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No description available.

Introduction: Rheumatoid arthritis (RA) is characterized by slow progression, functional limitations and poor quality of life. As a chronic disabling disease RA influence not only individuals but also their families. The impact of RA on family members includes providing the required care to the ill relative, postponing family plans, or altering family priorities and decisions due to the illness process. Purpose of the Study: The psychosocial changes that family members experience may possible compromise their health, family function and relationships with each other. The purpose of the current study was to describe the experience of family members who provide social support to their relative with RA. This study was set to explore the forms of support that are needed by family members to provide adequate support to their relative with RA. Method: The exploratory purpose of the study leads the researcher to conduct a descriptive qualitative study within the naturalistic inquiry. Naturalistic inquiry is consistent with the aims of this study in which the social support needs of family members of individuals with RA were explored and described. Findings: Five themes emerged from the data analysis, including: 1) effect of the disease; 2) reshaping the relationship; 3) providing support; 4) social support needs; and, 5) finding balance and coping. Conclusion: The impacts of RA on the lives of family members resulted from the chronicity of RA. Participants in this study described the effects of RA on themselves, the changes in the relationship with their relative with RA and their effort to maintain the relationship by providing support to their relative with RA. Additionally, they described the social support that they received from family members, friends and healthcare providers. They continuously identified the support they lacked. Nearly all participants were able to achieve balance between providing support and care to their relative with RA and engaging in their own life activities. They also utilized several coping strategies to achieve balance while providing support to their relative, carrying on their duty toward the family, work and their own personal needs. / Thesis (Master, Nursing) -- Queen's University, 2012-12-20 15:20:50.334

Higher levels of self-regulatory efficacy (SRE) appear to be helpful to those individuals with arthritis attempting to continue to be regularly physically active during an arthritis flare. Arthritis flares are presumed to represent a greater challenge to being physically active than usual arthritis symptoms but within-participant comparisons of pain intensity and SRE when considering flare status (flare vs no flare) have not been examined. While SRE has been compared between those who meet recommended levels of moderate to vigorous physical activity (MVPA) during an arthritis flare, persistence with MVPA has not been examined in arthritis. Finally, pain acceptance has been associated with differential levels of MVPA in arthritis but has not been examined in the circumstances of a flare and persistence with MVPA. Thus, 4 objectives were advanced. Primary objective one was to explore within-participant comparisons of pain intensity and SRE during a flare or usual symptoms. Primary objective two was to compare those meeting and not meeting MVPA guidelines in terms of their persistence and SRE. Secondary objective one was to explore whether persistence with MVPA in a flare could be predicted by pain acceptance and SRE, and secondary objective two was to examine psychosocial variables ability to predict MVPA volume prospectively over 4 weeks. To pursue these objectives, 53 adults with arthritis were recruited to complete an online survey with potential follow-up questions completed online four weeks later. Concerning objective one, participants reported SRE to overcome arthritis barriers (SRE-AB) and to schedule/plan MVPA (SRE-SP) in two contexts; in a flare and in the absence of a flare. Pain intensity was reported in the same flare contexts. 2 x 2 ANOVAs were conducted comparing both SRE measures and pain between those that met MVPA guidelines or not, and within-participants in a flare or usual symptoms. A MANOVA was iii conducted between MVPA groups on SRE and persistence to satisfy primary objective two. Secondary objective one was examined using a hierarchical multiple regression (HMR) with pain acceptance and SRE-SP predicting persistence. A second HMR was conducted attempting to predict MVPA at time 2 (T2) using SRE and persistence. Results of the 2 x 2 ANOVAs were that SRE (AB and SP) and pain intensity were significantly different within-groups (p < .001) such that SRE was lower and pain was higher in a flare than not in a flare. Only SRE-SP was different between MVPA groups (p < .05). The MANOVA identified only SRE-SP in a flare as significantly different between MVPA groups (p < .05). Pain acceptance did predict persistence in block 1 of the HMR (p < .01) but when SRE-SP was added, SRE-SP was the only significant predictor (p < .001). Results of the second HMR indicated that of all the psychosocial variables entered, only SRE-SP in a flare significantly predicted T2 MVPA (p < .01). Findings suggest that, as active individuals with arthritis feel less efficacious to be active and higher pain intensity during a flare, a flare does indeed represent an increased challenge to MVPA adherence. Interestingly, pain intensity did not differ between MVPA groups while SRE-SP did, supporting that greater SRE beliefs are required in challenging circumstances. Pain acceptance did initially predict persistence until SRE-SP was added to the model. SRE may have consumed the variance in the model not because of pain acceptance’s inability to predict but rather due to the high correspondence between SRE and persistence measures. Finally, SRE-SP predicted MVPA volume prospectively, further supporting the utility of high SRE when attempting to adhere to MVPA during the increased challenge posed by an arthritis flare.

Anteromedial osteoarthritis of the knee (AMOA) has been defined anatomically, histologically and radiologically and yet little is known about the epidemiology of the disease or the risk factors involved in the development of the disease. The broad aim of this thesis was to combine clinical insight with the utilisation of modern, large epidemiological datasets to provide information to inform better the clinical management of patients with AMOA. Specifically, the prevalence and incidence of AMOA, the time taken to progress from early disease to severe disease that may require surgical intervention, the radiological characterisation of disease and the assessment of mechanical risk factors implicit in the development of this pattern of disease are investigated. A cross-sectional study of the radiological prevalence of AMOA in a symptomatic cohort in a specialist secondary care knee clinic showed that AMOA was the commonest pattern of knee OA, present in more than 60&percnt; of symptomatic subjects. Less than 25% of subjects with AMOA presented with advanced or 'bone-on-bone' disease, emphasising the clinical importance of understanding the progression from earlier stages of disease to this advanced stage. A 20-year longitudinal radiographic study was performed on 1000 women to describe the prevalence, incidence and progression of AMOA. The prevalence of AMOA was 43&percnt; and the incidence over 20-years was 0.4. Life table analysis showed that the risk of developing advanced AMOA in a previously normal knee was 2.6&percnt;. Of those subjects with early radiological AMOA, 11&percnt; progressed to advanced 'bone-on-bone' disease within 10 years and 37% within 20 years. The role of mechanical risk factors in the development of AMOA showed that both anatomical limb and proximal tibial alignment were significantly more varus aligned in those that developed AMOA at 20-years. Assessment of the shape of the medial tibial plateau in a longitudinal MRI study showed that the angle of the upslope at the anterior aspect of the plateau was significantly increased in the group that subsequently developed AMOA. To enable AMOA to be studies in future MRI studies, the MRI description of the disease was defined. In summary, AMOA was shown to be the most common pattern of knee OA both in symptomatic surgical cohorts and in the community. The progression of the disease from an early stage to an advanced stage, which may require surgical intervention, was described for the first time. To enable better the recognition of AMOA in modern epidemiological studies, the MRI description of AMOA was defined and the clinical relevance of modern MRI was discussed. The anatomical alignment of the limb, the alignment of the proximal tibia and the morphology of the tibial plateau were all shown to have a role in the development of AMOA. Addressing these mechanical factors may provide a therapeutic surgical target for the management of patients with AMOA.

Arthritis is a growing aging and public health concern in Canada and elsewhere. As with many other chronic health conditions, arthritis occurs more often and has a higher impact on functioning for people who have lower incomes or live in an impoverished environment. There is a large body of research that supports a gradient between socioeconomic status and health and between area level poverty and decreased quality of life. Although this relationship is widely acknowledged, less is known about the influence of broader social conditions at the neighbourhood level on health outcomes. By examining quality of life from the theoretical framework of poverty as a fundamental cause of differences in health (Link & Phelan, 1995) and Bourdieu’s (1984) theory of habitus, I provide an analysis of the direct impact of material and social deprivation on health related quality of life (HRQoL), as well as the impact considering the influence of age, body weight, physical functioning, gender, and coexisting health conditions. I also examine interaction effects between neighbourhood deprivation and individual characteristics. An explanatory three-level multilevel model supported a relationship between individual factors as well as deprivation at the neighbourhood level on quality of life. The impact of neighbourhood deprivation was more pronounced for mental health related life quality, with a history of another health condition making the largest contribution to the model. Physical HRQoL was impacted by gender in interaction with material deprivation and body mass index in interaction with social deprivation. I discuss implications for practice, service delivery, and policy and make suggestions for further research. / May 2016

Die Dissertation beschäftigt sich mit der Oncostatin M-vermittelten Signaltransduktion und dessen Bedeutung für den entzündlichen Verlauf einer Rheumatoiden Arthritis, die immunmodulatorischen Fähigkeiten von Tumoren sowie die antivirale Immunantwort.

Im Rahmen dieser retrospektiven Studie wurden 23 Patienten mit Erkrankungen aus dem rheumatischen Formenkreis, überwiegend rheumatoide Arthritis und 22 Kontrollpersonen mit degenerativ bedingter Omarthrose, welchen zwischen 1993 und 2005 eine Schulterendoprothese unterschiedlichen Typs implantiert worden war, durchschnittlich 28 Monate postoperativ klinisch und radiologisch nachuntersucht. Das Alter zum Zeitpunkt der Operation betrug im Mittel 65 Jahre. Die Ergebnisse wurden anhand des Constant Score erhoben. Durch die Operation verbesserten die 23 Patienten mit Erkrankungen aus dem rheumatischen Formenkreis ihren Constant Score von durchschnittlich 21,7% auf 79,9%. Die Kontrollgruppe wies sowohl präoperativ (28,7%) als auch postoperativ (96,3%) eine signifikant bessere Schulterfunktion auf. Innerhalb beider Kollektive waren ca. 95% der Patienten mit dem Operationsergebnis sehr zufrieden bzw. zufrieden. / This retrospective study is an average 28 month follow-up of shoulder arthroplasty performed between 1993 and 2005 in 23 patients with rheumatoid diseases and 22 patients with degenerative arthrosis. The results were compared to each other. The average age at the time of operation was 65 years. To compare the results the Constant Score was used. Through the operation shoulder function improved as followed: The 23 patients of the rheumatoid group achieved an average preoperative score of 21,7%, the average postoperative score was 79,9%. The arthrosis group achieved an average preoperative score of 28,7% and an average postoperative score of 96,3%. Within both groups 95% of the patients were highly satisfied or satisfied with the result after shoulder arthroplasty.