensor strength protected against development of incident symptomatic whole knee OA in both sexes (adjusted odds ratio 0.5–0.6). H:Q ratio was not predictive of incident symptomatic whole knee OA in either sex. Conclusion Thigh muscle strength does not appear to predict incident radiographic OA, but does seem to predict incident symptomatic knee OA.
Tập 61 Số 9 - Trang 1210-1217 - 2009
Effects of strength training on the incidence and progression of knee osteoarthritis Abstract Objective Quadriceps weakness is a risk factor for incident knee osteoarthritis (OA). We describe a randomized controlled trial of effects of lower‐extremity strength training on incidence and progression of knee OA. Methods A total of 221 older adults (mean age 69 years) were stratified by sex, presence of radiographic knee OA, and severity of knee pain, and were randomized to strength training (ST) or range‐of‐motion (ROM) exercises. Subjects exercised 3 times per week (twice at a fitness facility, once at home) for 12 weeks, followed by transition to home‐based exercise after 12 months. Assessments of isokinetic lower‐extremity strength and highly standardized knee radiographs were obtained at baseline and 30 months. Results Subjects in both groups lost lower‐extremity strength over 30 months; however, the rate of loss was slower with ST than with ROM. Compared with ROM, ST decreased the mean rate of joint space narrowing (JSN) in osteoarthritic knees by 26% (P = not significant). However, the difference between ST and ROM groups with respect to frequency of knee OA progression in JSN consensus ratings was marginally significant (18% versus 28%; P = 0.094). In knees that were radiographically normal at baseline, JSN >0.50 mm was more common in ST than in ROM (34% versus 19%; P = 0.038). Incident JSN was unrelated to exercise adherence or changes in quadriceps strength or knee pain. Conclusion The ST group retained more strength and exhibited less frequent progressive JSN over 30 months than the ROM group. The increase in incident JSN >0.50 mm in ST is unexplained and requires confirmation.
Tập 55 Số 5 - Trang 690-699 - 2006
Epidemiologic surveillance of upper‐extremity musculoskeletal disorders in the working population Abstract Objective Since 2002, an epidemiologic surveillance system of work‐related, upper‐limb musculoskeletal disorders (MSDs) has been implemented in France's Pays de la Loire region to assess the prevalence of MSDs and their risk factors in the working population. Methods The surveillance was based on a network of occupational physicians (OPs) and used the recommendations of a group of European experts (criteria document consensus). In 2002–2003, 80 of 400 OPs volunteered to participate. All underwent a training program to standardize the physical examination. Health status was assessed by self‐administered questionnaire and physical examination. Occupational risk factors were assessed by self‐administered questionnaire. Exposure scores were computed for each anatomic zone by summing the risk factors taken into account by the criteria document. Results More than 50% of the 2,685 men and women randomly included in 2002–2003 experienced nonspecific musculoskeletal symptoms during the preceeding 12 months and ∼30% experienced them in the preceeding week. The prevalence of clinically diagnosed MSDs was high: ∼13% of workers experienced at least 1 of the MSDs. The most frequent disorder was rotator cuff syndrome followed by carpal tunnel syndrome and lateral epicondylitis. The prevalence of MSDs increased with age and varied widely across economic sectors and occupations. More than half of the workers were exposed to at least 2 risk factors of MSDs. Exposure varied according to industrial activity and occupation. According to the criteria document, a high percentage of MSD cases could be classified as probably work related (95% in men and 89% in women age <50, and 87% in men and 69% in women age >50). Conclusion Nonspecific upper‐limb symptoms and specific upper‐limb MSDs are common in the working population. These results show the need to implement prevention programs in most sectors to reduce the prevalence of MSDs.
Tập 55 Số 5 - Trang 765-778 - 2006
The self‐administered comorbidity questionnaire: A new method to assess comorbidity for clinical and health services research Abstract Objective To develop the Self‐Administered Comorbidity Questionnaire (SCQ) and assess its psychometric properties, including the predictive validity of the instrument, as reflected by its association with health status and health care utilization after 1 year. Methods A cross‐sectional comparison of the SCQ with a standard, chart abstraction‐based measure (Charlson Index) was conducted on 170 inpatients from medical and surgical care units. The association of the SCQ with the chart‐based comorbidity instrument and health status (short form 36) was evaluated cross sectionally. The association between these measures and health status and resource utilization was assessed after 1 year. Results The Spearman correlation coefficient for the association between the SCQ and the Charlson Index was 0.32. After restricting each measure to include only comparable items, the correlation between measures was stronger (Spearman r = 0.55). The SCQ had modest associations with measures of resource utilization during the index admission, and with health status and resource utilization after 1 year. Conclusion The SCQ has modest correlations with a widely used medical record‐based comorbidity instrument, and with subsequent health status and utilization. This new measure represents an efficient method to assess comorbid conditions in clinical and health services research. It will be particularly useful in settings where medical records are unavailable.
Tập 49 Số 2 - Trang 156-163 - 2003
Relationships between the fibromyalgia impact questionnaire, tender point count, and muscle strength in female patients with fibromyalgia: A cohort study Abstract Objective To test the hypothesis that fibromyalgia (FM) patients with reduced lower extremity strength are more symptomatic and tender than FM patients with normal muscle strength. Methods A total of 840 FM patients and 122 healthy subjects were evaluated between 1998 and 2005. All of the patients completed version 1 of the Fibromyalgia Impact Questionnaire (FIQ) and were assessed for tender points and knee muscle strength. All subjects underwent bilateral isokinetic knee muscle strength testing in flexion and extension. Normative knee muscle strength values were calculated from the healthy subjects, and the FM cohort was divided in 2 groups: 1) patients with normal muscle strength and 2) patients with low muscle strength (2 SDs below normal). The clinical characteristics of these 2 groups were compared. Results Significantly reduced knee muscle strength was found in 52% of the patients. There were no clinically significant differences between patients with low versus normal muscle strength. There were no clinically significant correlations between total FIQ score, tender point count, and muscle strength. Only 4.6% of the FIQ scores and 5.1% of the tender point counts were explained by muscle strength. Conclusion Significantly reduced knee muscle strength was found in more than half of the patients. Patients with subnormal muscle strength were not more symptomatic or tender than patients with normal muscle strength. There were no clinically significant correlations between FIQ, tender point count, and muscle strength; therefore, reduced knee muscle strength appears to be a common objective abnormality in FM that is independent of measurements of disease activity. The implication of this finding in regard to the clinical assessment of FM needs further study.
Tập 61 Số 6 - Trang 732-739 - 2009