Introduction: Effective treatment of rheumatoid arthritis (RA) requires suppression of the underlying inflammation. Measurement of such inflammation, the disease activity, is mandatory to target treatment and maximize outcomes. However, this is not as straightforward as it may seem.
Areas covered: The many tools developed to measure disease activity in RA, from composite scores and patient-reported outcomes, to laboratory markers and imaging are discussed, with a focus on their utility in guiding therapy and assessing response. The complex issues in measuring disease activity in RA, whether in clinical trials or normal clinical practice, and in the context of national guidelines and recommendations, available time, and resources are considered.
Expert commentary: The key to effective management of RA is the rapid suppression of inflammation, ideally to remission, with maintenance of such remission. The aim is to prevent disability and maximize quality of life. Central to this is the ability to determine disease activity (potentially open to suppression) as opposed to damage (irreversible). A variety of measures are currently available, allowing better assessment of response to treatment. In the future, the development of predictive biomarkers allowing targeting of drugs may revolutionize this field and render the tools of today redundant. 相似文献
An inverse relationship between workplace status and morbidity is well established; higher job status has been associated with reduced risks of heart disease, hypertension, and injury. Most research on job status, however, has focused on salaried populations, and it remains unclear whether job status operates similarly among hourly workers. Our objectives were to examine whether hourly status itself influences risk of hypertension after adjustment for socioeconomic confounders, and to explore the role of fine-scale job grade on hypertension incidence within hourly and salaried groups. We examined data for 14,999 aluminum manufacturing employees in 11 plants across the U.S., using logistic regression with adjustment for age, sex, race/ethnicity and other individual characteristics. Propensity score restriction was used to identify comparable groups of hourly and salaried employees, reducing confounding by sociodemographic characteristics. Job grade (coded 1 through 30, within hourly and salaried groups) was examined as a more refined measure of job status. Hourly status was associated with an increased risk of hypertension, after propensity restriction and adjustment for confounders. The observed effect of hourly status was stronger among women, although the propensity-restricted cohort was disproportionately male (96%). Among salaried workers, higher job grade was not consistently associated with decreased risk; among hourly employees, however, there was a significant trend, with higher job grades more protective against hypertension. Increasing the stringency of hypertension case criteria also increased the risk of severe or persistent hypertension for hourly employees. 相似文献
Objectives: This study examines the efficacy of the predicting power for hospital mortality and functional outcome of three different
scoring systems for head injury in a neurosurgical intensive care unit (NICU).
Design: On the day of admission, data were collected from each patient to compute the Acute Physiology, Age, and Chronic Health
Evaluation (APACHE) II and III, and Glasgow Coma Scale (GCS) scores. Hospital mortality was defined as the deaths of patients
before discharge from hospital. Early mortality was defined as death before the 14th day after admission. Late mortality was
defined as death after the 15th day from admission. Functional outcome was evaluated by Index of Independence in Activities
of Daily Living (Index of ADL).
Setting: An 8-bed NICU in a 1270-bed medical center in Taichung Veterans General Hospital.
Patients and participants: Two hundred non-selected patients with acute head injury were included in our study in a consecutive period of 2 years.
Patients less than 14 years old were not included.
Interventions: None.
Measurements and results: Sensitivity, specificity and correct prediction outcome were measured by the chi-square method in three scoring systems.
The Youden index was also obtained. The best cut-off point in each scoring system was determined by the Youden index. The
difference in Youden index was calculated by Z score. A difference was also considered if the probability value was less than
0.05. The area under Receiver Operating Characteristic (ROC) curve was computed. Then the area under ROC of each scoring system
was compared by Z score. There was statistical significance if p was less than 0.05. For prediction of hospital mortality, the best cut-off points are 55 for APACHE III, 17 for APACHE II
and 5 for GCS. The correct prediction outcome is 82.4% in APACHE III, 78.4% in APACHE II and 81.9% in the GCS. The Youden
index has best cut-off points at 0.68 for APACHE III, 0.59 for APACHE II, and 0.56 for GCS. The area under Receiver Operating
Characteristic (ROC) curve is 0.90 in the APACHE III, 0.84 in the APACHE II and 0.86 in the GCS. There are no statistical
differences among APACHE III and II, and GCS in terms of correct prediction outcome, Youden Index and the area under the ROC
curve. Other physiological variables excluding GCS in APACHE III and II (AP III-GCS, AP II-GCS) have less statistical value
in the determination of mortality for acute head injury. For the prediction of late mortality, APACHE III and II yield significantly
better results in the area under the ROC curve, correct prediction and Youden index than those of GCS. Other physiological
variables (AP III-GCS and AP II-GCS) play an important role in the prediction of late mortality in APACHE scores. For prediction
of the functional outcome of surviving patients with acute head injury, the APACHE III yields the best results of correct
prediction outcome, Youden index and the area under the ROC curve.
Conclusion: The APACHE III and II may not replace the role of GCS in cases of acute head injury for hospital or early mortality assessment.
But for prediction of the late mortality, the APACHE III and II have better accuracy than GCS. Other physiological variables
excluding GCS in the APACHE system play a crucial contribution for late mortality. GCS is simple, less time-consuming and
economical for patients with acute head injury for the prediction of hospital and early mortality. The APACHE III provides
better prediction for severe morbidity than GCS and APACHE II. Therefore, the APACHE III provides a good assessment not only
for hospital and late mortality, but also for functional outcome.
Received: 22 May 1995 Accepted: 2 September 1996 相似文献
Abstract We investigated factors correlated with abnormal behavior in the elderly residing in a special nursing home (group A) and a psychiatric hospital (group B) using the dementia behavior disturbance scale, the mini mental state examination, the Japanese version of the Philadelphia Geriatric Center morale scale, and the ADL assessment scale. The cognitive function of group B was decreased compared with that of group A, but most activities of daily living (ADL) in the latter group were disrupted compared with those in the former. Only a few categories of ADL correlated with abnormal behavior in group A, whereas cognitive function, quality of life, and most categories of ADL correlated with abnormal behavior in group B. These results suggest that factors correlated with abnormal behavior in the elderly differ within institutions of medical and social welfare systems. 相似文献