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Thesis (M.S.)--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. / 2031-01-01

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Thesis (M.S.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains v, 76 p. Includes abstract. Includes bibliographical references (p. 38-42).

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Background: Rheumatoid arthritis (RA) is an inflammatory disease associated with an increased risk of cardiovascular morbidity and mortality. Methotrexate is a widely used RA medication that has encouraging results for being protective from RA cardiovascular related complications. In a published meta-analysis, MTX showed a 21% reduction in cardiovascular mortality; however, this meta-analysis had multiple limitations. Arterial stiffness is considered to be one of RA's extra-articular manifestations. As a common medication, could MTX have a beneficial effect on traditional cardiovascular risk factors and arterial stiffness parameters? Aims: The aim of this thesis is to assess the effect of MTX on cardiovascular morbidity and mortality using meta-analysis and a cross sectional and longitudinal study to determine whether MTX therapy is associated with reduced blood pressure, AS parameters (measured by pulse wave velocity (PWV), augmentation index (AIX)) and other traditional cardiovascular risk factors (glucose, lipids) in rheumatoid arthritis patients in Saudi Arabia. Methods: Meta-analysis of cohort study design was conducted using combined reporting guidelines. Studies were selected using a systematic search in five databases. Meta-analysis of the effect estimate of the cohort study design was done using a fixed effect model. Another part of the thesis is a cross sectional and longitudinal study of RA patients attending the rheumatology clinic at the university hospital in Saudi Arabia that were classified into three groups: 'current-MTX', which were patients that took MTX for at least three months; 'no-MTX', which were patients that were not on MTX for at least one year; and 'new-MTX', which were patients that were due to commence MTX directly after recruitment. Arterial stiffness and central 2 blood pressure parameters were assessed in RA patients using a validated non-invasive Mobil-O-Graph device. Other cardiovascular and non-cardiovascular parameters were also assessed during patient recruitment from patient interviews, medical records and the laboratory database. Patients were followed-up with two times. Linear regression analysis was performed; a mixed model for repeated measures was done to evaluate the effect of time on differences in blood pressure and arterial stiffness between groups. Results: Nine studies were included in the meta-analysis, and MTX showed a 46% reduction in cardiovascular events. Non-significant heterogeneity was documented between studies. A total of 353 patients (mean age 49 years, female 89%, median RA duration 10 years) were recruited at baseline (March 2013 to January 2014); with 117 reassessed over 3-6 months of follow-up. Augmentation index of the 'current-MTX' group was reduced compared to the 'no-MTX' group by 1.1 (95% CI -4.7 to 2.6) %; and systolic blood pressure was increased by 2.5 (95% CI -2.3 to 7.4) mmHg in 'current-MTX', but results were not statistically significant. During follow-up, no difference was found between treatment groups or within each individual group in the longitudinal analysis. Conclusion: Methotrexate is associated with reduced cardiovascular events on meta-analysis of cohort studies. In the cross sectional setting and longitudinal analysis, methotrexate did not prove to be beneficial in reducing arterial stiffness and blood pressure parameters and other cardiovascular risk factors in rheumatoid arthritis patients in Saudi Arabia.

published_or_final_version / Medicine / Master / Master of Philosophy

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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