ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Emerging osteoarthritis studies suggest that certain occupations are associated with a high risk for development of hip and knee osteoarthritis, at least in men. The main activities identified are regular lifting for the hip and knee bending for the knee. Obesity is a well‐known risk factor for the knee, and it has been suggested that this risk can be halved by losing weight. Studies of the natural history of knee osteoarthritis suggest that many individuals do not develop osteoarthritis, although precise prognostic indicators are lacking at present. No new etiologic information on rheumatoid arthritis has appeared recently, although hormonal and reproductive factors in women continue to be studied with variable results. Agreement is slowly being reached on how to define vertebral fractures for epidemiologic study, which should produce more consistent results. In a study from Rochester, Minnesota, US incidence rates were produced for clinically diagnosed vertebral fracture (117/100,000) that are similar to hip rates, although they occur at an earlier age. Continued study of risk factors continues to show them to be of little use in screening. In systemic lupus erythematosus, hair dyes have not been confirmed as a risk factor, although there may be a link with domestic pets. There are conflicting data on the roles of obesity and occupational factors in carpal‐tunnel syndrome.Current Opinion in Rheumatology 1993,5:132‐137

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Version 2 of the Arthritis Impact Measurement Scale (AIMS2), together with the Medical Outcomes Study 36‐Item Short Form Health Survey provide two state‐of‐the‐art health‐status instruments. The Medical Outcomes Study can be used in all illnesses, including rheumatic diseases. The AIMS2 incorporates new items concerning work status, satisfaction, attribution of problems to arthritis, and self‐designation of priority areas for improvement. Measure of osteoarthritis and ankylosing spondylitis and review of the measures used to assess these illnesses were comprehensively evaluated, and data on reliability, sensitivity to change, sample size, and clinically significant change were provided this year, supplying an invaluable resource for trialists and clinicians.Current Opinion in Rheumatology 1993,5:138‐145

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The randomized controlled trial continues to be the standard for evaluating the clinical utility of new procedures or treatments. The randomized controlled trial seems to affect the clinical practice of physicians. Although the design of the randomized controlled trial is well described, consideration should be given to the questions asked and whether the trial is conducted and analyzed so that the questions can be answered. Comparative trials have become more frequent than placebo trials in the past decade, and clinical research financing is falling increasingly to the pharmaceutical industry. Process and outcome measures are receiving more attention. Various groups and committees are evaluating disease activity measures to delineate a small number that can become core or foundation measures. These measures are also being defined and standardized. The process is much further advanced for rheumatoid arthritis than for other diseases, and some common and perhaps “mundane” disease states are being neglected.Current Opinion in Rheumatology 1993,5:146‐152

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;In this review, we discuss large epidemiologic and focused clinical and laboratory studies published over the past year that advanced our current knowledge of the physical and functional impairments, societal handicaps, and disability related to the rheumatic diseases. Studies of rehabilitative methods appropriate for patients with a variety of rheumatic and musculoskeletal disorders are presented.Current Opinion in Rheumatology 1993,5:153‐158

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;In the first three sections of this review, studies of disability among patients with musculoskeletal conditions are discussed. Evidence continues to demonstrate that arthritis has a substantial impact on disability. Correlates of disability for patients with general musculoskeletal conditions, rheumatoid arthritis, and osteoarthritis are reviewed, as are strategies to ameliorate arthritis‐related disability. The fourth section of this review highlights the importance of pain‐coping strategies for arthritis patients. The concluding section reviews educational strategies in the rheumatic diseases.Current Opinion in Rheumatology 1993,5:159‐165

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;One of the genetic components of seropositive rheumatoid arthritis has been mapped to a short sequence stretch in the third hypervariable region of the HLA‐DRB1 gene. A new concept has emerged, proposing that the shared‐sequence motif is functional in determining the clinical patterns of rheumatoid arthritis and the severity of the disease in a codominant mode. Patients with a double dose of the shared sequence tend to have more serious disease manifestations, suggesting a model in which the genetic element is involved in perpetuating the disease. The pathogenetic model in which the shared epitope selectively binds and presents an arthritogenic peptide appears too simplistic to account for these findings. Our understanding of how the shared epitope may contribute to forming the molecular complex of the T‐cell receptor, peptide, and HLA‐DR molecule is advancing. Molecular analyses of the synovial T‐cell infiltrate continue to define the various components involved in recruiting T cells to the site of synovial inflammation. Adhesion molecules, predominantly the endothelial cell ligands vascular adhesion molecule 1 and endothelial leukocyte adhesion molecule 1, attract phenotypically selected T cells with a wide spectrum of specificities. The rheumatoid factor‐positive B cells may be important antigen‐presenting cells in the joint and may activate T cells with many different specificities. Rheumatoid factor immunoglobulin genes show clear evidence of somatic mutation, indicating a T cell‐dependent, antigen‐driven process. Thus, multiple factors contribute to the composition of the inflammatory infiltrate and may well modulate the repertoire of T cells recruited to the tissue. Studies in early synovitis may provide valuable information on the selection forces creating the inflammatory infiltrate and may demonstrate a more restricted role of some but not other T‐cell specificities.Current Opinion in Rheumatology 1993,5:169‐177

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Although the pathogenesis of rheumatoid arthritis increasingly continues to be well understood, therapeutic approaches to the disease remain relatively unsophisticated and based more on anecdote than scientific reasoning. During the past year, additional supportive data regarding the usefulness of front‐line agents such as methotrexate and hydroxychloroquine were acquired, and novel potential interventions, such as pulse gammaglobulin and OM‐8980 were identified. Animal model studies still support the prospect that genuine remission‐inducing strategies will be realized in the future.Current Opinion in Rheumatology 1993,5:178‐183

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The past year has witnessed a modest expansion in our understanding of the clinical, diagnostic, and prognostic features of rheumatoid arthritis. Almost every continent has reported prevalence, phenotype, and clinical features of rheumatoid arthritis subpopulations. Reviews of the natural history and therapy of cervical spine disease, Felty's disease, and lung involvement dominate the clinical literature. Rheumatoid arthritis‐like syndromes have been reported to occur after immunotherapy with interferon alfa and interleukin‐2. There have been case studies on human immunodeficiency virus, cachexia, pregnancy, “pseudosepsis,” bone loss, and malignancy in rheumatoid arthritis. Diagnostic criteria and new classifications for functional and global impairment have been published, and new health impairment questionnaires have been evaluated. Novel isotopes and the role of magnetic resonance imaging in damaged joints were discussed. Rheumatoid factor was reaffirmed as a significant prognostic variable, and the roles of immunogenetic loci, sulfur oxidation, and serum matrix proteins were evaluated in early rheumatoid arthritis. Functional status was again verified as a strong prognostic marker.Current Opinion in Rheumatology 1993,5:184‐190

ISSN:1040-8711    

出版商:OVID    

年代:1993

数据来源: OVID