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No description available.

Background: Standardized outcome measures used in assessment of chronic disease need to be relevant to the client if interventions based on the results are to be meaningful. The Modified Health Assessment Questionnaire (MHAQ) (Pincus et al., 1983) is an eight-item questionnaire used commonly with individuals with Rheumatoid Arthritis (RA) to assess self-reported function. This scale has been translated and validated in multiple languages and cultures but has never been evaluated for its relevance with a Canadian Indigenous population despite its frequent application in clinical and health research settings. Purpose: The primary objective of the following study was to determine whether or not the MHAQ is an appropriate measurement tool to adequately document the lived experiences of activity and participation in First Nations individuals diagnosed with RA. Methodology: A mixed methods sequential explanatory approach was utilized. The quantitative component consisted of secondary analysis of an existing clinical database developed at the University of Manitoba Health Sciences Arthritis Centre (UMHSAC). MHAQ scores and other indicators of disease activity of First Nations (n=252) and Caucasian (n=633) individuals with RA were examined for significant differences. The results informed a qualitative phase using interpretive description methodology whereby semi-structured interviews were held with 25 First Nations individuals with RA. Results: A significant relationship was observed between ethnicity and MHAQ score (p<0.001) where the First Nations cohort demonstrated significantly higher scores in pain and MHAQ scores (p<0.001), as well as physician global assessment and morning stiffness (p<0.05). Pain was the single greatest predictor of MHAQ score (p<0.001). In contrast, a convergence coding matrix comparing MHAQ scores to first-hand narratives found only 65% agreement in responses. The thematic analysis of the qualitative component resulted in three key themes: Ka-wachi-wa-pinaywin (“Coldness in the bones”), Adaptive Resilience, and Family Relations. Conclusion: Concurrent validity of the MHAQ in a First Nations population was supported through statistical analyses but convergent validity was not supported by subsequent qualitative and mixed methods approaches. The assessment of disability requires an integrated approach that takes into consideration an individual’s personal context. Both barriers and facilitators in the environment, as well as personal factors, must be addressed. / February 2016

Arthritis deformans in its atrophic form (rheumatoid arthritis) is, perhaps, best defined as a chronic disease affecting many joints, principally the smaller ones. It occurs chiefly in the female sex, is due probably to the action of a toxin, and is characterised by changes in the cartilages and the soft structures surrounding the joints, thus causing great immobility and deformity. That arthritis is a disease of great antiquity is borne out by the fact that recently-unearthed bones from tombs of about 3700-1300 B.C. showed unmistakable evidence of the affection. In exarnination of remains in Egypt, remains representative of all periods from early predynastic times dovm to the Fifth Dynasty after Christ, "the disease which showed itself with by far the greatest frequency in the bodies of all periods is rheumatoid arthritis". Virchow has left records describing the affection in bones unearthed from Pompeii. From these remote times onwards through the Middle Ages to the present day, an almost continuous series of historical records testifies that the disease has always been with us, and also that its clinical characters have remained unaltered through all the ages. The aetiology and pathology of the disease have, however, been so shrouded in darkness that we find the various writers, in their information on the subject, making indiscriminate use of the terms rheumatism, gout and arthritis to designate this affection.

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Introduction The association of the HLA shared epitope with rheumatoid arthritis (RA) in black South Africans is well established. The aims of the thesis were to identify non-HLA risk loci associated with RA using the Immunochip array and to assess the association of specific amino acids at specific positions of the DRB1 locus with the risk for developing RA in black South Africans. Methods Ethnically and geographically matched RA cases (n=435) and controls (n=463) were genotyped using the Immunochip array which has ~196 000 single nucleotide polymorphisms (SNPs) previously associated with 12 autoimmune diseases. After quality control, 103 700 SNPs were tested for association in 263 cases and 374 controls. For the amino acid study, DNA sequencing of exon 2 of the DRB1 locus was performed on the seropositive cases (n=261) using the Allele SEQR HLA-DRB1 (Abbot) assay and four digit HLA typing was assigned using the Assign software (Conexio Genomics). The amino acid sequences were inferred from the called allele type. Association testing and conditional analysis were performed. Results A total of 72 HLA SNPs reached statistical significance (p< 5x10-8) of which 71 SNPs locate to the HLA-DR or DQ genes or to the intergenic region between these two genes. Specifically, 4 SNPs in the intergenic region between HLA-DRB1 and HLA-DQA1 (rs3104413, OR=3.88, p=5.49x10-21; rs3129769, OR=3.91, p=4.60x10-21; rs6931277, OR=3.97, p=1.03x10-21; rs9272353, OR=4.1, p=3.01x10-21) were highly associated. Ten non-HLA SNPs on chromosome 6 reached significance of which 7 SNPs locate to the intergenic region between BTNL2 and HLA-DRA and confer protection. Four “SNPs” on chromosome 1 locating to a copy number variant region of the intergenic region between PLD5 and LOC400723 were significantly associated with RA in this study (rs2809867, OR=0.33, p=5.01x10-08; rs12738883, OR=0.33, p=3.98x10-08; rs78352781, OR=0.33, p=3.98x10-08; rs12739315, OR=0.33, p=3.98x10-08) and showed an even stronger association with the rheumatoid factor positive subgroup. Valine at amino acid position 11 of DRB1 demonstrated the strongest associated with RA (OR=5.1(3.7, 7.0), p=1.63x10 -27) and serine at this position was protective (OR=0.4(0.3, 0.5), p=2.46x10 -16). Interestingly, the frequency of valine in black South African RA cases was much lower than in Caucasians with RA. Using principal component analysis, black South Africans were found to be genetically distinct from west and east African populations. Conclusion This study demonstrated both similarities and differences in the risk for RA between Caucasians and black South Africans. Similar to Caucasians, the HLA region confers the strongest genetic risk for RA in black South Africans. More specifically, valine at position 11 of DRB1 confers the strongest risk for RA in black South Africans and serine confers protection. Four novel non-HLA RA-associated SNPs in the intergenic region between LOC400723 and PLD5 were identified. Variants of the PTPN22 gene, although strongly associated with RA in Caucasians, are not associated with RA in this population. Since this population is genetically distinct, the findings need to be independently validated in other African populations.

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No description available.

No description available.

A consecutive series of 280 Charnley low-friction arthroplasties, performed between 1966 and 1978, on 192 patients, who were less than 40 years of age at the time of operation, were followed up for an average duration of 20.1 years. Patients were divided into four groups based on underlying disease process, and only three patients (5 hips) could not be traced. Patients with rheumatoid arthritis had significantly lower rates of acetabular component loosening, migration and revision (all p< 0.05), and patients with developmental dysplasia of the hip had the highest rates as well as a significantly higher rate of combined clinical and radiological component failure (p < 0.05). Patients with degenerative arthrosis had the highest rates of femoral implant loosening, revision and failure (all p < 0.05), and patients with ankylosing spondylitis and rheumatoid arthritis had the lowest. Age (< 30 years or 30 to 40 years at operation), gender, heterotopic ossification, hypertrophy of the femoral cortex at the tip of the prosthesis or development of changes in the medial femoral calcar were not associated with an increased risk of component failure or revision (all p > 0.05). The average annual rate of wear of revised components, in each of the four groups and the series as a whole, was significantly higher than the rate in surviving original components (p < 0.04), and the development of osteolysis, and increasing wear of the acetabular component were associated with failure and revision of both the acetabular and femoral components (both p < 0.01). Cox regression analysis confirmed that increasing average annual acetabular wear was the most significant factor determining the outcome of the arthroplasty (p < 0.001). For each additional millimetre of wear observed, the risk of component failure or revision in any one year increased significantly (p < 0.02). The 25-year survivorship of implants with an average acetabular wear rate of less than 0.1 mm/yr (117 arthroplasties) was greater than 90% but no arthroplasties with a rate in excess of 0.2 mm/yr survived 25 years, and only 40% survived 20 years.