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OBJECTIVE: To quantify the disease associated time consumption of normal activities of daily living and of treatment and monitoring activities in a cohort of patients with early rheumatoid arthritis (RA) with followup of at least 6 years. Comparison was made with a group of patients with asthma and chronic obstructive pulmonary disease (COPD). METHODS: A prospective and retrospective inventory was carried out, by interview and record investigation, of RA related and RA unrelated items covering the period from the start of the disease. Interviews were also performed in a group of patients with asthma and COPD. RESULTS: For patients with RA there was a mean disease associated time consumption of at least 1.9 h/day during the first 6 years of the disease. The time consumption was mainly due to extra time needed for activities of daily living and daily disease related activities. Patients with the greatest progression of radiographic damage, with the most severe disability, and with the greatest cumulative disease activity had the greatest time consumption. For patients with asthma and COPD the consumption of time was comparable. CONCLUSION: RA is a time consuming disease. Recognition of the disease associated time consumption will have implications for work (dis)ability assessments in patients with chronic diseases such as RA.
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Artritis Reumatoide/psicología , Adolescente , Adulto , Anciano , Artritis Reumatoide/fisiopatología , Asma/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate at what disease duration and to what extent a ceiling effect, due to reaching maximum scores for erosions (E) and/or joint space narrowing (JSN) in separate joints, started to influence the assessment of radiographic progression according to the modified method of Sharp, in patients with recent onset rheumatoid arthritis (RA). METHODS: Prospective followup study of 87 patients with classical or definite RA, joint symptoms <1 year at study entry. Radiographs of hands and feet were made at study entry (Time 0), after 3 (T3), and after 6 years (T6) of followup. Assessment of radiographic progression according to the Van der Heijde modification of Sharp's method. The scores for E and JSN were analyzed separately in the individual groups of joints. Percentages of E joints, of joints with JSN, and of joints with maximum scores were assessed at T0, T3, and T6. The relative risks for the development of radiographic damage and of maximum scores were assessed for the individual joints. An approximation of the magnitude of the ceiling effect was calculated. RESULTS: After a disease duration of 6 years, a significant influence of a ceiling effect on the mean radiographic progression was found. In some individual patients the ceiling effect appeared to occur earlier. After 6 years, the maximum scores were distributed over 50% of the patients, and 20% of the patients had maximum scores in more than 10 joints without preference for specific localization. CONCLUSION: The ceiling effect appeared to be clinically relevant and should be taken into account when interpreting the effects of disease modifying antirheumatic drugs on radiographic progression in RA during the first years of the disease. Furthermore, it must be accounted for when describing the relationship between radiographic progression and process variables.
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Artritis Reumatoide/diagnóstico por imagen , Adolescente , Adulto , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artrografía/estadística & datos numéricos , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Pie/diagnóstico por imagen , Mano/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Estudios Prospectivos , TiempoRESUMEN
OBJECTIVE: Evaluation of the individual relationship between C-reactive protein (CRP) production or erythrocyte sedimentation rate (ESR) and progression of radiologic damage in early rheumatoid arthritis (RA), to improve the predictive value of monitoring the acute phase response. METHODS: The relationship was modeled mathematically using adjustments for discontinuity in the radiographic scoring system and for clustering in the occurrence of score points in the initial phase. The model was evaluated in a prospective study of 149 patients with early RA, monthly CRP assays, and 6-monthly Sharp scores of radiographs of the hands and feet. RESULTS: Time integrated CRP values correlated closely with radiologic progression in each patient, but there was considerable variation between individuals with similar radiographic scores. The theoretical model accommodated these results, and based on CRP measurements and radiographic scores over 6 months, it provided a k value for each patient that reflected the individual relationship between CRP and radiologic damage. Using this k value combined with actual CRP levels over 3 and 6 years, the model accurately predicted the extent of radiologic progression that was actually observed at these times. Best results were obtained using estimation of the k value from 6 or 12 month observational data. The model has been incorporated into a software program for routine clinical use that indicates the levels to which CRP should fall to prevent further joint damage. Similar results were obtained for ESR. CONCLUSION: A model has been established defining the individual relationship between time integrated CRP and ESR values, reflecting rheumatoid disease activity, and progression of radiologic damage. It accurately prediets outcome from 6 months after presentation and can be used as a practical decision support system.
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Proteínas de Fase Aguda/fisiología , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/fisiopatología , Traumatismos por Radiación/fisiopatología , Enfermedad Aguda , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Radiografía , Reproducibilidad de los Resultados , Factores de TiempoRESUMEN
To investigate radiosensitization by halogenated pyrimidines in human cells, SW-1573 lung tumor cells were grown in absence or presence of 4 mu M of iododeoxyuridine (IdUrd). Cell survival after irradiation with gamma-rays from a Cs-137 source with single doses up to 8 Gy, was determined by clonogenic assay, Radiosensitization by IdUrd was observed in both exponentially growing and plateau phase cells. Linear-quadratic analyses of the radiation survival curves demonstrated that radiosensitization was mainly expressed by an increase of the value of alpha (determining the initial slope of the survival curve) which can be interpreted as an enhancement of fixation of potentially lethal damage (PLD). The value of beta (determining the curvature of the survival curve), which might be attributed to enhanced interaction or to fixation of sublethal damage (SLD), was not influenced. In view of clinical applications of IdUrd it is of interest that radiosensitization has its main effect in the low dose region of the cell survival curve, described by the linear term alpha D.
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OBJECTIVE: To investigate the reproducibility and validity of self-administered joint counts (JC), measuring tenderness, swelling and the combination of both, in a longitudinal study. METHODS: At the outpatient department a form self-administered by patients (SAI-form), was used to measure joint involvement. Concurrent joint examinations were performed by an assessor. The JC and scores for groups of joints by assessors were correlated with those by patients. As a retest the form was completed again by the patients within 10 days. Correlations between the JC measured by the test and retest were computed to investigate reproducibility. RESULTS: Correlations between test and retest were high (> 0.7). Correlations between JC and groups of joints measured by the assessors and by the patients were moderate (0.06). Correlations with other disease activity variables did not differ between assessors' and patients' joint examination scores. CONCLUSION: The patient-administered joint examination was reproducible; however, correlation with the assessors' joint examination was moderate. The value of the self-administered joint count needs further examination and cannot yet replace the assessor's joint examination.