Thesis--Lund University, 1995.

Thesis (Ph.D. in Immunology) -- University of Colorado at Denver and Health Sciences Center, 2005. / Typescript. Includes bibliographical references (leaves 91-100). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Background: Presenteeism is an economic concept that is difficult to identify, measure, and value. Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are three chronic auto-immune conditions that increase levels of presenteeism. Workplace interventions (WPIs) help individuals to manage their health condition at work. Existing methods used to quantify the impact of presenteeism are unable to adequately inform the employer of the productive benefits of WPIs. The overall aim of this thesis was to appraise current methods used to quantify presenteeism and to develop methods to value the impact of presenteeism suitable for use in economic evaluations (EE) of WPIs. Methods: Two systematic reviews were conducted: 1) to assess the extent to which self-report measure of presenteeism were underpinned by economic theory; and 2) to explore if, and how, productivity was quantified and included in EE of WPIs for musculoskeletal conditions (MSDs). Thematic analysis methods were used to analyse qualitative data collected from working individuals with RA, AS or PsA (n=22) that explored the extent to which measures of health status (EQ5D; SF6D) and capability (ICECAP-A) capture the impact on ability to work caused by RA, AS or PsA. Econometric methods were used to specify prediction models that included measures of health status, capability and presenteeism, using a sample of 542 working people with RA and AS. Results The first systematic review identified 24 self-report measures of presenteeism; all, except one measure were not underpinned by economic theory. The second systematic review identified 20 EE of WPIs for MSDs. Absenteeism was included in all studies (n=20); however, presenteeism was included in only four. The qualitative data confirmed measures of health status and capability had the ability to capture those aspects of RA, AS and PsA that impact an individual’s ability to work. The best performing prediction model used an OLS specification including SF6D, age and gender to predict presenteeism measured by the WPAI. Conclusion: The results suggest that HRQoL measures, specifically the SF6D, can be used to capture and predict levels of presenteeism caused by RA, AS and PsA.

M.A. (Clinical Psychology) / Rheumatoid arthritis, lithe great crippler" 1 has now established itself firmly in the category 'psychosomatic disease' and a psychosomatic approach is used when considering the aetiology of the disease and often the therapy and prognosis of the patient as well. The rehabilitation of the afflicted patient is the central concern of medical and para-medical personnel engaged in rheumatology. The patient's motivation for rehabilitation is generally considered to be the single most important factor affecting the rehabilitation process. The task of assessing this motivation falls to the psychologist...

This research investigated the role of coping strategies in reducing the pain experience of rheumatoid arthritis (RA) patients over a seven-day period. Sixty-three patients completed a twice-daily structured dairy consisting of an eight scale revision of the Ways of Coping (WOC), the depression subscale of the Affects Balance Scale (ABS), and a pain visual analogue scale (VAS). Multivariate analyses for repeated measures identified two coping strategies, Self-Care and Positive Reappraisal, as significantly effective in pain reduction. Self-Care includes behavioral attempts to manage the symptoms of RA. Positive Reappraisal involves cognitive efforts to redefine pain experience in positive terms. The other six coping strategies also demonstrated a trend to increased use on days when pain decreased. These data imply that intraindividual approaches in examining the coping/pain association have potential benefit for determining a causal relation between coping and pain. / Medicine, Faculty of / Cellular and Physiological Sciences, Department of / Graduate

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most prevalent childhood rheumatic disease and significantly impacts a child’s well-being by potentially leading to disability and long-lasting effects. It consists of all forms of arthritis developing before the age of 16, therefore managing this disease is not simple. JIA can lead to a host of different medical problems over time and requires early attention and adequate treatment to prevent these long-term consequences. However, many children still experience pain after traditional treatment, indicating a need for alternative treatment modalities. Exercise therapy is one form of treatment that can potentially enhance a child’s quality of life. LITERATURE REVIEW FINDINGS: Multiple forms of exercise therapy have been shown to improve quality of life, functional ability and pain in patients with JIA. Exercise does not worsen disease activity, including the number of joints affected. While there are a limited number of studies in the JIA population, studies on patients with rheumatoid arthritis, a rheumatic disease diagnosed in adulthood, demonstrate the potential for exercise therapy to alter the pathophysiology of the disease and lead to better immune function. Exercise may have the ability to affect children with JIA in the same way as the two diseases share a similar pathophysiology. PROPOSED PROJECT: The goal of the proposed randomized control trial is to measure the impact of an exercise intervention on the quality of life of children with JIA, the effect exercise on participant immune function and variations in response between each subtype of JIA. Children will either complete high intensity interval walking training three times a week or no exercise intervention for 10 weeks. Various outcomes including quality of life, functional status, pain and fitness level will be measured before and after the intervention. Blood analysis to assess changes in immune function and further analysis between subtypes will also be conducted. CONCLUSIONS: The use of exercise therapy as a management tool for JIA should be considered earlier on in the disease course. It has not been found to worsen the disease and has produced increases in quality of life, functional status and pain. The benefits of this therapy are widespread and are not limited to healthy individuals. SIGNIFICANCE: This will be the first time these analyses will be performed and, if improvement is seen, this could help guide a physician’s disease management plan. Data from this study could provide information on how exercise modifies the disease and how to design more structured exercise programs appropriate to each subtype of JIA. Exercise may begin to be incorporated into the treatment plan for these children to increase disease remission rates, reduce the amount and severity of disease flares and provide both physical and psychological benefits.

No description available.

The literature is replete with reports of osteoporosis in rheumatoid arthritis, but the mechanism of bone loss remains obscure. This is probably due to the overlap with bone loss of aging and the menopause, whose exact mechanisms are also poorly understood. Against this background, a study was designed to evaluate generalised bone loss in young, premenopausal (if female), patients with rheumatoid arthritis. The protocol was designed to record demographic data, as well as information pertaining to the disease. Cortical bone mass was measured at the metacarpals and left femur, using an automated, computer-controlled technique. Trabecular bone was evaluated at the left femur (Singh index) as well as at the 3rd lumbar vertebra (Saville index). Bone kinetics were studied by the measurement of urinary excretion of calcium, phosphate and hydroxy-praline (resorption) and serum alkaline phosphatase (formation). Disease activity was measured clinically and with laboratory indices. Physical activity was indirectly measured by quantitating the disability, using the Keitel function test as well as a modified health assessment questionnaire (HAQ). The radiograph of the right wrist was scored by the Larsen index. The carpometacarpal ratio was also calculated from the radiograph. Numerous statistical techniques were applied in the analysis of the data. Healthy volunteers were used as controls. Patients with SLE were also studied, in order to compare the 2 inflammatory diseases. Patients with RA had generalised cortical bone loss (metacarpal and femur) (p < 0.001). Trabecular bone measurements were not significantly different from normals, using the crude radiographic techniques. Duration of disease was the most important clinical determinant of this bone loss. The relative contributions of disease activity and lack of physical activity to the loss of bone could not be adequately separated using conventional statistical techniques. Corticosteroid therapy did not promote metacarpal bone loss in these subjects, but may have contributed to thinning of the femoral cortex. Nonsteroidal anti-inflammatory drugs and disease modifying agents did not seem to influence the extent of the bone loss. Nutritional status and skinfold thickness did not correlate with bone mass. Dietary factors played no role in the genesis of bone loss, but may have had some effect on disease activity. Metacarpal measurements showed a sensitivity of 80% and specificity of 85% in discriminating between osteopaenic and normopaenic groups with RA. Osteopaenia could not be adequately predicted in the absence of metacarpal measurements. Metacarpal bone loss in RA was due to endosteal resorption, while in SLE it was due to periosteal resorption. The semi-automatic technique for measurement of metacarpal bone mass showed good reproducibility among 5 observers and at 2 different centres. The pathogenesis of bone loss in RA was multifactorial, the largest contribution probably coming from a humoral factor in the circulation, closely related to disease activity. Ionised calcium was elevated in 55% of RA patients, but only 5% of SLE patients. Serum PTH levels were normal in 99% of the RA subjects. Elevations in alkaline phosphatase. (25%) probably reflected disease activity rather than increased bone formation. Factor analysis of 27 variables showed that disease activity was central to the development of OP in RA. CS therapy tended to be used in the presence of active disease. Disability was not an important determinant of bone loss in RA, but may be a useful measure of activity of the disease. This study did not evaluate the relationships with sex hormonal status or vitamin D metabolism. Future research should aim at cohort analysis at 2 different periods, in order to improve our understanding of the pathogenesis of bone loss in RA.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20667号 / 医博第4277号 / 新制||医||1024(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 三森 経世, 教授 妹尾 浩, 教授 竹内 理 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purposes of this study were to describe the relationship of sociodemographic and biomedical characteristics to health perceptions among individuals with rheumatoid arthritis (RA) and to identify which functional measures are associated with one's health perceptions. Data were extracted on 395 individuals with classical or definite RA for a secondary data analysis. These data had been collected between 1978 and 1982 using the Arthritis Impact Measurement Scales (AIMS), a reliable and valid self-administered questionnaire on health status. Sociodemographic information included age, sex, current marital status, occupation, income, and engagement in a productive role. Biomedical data included a respondent's disease duration, disease severity, and comorbid conditions. A dependent variable which classified health perceptions (HP) was constructed from two AIMS questions concerning self-assessed current health and belief in the ability to resist illness. Using subjects' sociodemographic characteristics and biomedical indicators as determinants of health perception classifications (HPC), repondents were grouped into nodes through a recursive partitioning technique (CART). Income, disease activity, current marital status, age, and comorbidity were identified by CART as important and interactive determinants of HPC. In the second phase of analysis, differences in function between HP groups on the nine AIMS scales were explored using subjects' self-assigned HP groups, while controlling for sociodemographic and biomedical characteristics and their potential interactive effects as they had been identified by the CART algorithm. Analysis of these differences demonstrated that the explanatory sociodemographic and biomedical variables used in this study both explained and masked significant differences between HP groups on certain functional measures. Finally, the analysis determined which functional measures were most associated with self-assigned HP using a stepwise logistic regression model. Anxiety, physical activity and household activity formed an overall explanatory model of HP. Physical activity and depression were associated with current health perceptions. Perceived resistance to illness was related to subjects' levels of anxiety and household activity. / 2999-01-01