Effects of a cognitive–behavioral intervention for women with rheumatoid arthritis

The purpose of this quasi-experimental study was to evaluate the effectiveness of a cognitive–behavioral nursing intervention for women with rheumatoid arthritis (RA). Ninety adult women with RA participated in 1 of 14 nurse-led groups over an 18-month period. Personal coping resources, pain-coping behaviors, psychological well-being, and disease symptomatology were measured at four time periods. There were significant changes on all of the measures of personal coping resources (p < 0.001) and psychological well-being (p < 0.05), half of the pain-coping behaviors (p < 0.05), and one indicator of disease symptomatology (fatigue, p < 0.05) from pre- to postintervention. Furthermore, the positive changes brought about by the program were maintained over the 3-month follow-up period. The intervention may be adapted to benefit individuals with a variety of stressful medical conditions. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 315–326, 1998     

A causal model of coping and well-being in elderly people with arthritis

The purpose of this longitudinal study was to test a model of the relationships among social economic status, gender, severity of impairment, stress emotions, coping strategies and psychological well-being. A sample of 78 elderly women and men, 60 years old or over, and diagnosed as having rheumatoid arthritis since mid-life, volunteered to participate in the study. Twelve months later, 64 of these elderly people were re-interviewed. Path analysis was used to examine the empirical import of the Lazarus and Folkman theory of stress and coping. Analysis of variance for repeated measures was used to test for changes over time among the study variable. A consistent relationship between severity of impairment, emotions, coping strategies and psychological well-being emerged from the data at time one and time two. Choice of coping strategies and psychological well-being were primarily influenced by emotions. The best predictor of psychological well-being at both time periods was the stress emotion of challenge. At both time periods, optimistic and self-reliant coping strategies were used most often and evasive and emotive strategies the least.     

Dynamic and static physical training in patients with rheumatoid arthritis : application of a self-appraisal and coping model

A self-appraisal and coping model was examined using a longitudinal data set involving 56 classical or definite rheumatic arthritis patients randomly assigned to either dynamic (n = 28) or static (n = 28) physiotherapeutic training. The model considers both adaptational consequences and antecedents of training (muscular endurance, pain, self-appraisal, and coping through avoidance or planful problem-solving). Measures were obtained prior to and after a 6-week training period (partly supervised and partly self-training) at a health-care centre, and after an additional 3 months of self-training only. Path analysis supported the mediating role of self-appraisal and of avoidance in influencing muscular endurance in dynamic training patients. Regression analyses likewise supported these conclusions, suggesting some patients in dynamic training to be caught in a vicious circle of avoidance and low self-appraisal. Theoretical issues are discussed, and suggestions made for developing more effective interventions in rheumatic patients.     

Pain and daily activities in rheumatoid arthritis

Aim: The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method: Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results: Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it. Conclusion: The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

Implications for Rehabilitation

• Pain in RA needs to be comprehensively analyzed and treated in the context of the patients’ perspective and needs.

• The relation between pain and performance of activities in RA highlights the importance of rehabilitative interventions to reduce pain in order to facilitate daily activity.

• The complexity of pain implies the need for multimodal approach in rehabilitation.

     

200例类风湿关节炎抗突变型瓜氨酸波形蛋白抗体检测结果分析

目的分析200例类风湿关节炎(RA)患者抗突变型瓜氨酸波形蛋白(抗MCV)抗体检测结果,探讨抗MCV抗体在RA诊断中的临床意义。方法收集200例RA患者血清标本,120例健康体检者血清标本检测其抗MCV抗体和类风湿因子(RF),计算并绘制受试者ROC曲线下面积。结果抗MCV抗体和RF的灵敏度分别为86.0%和70.5%,特异性分别为92.5%和48.3%,Kappa系数分别为0.78和0.28。抗MCV抗体的ROC曲线下面积为0.933(95%置信区间为0.875～0.975)。结论抗MCV抗体是诊断RA的良好指标,具有很高的灵敏度和特异性,优于RF,对于辅助诊断RA具有重大意义。     

14847例就诊患者类风湿关节炎相关自身抗体检测结果分析

目的：探讨就诊人群中抗环瓜氨酸肽（CCP）抗体、抗角蛋白抗体（AKA）、抗 RA33抗体、磷酸6葡萄糖异构酶（GPI）、类风湿因子（RF）等类风湿关节炎相关抗体的阳性分布趋势,及其在不同疾病中的分布与临床应用价值。方法用固相酶联免疫吸附法（ELISA）检测抗 CCP 抗体、抗 RA33抗体、磷酸6葡萄糖异构酶（GPI）、用间接免疫荧光法检测 AKA,用免疫比浊法检测 RF。结合患者临床资料分析这些自身抗体在不同年龄、性别和疾病中的阳性分布趋势及临床应用价值。结果抗 CCP 抗体、AKA、抗 RA33抗体、GPI、RF 例就诊人群的阳性率分别为26．22％、6．65％、7．13％、41．19％、32．95％;女性中抗 RA33抗体阳性率高于男性,男性抗 CCP 抗体阳性率高于女性（P ＜0．05）。在 RA 患者组各种抗体阳性率明显高于其他组,且抗体滴度也明显高于其他组。结论抗 CCP 抗体、AKA、抗 RA33抗体、GPI、RF 主要见于类风湿关节炎患者,但是也可出现在其他疾病中,但滴度较低。因此在临床诊疗过程需综合分析,应避免片面根据自身抗体检查结果所致误诊。     

Negotiating disability in everyday life: ethnographical accounts of women with rheumatoid arthritis

Abstract

Purpose: Drawing on data from a larger study, the aim of this paper is to illuminate how the everyday doings of women with disabilities are coordinated to and shaped by organizational processes and social context, particularly as these relate to the potential of being labelled disabled. Methods: An institutional ethnography was conducted with seven Austrian women diagnosed with rheumatoid arthritis (RA). Interviews and participant observations were conducted, and texts about the historical development of disability policies were identified. Data analysis included grouping similar doings of participants together to subsequently explore links between what the women did and how their doings are shaped by disability policies and the social context. Results: The women, who participated in this study, spent time and effort to keep the disease invisible, resist disability and negotiate a disability pass. By drawing upon the historical development of Austrian disability policies, the interpretation reveals how this development infiltrates into participants’ lives and shapes their everyday doing. Conclusion: This study furthers understanding of how broader policies and practices, shaped over historical time, infiltrate into the daily lives of women with disabilities. It illustrates how full participation may not necessarily be a lived reality for people with disabilities at this point in Austria.

• Implications for Rehabilitation

• Maximising full participation for people with rheumatoid arthritis is important.

• This requires focusing not only on the bodily health of people with rheumatoid arthritis but also on their interaction with the social, cultural and political context in their daily lives.

• This requires also understanding how knowledge about disability is passed on from previous generations.

     

Leukocytapheresis in rheumatoid arthritis

In this article, we discussed leukocytapheresis (LCAP) for rheumatoid arthritis (RA). Recently, a simple and practical on-line continuous LACP system has been developed. It is equipped with a direct hemoperfusion column (Cellsorba^®, Asahikasei Medical Co., Ltd.) packed with fine-diameter polyester fibers, which are commonly used to adsorb white blood cells to prevent a graft-versus-host reaction during blood transfusion. Clinical trials revealed that LCAP is a effective and safe therapy for patients with drug-resistant RA or RA complicated with vasculitis. Because the procedure is simple and requires no plasma substitutes and the volume needed for extracorporeal circulation is less than that for other plasmapheresis, LCAP might be accepted as an optional therapeutic modality for active RA that was refractory to conventional drug therapy including biological agents. The mechanism of the efficiency of LCAP on RA is unclear. LCAP may cause a reduction of activated T cells from affected joints, down-regulation of Pgp on helper T cells and restoration of Treg function, and that may modify the abnormal cytokine balance. These findings may explain some of the mechanisms by which the articular symptoms are improved by LCAP.     

抗环瓜氨酸肽抗体联合类风湿因子诊断类风湿关节炎的临床意义

目的探讨类风湿关节炎(RA)血清标志物抗环瓜氨酸肽(CCP)抗体的临床价值,并分析其与类风湿因子(RF)的关联性。方法采用化学发光法检测CCP抗体,使用免疫散射比浊法检测RF,并对结果进行统计学分析。结果 113例RA患者抗CCP抗体对RA诊断的敏感性73.5%,阳性83例;84例非RA患者抗CCP抗体特异性97.6%,阳性2例。82例抗CCP抗体与RF检测结果相同(72.6%)。两者无相关性(P0.05)。抗CCP抗体与RF联合检测的敏感性84.1%,特异性98.8%。结论抗CCP抗体与RF抗体联合检测可提高RA的特异性。     

Regulatory and other rheumatoid factors in rheumatoid arthritis patients with active disease or in remission

BackgroundPreviously, we identified a regulatory rheumatoid factor (regRF), the production of which provides rats with resistance to collagen‐induced arthritis (CIA). Immunization with conformers of IgG Fc fragments carrying epitopes specific to regRF reduces symptoms of CIA. The aim of this study was to determine whether there is a link between regRF levels and rheumatoid arthritis (RA) activity in humans in order to assess the potential of regRF as a therapeutic biotarget in RA. The variability of rheumatoid factor (RF) specificities present in the blood of RA patients was also studied.MethodsThe regRF were studied in RA patients with active disease and in remission. Variability in the specificities of RF associated with RA was studied by concurrent inhibition of RF latex fixation by variants of modified IgG.ResultsPatients in remission had regRF levels higher than in healthy subjects. The regRF in remission was characterized by tight binding to its antigen, as in healthy subjects. The regRF levels in patients with active RA varied dramatically, and regRF binding to its antigen was weak. The exacerbation of Still''s disease coincided with low regRF levels and affinity, while an improvement in patient condition was associated with an increase in regRF levels and affinity. The RF specific to RA, which was detected by the RF latex‐fixation method, was a nonhomogeneous population of antibodies that included RF to lyophilized IgG, to IgG immobilized on polystyrene, and to rabbit IgG.ConclusionStimulating regRF production might enable improved RA therapy.     

类风湿性关节炎患者自身抗体的检测及应用

目的探讨抗核抗体（ANA）检测在类风湿性关节炎（RA）诊断中的意义。方法随机选取该院2010～2013年收治的RA患者67例,以间接免疫荧光法及免疫印迹发检测ANA,以速率散射免疫比浊法检测类风湿因子（RF）,并分析ANA和RF在诊断RA中的相关性。结果检测ANA有利于RA的诊断。67例标本中抗-nRNP／Sm、抗-SS-A、抗一组蛋白阳性率最高,分别为21％、18％、18％。RA组ANA核型主要为均质型,其次为颗粒型,也有部分为阴性。结论临床上治疗RA患者时,应注意监测是否同时患有多重自身免疫性疾病。     

类风湿关节炎患者血清白细胞介素的检测及意义

目的探讨白细胞介素(IL)-6、IL-17、IL-23及类风湿因子(RF)、C-反应蛋白(CRP)在类风湿关节炎(RA)患者发病中的作用。方法采用流式液相多重蛋白定量技术(CBA)检测60例活动期RA患者和32例健康对照组血清中IL-6、IL-17、IL-23的水平,采用免疫比浊法检测RF及CRP水平。结果活动期RA患者血清中IL-6、IL-17、IL-23、RF、CRP的水平高于健康对照组,差异具有统计学意义(P0.05)。RF与IL-17呈正相关。不同年龄组的RA患者之间,IL-17水平差异有统计学意义(P0.05)。结论 IL-6、IL-17、IL-23、RF及CRP在RA的发病过程中起着重要的作用,IL-17可能成为临床诊断的潜在候选指标之一。     

抗环瓜氨酸肽抗体联合类风湿因子诊断类风湿性关节炎

目的探讨抗环瓜氨酸肽抗体（抗-CCP）和类风湿因子（RF）联合检测对类风湿性关节炎（RA）的诊断价值。方法抗-CCP采用酶联免疫吸附试验法定量检测，RF采用速率散射免疫比浊法检测。结果83例RA患者抗-CCP阳性52例，阳性率62．7％，RF阳性59例，阳性率71．7％，126例非RA患者抗-CCP阳性2例，阳性率1．6％，RF阳性23例，阳性率18．3％，抗-CCP对RA诊断的灵敏度为60．8％，特异性为93．7％；RF对RA诊断的灵敏度为69．2％，特异性为78．5％，二者联合检测时特异性达到99．7％。结论抗-CCP对RA的诊断有良好的灵敏度和特异性，比RF更具特异性，二者联合检测可极大地提高对RA诊断的准确性。     

FRAX评估类风湿关节炎患者骨质疏松性骨折风险的临床应用

目的探讨骨折危险性评估工具(FRAX)评估类风湿关节炎(RA)患者骨质疏松性骨折风险的临床应用。方法选择本院就诊RA患者54例,采集患者骨折危险因素等临床资料,应用FRAX,使用或不使用骨密度(BMD)分别计算出未来10年髋部骨折及主要骨质疏松性骨折的概率,对结果进行分析比较。结果 54例RA患者,未使用BMD未来10年髋部骨折概率0~20%,主要骨质疏松性骨折概率2.5%~24%;使用BMD计算的骨折概率高于未使用BMD计算的骨折概率,差异有统计学意义(P<0.01);糖皮质激素疗程≥1年的患者使用BMD计算的骨折概率高于未使用BMD计算的骨折概率,差异有统计学意义(P<0.01);按骨折风险分组,中高危组与低危组在类风湿因子、抗ccp、c反应蛋白水平方面的差异有统计学意义(P<0.01)。结论 FRAX可作为评估RA患者骨质疏松性骨折风险的一种切实可行的方法,若联合BMD可更准确地评估骨折风险。类风湿因子、抗ccp、C反应蛋白高水平的RA患者更应注重骨质疏松的防治。     

Edaravone inhibits the disease activity in rheumatoid arthritis

A male patient with rheumatoid arthritis (RA) developed acute stroke and was treated with the free radical scavenger, edaravone. Polyarthralgia improved with a reduction in serum C-reactive protein concentration soon after the start of edaravone administration. The disease activity score 28 (DAS28) also decreased. Edaravone appears to be effective for the control of RA. The usefulness of this potentially novel therapeutic agent should be tested in a well designed randomized controlled trial.     

抗环瓜氨酸肽抗体在类风湿关节炎中的应用

目的类风湿关节炎(RA)是一种致畸性较高的自身免疫性疾病,本实验探讨抗环瓜氨酸肽抗体(抗-CCP)和类风湿因子(RF)对RA的诊断作用。方法用酶联免疫吸附试验法测定抗-CCP,用速率散射免疫比浊检测RF。结果 380例RA患者抗-CCP和RF阳性率分别为63.4%、68.2%;152例非RA患者抗-CCP和RF阳性率2.0%、15.1%;抗-CCP和RF对RA诊断的灵敏度分别为63.4%、68.9%,特异性分别为98%、84.9%,二者联合时特异性达到97.4%。结论抗-CCP在RA诊断中有良好的灵敏度和特异性,二者联合能极大地提高RA诊断的准确性。