published_or_final_version / Orthopaedics and Traumatology / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

This study investigates the psychosocial aspects of rheumatoid arthritis (RA),a chronic debilitating disease. It explores the quality of life in a low socio-economic group of clinic-based adult RA patients. The aims of the study were as follows: (1) to assess the impact of both socio-demographic and psychosocial factors on RA health outcome, (2) to develop a multivariate, predictive model for RA, and (3) to assess the moderating role (or stress-reducing function) of psychosocial factors between the objective experience of RA and the subjective experience of RA. A sample of 186 RA patients with a mean age of 49.51 years and a mean duration of RA of 10.80 years were subjected to a series of selfadministering questionnaires to assess their subjective experience of the disease. Coping, social support, causal attribution, cognitive illness representation, pain and functional status were assessed. The objective experience of RA was based on those health status measures that included the following: firstly, ESR levels (a laboratory measure), and secondly, class (classified level of disability) and joint status (severity of joint inflammation) which were assessed and recorded by the rheumatologist. The data obtained were subjected to a systematic statistical analysis to assess the following: (1) the relationships between the socio-demographic factors, psychosocial factors and factors representing RA health outcome using correlational analysis (Pearson r), (2) the value of socio-demograhic and psychosocial factors in predicting subjective and objective RA health outcomes using step-wise hierarchical multivariate regression analysis, and (3) the moderating or stress-reducing effect of psychosocial factors between the objective and subjective health status measures using moderated regression analysis. Findings revealed that psychological factors, especially coping, were more significant predictors than socio demographic factors of RA health outcome (quality of life of RA individuals). Furthermore, the psychosocial factors coping, network social support, helplessness and causal attribution were found to play a moderating role in RA health outcome. The results of the study confirm both the health-sustaining and the stress-reducing function of psychological factors. Theoretically this study is located within the stress and coping paradigm of Lazarus and Folkman (1984). / Thesis (Ph.D.)-University of Natal, Pietermaritzburg, 2002.

A problems/needs inventory enquired into special social-psychological-emotional problems experienced by seniors in care facilities, due to arthritis. The inventory was based on three questions: are there any such problems? If so, what are they? And, what could be done by facility staff to help relieve such problems? This was the first stage in a proposed larger project: to develop a Social Work component dealing with such special problems, in order to augment an existing staff training program, and to test, evaluate, revise and implement the complete program package. A community-based approach was used. The Department of Social Work Services at the Arthritis Society produced a listing of key areas of concern at a brainstorming session; health-care and social-service professionals were surveyed by interview or by the Delphi Technique; a seniors' arthritis support group participated in a Nominal Group Technique session; care-facility staff met to discuss relevant issues; and, data was gleaned from current literature by a content analysis method. There was general agreement that seniors in care with arthritis do have special social-psychological-emotional problems because of the disease, and also there was consistency regarding the nature of these problems. Analysis of the data led to findings that included the following propositions: A sense of self-reliance and of social integration are essential to well-being. Limitations on movement, and the effects of chronic pain and of pain medication are associated with significant social-psychological emotional problems among seniors in care with arthritis. Two principles of care were identified: 1) support and encourage independence; and, 2) support and encourage social integration. The propositions will be applied to the development of the content of the Social Work component of the training program. Also, many respondents made important recommendations regarding methods and format for the training program. These are included in this paper. / Arts, Faculty of / Social Work, School of / Graduate

Very few good empirical investigations of pain and coping in children and adolescents currently appear in the published literature. In contrast to the adult literature, for ethical reasons, a foundation of basic research using experimentally-induced pain does not exist in the pediatric literature (McGrath, in press). This remaining deficiency in knowledge about children's spontaneous abilities to cope with pain is particularly harmful because it means that clinicians must base their assessment and treatment of pain in children on their knowledge of adults (Jeans, 1983). The need to consider cognitive-developmental issues has been emphasized in several recent papers (Lavigne, Schulein, & Hahn, 1986; Maddux, Roberts, Sledden, & Wright, 1986; Thompson & Varni, 1986). The present investigation evaluated the pain experienced and spontaneous coping strategies used by 39 children and adolescents with various forms of arthritis, during a painful joint-measuring task which is typically part of physiotherapy treatments for this illness. The two purposes of the study were: 1) to assess age/cognitive-developmental differences and 2) to compare "effective copers" versus children who were having some difficulties coping with pain (i.e. pain was interfering with their activities of daily living). Three age groups (5-7 years, 8-10 years, and 11-18 years), corresponding to the Piagetian stages of preoperational, concrete operational and formal operational thought, were compared. Subjects were videotaped while the range of motion in their joints was measured by the physiotherapist. Videotapes were subsequently coded for behavioral coping strategy use. Immediately following the joint measurement task, subjects were interviewed regarding thoughts they recalled experiencing. Transcribed interviews were subsequently coded for cognitive coping strategies reportedly used and catastrophizing cognitions reportedly experienced. In addition, parents completed two questionnaires rating the degree to which pain interferes with their child's activities of daily living, and the physiotherapist made a global rating of each child's functional capacity. The overall MANOVA using age group as a between groups factor, with self-reported pain variables entered as dependent measures was nonsignificant. A significant multivariate effect did emerge, however, when the coping variables were entered as dependent measures in a second overall MANOVA. Follow up univariate analyses revealed an age/cognitive-developmental trend in behavioral and cognitive coping strategy use. Children in the youngest group (preoperational) used primarily behavioral strategies to cope with pain elicited by the physiotherapy joint-measuring task, whereas slightly older children (concrete operational) began to supplement their repertoire of behavioral coping strategies with some cognitive coping strategies. A significant rise in reported cognitive coping strategy use was observed in the oldest group (formal operational). In addition, a discriminant function revealed that the two most important discriminators between "effective copers" versus children having some difficulties coping with pain were the amount of pain expression (vocal or nonvocal) coded and the amount of catastrophizing thoughts reportedly experienced during the physiotherapy task. Implications of these results for the treatment of children having difficulties coping with arthritic pain are discussed. / Arts, Faculty of / Psychology, Department of / Graduate

published_or_final_version / Social Work / Master / Master of Social Work

Thesis (Ph. D.)--University of Hawaii at Manoa, 1982. / Bibliography: leaves 349-358. / Microfiche. / x, 358 leaves, bound ill., maps 29 cm

Rheumatoid arthritis (RA) is a debilitating chronic inflammatory disease causing bone and cartilage degradation. Macrophages are known to play a role in RA pathology by producing pro-inflammatory cytokines and chemokines, which activates immune cells, drives inflammation and facilitates the degradation of bone and cartilage. Alterations in epigenetic mechanisms, processes that regulate gene expression, have been implicated in the regulation of pro-inflammatory cytokines in RA. Therefore, the aim of this thesis was to determine specific epigenetic variation between RA patient blood and synovial fluid (SF)-derived macrophages (SF MLS). Granulocyte and macrophages colony stimulating factor (GM-CSF) was used to differentiate healthy donor and RA patient blood monocytes into macrophages. Lipopolysaccharide (LPS) was used to stimulate blood and SF-derived macrophages to initiate inflammatory cytokine production. A library of small molecule inhibitors was used to identify key epigenetic regulators of pro-inflammatory cytokine production. Bromodomain and extra-terminal (BET) protein inhibitors (JQ1, I-BET151, PFI-1) were the only class of inhibitor to show consistent down regulation of pro-inflammatory cytokines in both healthy and RA patient-derived macrophages. However, only JQ1 was shown to reduce TNFα production significantly in SF MLS. Transcriptional profiling of RA patient SF MLS indicated a preference for a pro-inflammatory phenotype, and a resistance to steroids (a trait found in 30% of RA patients); SF MLS production of chemokines and cytokines were not downregulated by glucocorticoids in comparison to corresponding blood-derived macrophages. However, JQ1 treatment successfully suppressed these genes. In addition, silencing of BRD4 in blood-derived macrophages from healthy donors reduced pro-inflammatory cytokine production. Chromatin immunoprecipitation studies showed BRD4 was localised to pro-inflammatory promoter regions upon LPS stimulation and displaced in the presence of JQ1. These studies identified BET proteins BRD2, 3 and 4, as essential epigenetic regulators of pro-inflammatory cytokine and chemokine production in both healthy donors and RA patient macrophages. Furthermore, the observation that BET inhibitors can regulate genes that are steroid resistant in RA patient SF MLS, highlights their therapeutic potential in RA.

Having identified the need to provide services to elderly, homebound people with arthritis, the Social Work Department at the Vancouver Arthritis Centre initiated an Arthritis Telephone Contact Program in Autumn, 1989. The purpose of this study was to investigate whether or not a weekly telephone call from volunteers would impact positively on subjects' physical and psychological functioning, level of pain and perceived level of social support. The 11 subjects in this study were elderly, Caucasian women identified by health care professionals as being socially isolated due, in part, to the limits placed on them by either osteoarthritis or rheumatoid arthritis. The one-group pretest-posttest research design was employed for this study. Quantitative measures used were the Arthritis Impact Measurement Scales (AIMS) and the Perceived Social Support From Friends and From Family Scale (PSS-Fr & Fa). Interviews of subjects were conducted in order to describe the efficacy of the Telephone Contact Program from more than one perspective. Over 16 weeks, paired t-test found that the physical functioning of subjects had improved significantly. It was noted that there was a trend towards improved health status for the experimental group in that seven out of the eight subscales of AIMS measured improvement, while one subscale showed no change. Contrary to prediction, perception of social support from family members decreased significantly, as measured by the PSS-Fa scale. Pearson correlation coefficients found no association between changes in perception of social support and changes in health status. Interview data suggests that callers were perceived as sources of social support. Specifically, callers seemed to provide participants with emotional support, informational support, and positive social interaction. Overall, the data suggested that the Telephone Contact Program had the capability to evoke small, but clinically meaningfully improvements in the health status of elderly women with arthritis. Further investigation into the use of telephone contact programs as a minimal intervention is advised. / Arts, Faculty of / Social Work, School of / Graduate

Two instruments were developed and administered to fifteen female and three male rheumatoid arthritics (mean age 44) previously hospitalized for allergy treatment by ecological methods. The Physical Functioning Ability Scale assessed functional capacity according to common daily activities, and the Rehabilitation Questionnaire surveyed adjustment problems subjects encountered after hospital discharge. ANOVA was performed on the functionality scale comparing dimensions of dependence, pain, and difficulty with categorical activities of mobility, work, and personal care, Significant F values (p(.05) were obtained for interaction and dimensions, but not for categories. Functional independence from human/mechanical assistance was particularly noted. Recommendation for future research concerns replicating this study using a control group of rheumatoid arthritics treated by traditional medical approaches.