Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1988.

Diss. (sammanfattning) Uppsala : Univ., 2005. / Härtill 4 uppsatser.

Thesis (Ph.D.)--University of Adelaide, Dept. of Medicine, 1997. / Copy of author's previously published article. Bibliography: leaves 189-219.

Thesis (Ph. D.)--University of Minnesota, 1999. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 80-96).

Thesis (Ph.D.) - University of Queensland, 2005. / Includes bibliography.

Thesis (Ph. D.)--University of Minnesota, 1999. / Includes bibliographical references.

Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease that can lead to important functional impairment. Although improvements in treatment have been made, still there are a high proportion of patients in whom response to treatment is not complete. Fibromyalgia (FM) is a condition characterized by bodily pain that often coexists with RA. Cross-sectional studies have shown that patients with RA and FM symptoms, or fibromyalgic RA (FRA), have higher disease activity scores than patients with RA and no FRA. Concern has been raised regarding the validity of RA disease activity scores in patients with coexistent RA and FM. In this prospective study, we hypothesized that patients with FRA have an impaired response to treatment measured by traditionally used scores. The present analysis used a study sample obtained from the ESPOIR French cohort. This is a longitudinal prospective cohort of adults with early RA. Patients with RA were classified in two groups according to the presence of FRA. RA disease activity scores (DAS28, SDAI, CDAI and HAQ) were compared as a measure of response to treatment at 6, 12 and 18 months. Results showed that after adjusting for confounders, patients with FRA (120) had higher activity scores than patients with RA and no fibromyalgic characteristics (548). DAS28 and other disease activity scores started out higher in subjects with FRA and while they improved to a similar extent as in the isolated RA group, they remained consistently higher among FRA patients. Achievement of low disease activity and of remission according to established activity score cut-points was significantly less likely in subjects with FRA. In conclusion, patients with FRA and RA had a similar response to treatment according the decrease in indexes of disease activity but more frequently missed the target of remission or low disease activity. These findings may have implications in RA treatment in patients with FRA, as therapy is escalated not in relation to change in scores but to achieving remission.

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Made available in DSpace on 2014-06-11T19:28:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2004-02-19Bitstream added on 2014-06-13T19:57:16Z : No. of bitstreams: 1 ishi_ep_me_arafo.pdf: 346197 bytes, checksum: 6795ce77ad2dd590c6c320a2852cea60 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Tendo em vista que existem controvérsias na literatura quanto à existência de associação entre a doença periodontal e a artrite reumatóide e que as metodologias empregadas são tão diversas quanto os seus resultados e conclusões, este estudo transversal teve por objetivo avaliar a condição periodontal em portadores de artrite reumatóide e verificar se existe associação entre essas duas condições. Para isso, foram aplicados questionários de saúde geral e bucal, e foi realizado o exame periodontal em 49 portadores de artrite reumatóide e em 22 indivíduos não portadores de artrite reumatóide ou qualquer outra doença auto-imune. Fumantes e portadores de diabetes mellitus foram excluídos deste estudo. Os resultados indicaram que portadores de artrite reumatóide possuem menor número de dentes na cavidade bucal, apresentam maior extensão de placa bacteriana e maior proporção de sítios com perda de inserção periodontal avançada do que os indivíduos não portadores de artrite reumatóide Apesar da maior extensão de placa bacteriana dentre portadores de artrite reumatóide, a porcentagem de sítios que apresentaram sangramento marginal foi semelhante nos dois grupos, provavelmente devido ao uso de drogas antiinflamatórias e drogas de base, imunoreguladoras. Além disso, portadores de artrite reumatóide que utilizavam a associação de drogas de base apresentaram menor perda de inserção periodontal do que aqueles que não utilizavam a associação dessas drogas. Os resultados do estudo sugerem que existe associação entre periodontite e artrite reumatóide e que novos estudos serão necessários para identificar os fatores presentes nos portadores de artrite reumatóide que predispõem esses indivíduos a uma maior perda de inserção periodontal. / There are controversies in the literature concerning the association between periodontal disease and rheumatoid arthritis. There are no consistent methodologies and results. The aim of this cross-sectional study was to assess periodontal condition in rheumatoid arthritis patients and verify if there is an association between these two conditions. We have produced general and dental health questionnaires and periodontal examination was achieved in 49 rheumatoid arthritis patients and 22 healthy individuals. Smokers and diabetes mellitus patients were excluded of the sample. Our results indicated that rheumatoid arthritis patients had lesser remaining teeth, higher extension of dental plaque and higher proportion of sites presenting advanced attachment loss than controls. Although rheumatoid arthritis patients had higher extension of dental plaque than the control group, gingival bleeding was similar between them, maybe because of the fact that rheumatoid arthritis patients take anti-inflammatory and disease-modifying antirheumatic drugs (DMARDs) for their treatment. Rheumatoid arthritis patients who were taking an association of two or more disease-modifying antirheumatic drugs had lesser attachment loss than patients that were taking only one of these drugs. Our results suggest that there is an association between periodontitis and rheumatoid arthritis and that more studies are required to identify specific risk factors for attachment loss in rheumatoid arthritis patients.