Measurement of functional ability and health status in the arthritic patient

Chronic arthritis may have great impact on the patient but also on his or her family, relatives and friends. The assessment of the consequences of chronic arthritis and the effect of therapy not only in terms of physical, but also psychological and social dimensions deserves more attention. Functional ability and health status can be measured using a questionnaire or ‘instrument’, high-lighting important aspects not quantified with more traditional measurements. In this paper, arguments to apply such instruments more frequently are given. Health status instruments can be used not only to assess beneficial but also deleterious (side-)effects of therapeutic interventions. The properties are summarized of the most frequently used instruments assessing functional ability and health status. Many of these instruments have been evaluated sufficiently for validity and reliability; their sensitivity to detect change seems to be satisfactory. Therefore it is advisable to choose an internationally accepted, frequently used instrument, reflecting the area of interest.     

Health status, adherence with health recommendations, self-efficacy and social support in patients with rheumatoid arthritis

A study was performed in 86 patients with rheumatoid arthritis (RA) to assess their health problems, the problems they experience in adhering to health recommendations and the relationships of these problems with self-efficacy and social support. Feeling dependent, disability and pain were the most important health related problems. The results showed self-efficacy to be related to the subjective experience of health status as measured by DUTCH-AIMS. Social emotional support was not related to health status and contrary to what we expected social instrumental support was positively related to health status. The majority of the patients (55%) experienced adherence problems with health recommendations. These problems were not related to functional incapacity, pain or other aspects of health status but to the patient's self-efficacy expectations about coping with arthritis. Our conclusion is that to improve the self-management of disability and pain and adherence to health recommendations, patient education should be aimed at strengthening self-efficacy expectations in which social emotional support might be a motivating factor.     

Transient osteoporosis of the hip, complete resolution after treatment with alendronate as observed by MRI description of eight cases and review of the literature

Transient osteoporosis of the hip (TOH), also referred to as transient bone marrow edema syndrome, is most common in middle-aged men and often after trivial trauma or sport-related injuries. Diagnosis is usually made by eliminating other possible causes of hip pain. Magnetic resonance imaging (MRI) plays an important role in diagnosis and demonstrates a typical pattern of bone marrow edema (BME) in the form of diffuse low signal on T1-weighted images and high signal on T2 fat-suppressed or short T1 inversion recovery images. No consensus exists about the management of TOH, as it may progress to avascular necrosis. We describe eight cases of TOH treated with alendronate resulting in improvement of pain and function and complete resolution of BME on MRI. The literature is reviewed regarding TOH and the relationship with bone marrow edema syndrome, avascular necrosis of the hip, and regional migratory osteoporosis. To our knowledge, this is the first report describing the improvement of this condition after of alendronate with documented radiological improvement on follow-up MRI.     

The general public's knowledge and perceptions about rheumatic diseases

OBJECTIVE: In the Netherlands, the mass media pay little attention to rheumatic diseases. For this reason, it might be assumed that in general people know very little about rheumatic diseases and thus have an unrealistic image of them. The purpose of this study was to gain insight into the general public's knowledge and perceptions regarding rheumatic diseases in the Netherlands. METHODS: A questionnaire was sent by mail to a random sample of 1800 Dutch homes; the response was 658. Questions mainly focused on knowledge, attitudes, behavioural intentions and use of the mass media with regard to rheumatic diseases. RESULTS: The respondents gave the right answer to a mean of 8.2 statements out of 17 true/false statements regarding factual knowledge of rheumatic diseases. Respondents particularly underestimated the prevalence of rheumatic diseases and were unaware of several rheumatic disorders. Most respondents had rarely used the mass media to gain information about rheumatic diseases, but they did show a moderate interest in acquiring information. Knowledge correlated positively with the respondents' level of education, acquaintance with rheumatic patients, and use of the mass media. Knowledge correlated negatively with the idea that rheumatic patients are themselves able to influence the course of their disease. In general, respondents judged rheumatic diseases to be rather serious but did not feel very frightened or vulnerable of becoming a rheumatic patient. Fear of rheumatic diseases correlated positively with interest in information about rheumatic diseases, intentions of visiting a doctor if experiencing rheumatic complaints and helping rheumatic patients in daily life. CONCLUSIONS: This study found that the public in general do not know very much about rheumatic diseases, but they do have a moderate desire for more information about them. Furthermore, they do not feel frightened of being confronted with a rheumatic disorder. More information about rheumatic diseases in the media might lead to better knowledge and perception of rheumatic diseases among the general public.     

In palindromic rheumatism,hand joint involvement and positive anti-CCP antibodies predict RA development after 1 year of follow-up

This study aimed to determine the frequency of rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies in a cohort of patients with palindromic rheumatism (PR) and to find determinants for progression to rheumatoid arthritis (RA). All new cases of PR (n?=?90) were included prospectively and followed up for 1 year, and a comparison group of RA cases (n?=?70) was also included. At study entry in all patients in both groups, RF and anti-CCP antibodies were tested, and the findings were compared and correlated. In the PR group at presentation, RF was positive in 30 patients (33.3 %) and, in the RA group, in 45 patients (64.3 %). Anti-CCP antibodies were positive in 35 patients (38.9 %) with PR and in 58 patients (82.9 %) with RA. In the PR group, positive correlations were observed between RF and C-reactive protein (CRP) (p?=?0.036), while anti-CCP positively correlated with disease duration (p?=?0.015) and CRP (p?<?0.001). At 1-year follow-up, 25 cases (27.5 %) had progressed to RA, 3 (3.3 %) cases had developed systemic lupus, 43 cases had responded to hydroxychloroquine with complete remission, five cases had developed other rheumatic diseases, and 14 cases had progressed to undifferentiated arthritis. After regression analysis, the involvement of hand joints and positive anti-CCP were the only predictors that determined progression into RA within a year (p?<?0.001 and p?=?0.02, respectively). Early hand joint involvement and positive anti-CCP at disease onset are good predictors for progression to RA in this domain.     

The Effect of Local Heat and Cold Therapy on the Intraarticular and Skin Surface Temperature of the Knee

Objective. To evaluate the effects of local application of ice chips, ligno-paraffin, short-wave diathermy, and nitrogen-cold air on skin and intraarticular temperature. Methods. Forty-two healthy subjects were divided into 4 treatment groups. A temperature probe was inserted into the knee joint cavity and another placed on the overlying skin, and changes in temperature over 3 hours, by treatment group, were recorded. Results. The mean skin surface temperature dropped from 27.9°C to 11.5°C after application of ice chips, and from 28.8°C to 13.8°C after application of cold air. The mean intraarticular temperature decreased from 31.9°C to 22.5°C and from 32.9°C to 28.8°C, respectively, after these 2 treatments. Short-wave diathermy increased skin temperature by 2.4°C; intraarticular temperature was increased only 1.4°C by short-wave diathermy. Treatment with ligno-paraffin increased the skin surface temperature 8.9°C; the temperature in the joint cavity was increased 3.5°C. Conclusion. The use of short-wave diathermy and superficial heat packs in the treatment of patients with arthritis may potentially cause harm by increasing intraarticular temperature. This may have major implications regarding treatment policy for patients with arthritis.