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.

The purpose of this project was to examine the effect of hypnosis as a treatment in the control of pain in a population of rheumatoid arthritic patients and further to examine any associated change in emotionality. Three groups of patients suffering from the pain of rheumatoid arthritis were selected. One group served as a control group. The other two groups served as a modified control group and as a treatment group, respectively. All three groups were pre, mid, and post-tested using the McGill Pah Questionnaire, the Minnesota Multiphasic Personality Inventory, the California Personality Inventory Well-Being scale items, and a check of their medication intake. The testing periods were before any treatment procedures were introduced, after a 6 week therapy involvement period for the modified control group and treatment group, and after another 6 week period with no further interaction of the patients with the therapists. The treatment group received hypnosis instruction for the treatment of pain, the modified control group received a ventilation or talk therapy, and the control group was not seen by any therapist. It was fond that self-hypnosis offers a viable and practical treatment technique to individuals in the control of their pain. individuals were not only able to reduce their perception of pain and its effect on their lives, but they were also able to be the ones in control of the process. Both the treatment group and the modified control group were able to achieve positive change in several emotional factors. The treatment group was able to achieve a more significant change and one that persisted after the therapy sessions were terminated. The members of the treatment group were thus able to increase their emotional functioning and decrease their dependency on medications. The treatment group was the only group able to decrease medication intake significantly thus gain indicating the importance of learning self-help procedure for controlling pain. It would seem from the results of this study that using self-hypnosis for pain control is useful and practical.

Bakgrund: Reumatoid artrit (RA) är en autoimmun sjukdom som påverkar leder, senor och skelettvävnad genom att den orsakar inflammation. Det finns evidens för ärftlighet och även immunologiska faktorer spelar en roll men varför sjukdomen utvecklas är ännu inte känd. Omvårdnad sker främst i form av utbildning om egenvård och träning samt medicinering. Syfte: Syftet var att beskriva vilka faktorer som påverkar livskvaliteten hos personer med Reumatoid Artrit. Metod: Arbetet är en litteraturöversikt. Urvalskriterierna var att artiklarna ska vara på engelska, publicerade inom de senaste fem åren (2016–2021), peer-reviewed och deltagare ska vara vuxna. De valda databaserna var PubMed och Cinahl complete. Databasernas fokusområden är omvårdnadsforskning och medicin vilket är relevant för det som eftersöks i arbetet. Sökmetoden var boolesk och sökorden var rheumatoid arthritis och quality of life. Artiklar som bedömts relevanta för att besvara syftet valdes ut. Resultat: Resultatet visar att de faktorer som kan påverka den mentala och fysiska livskvaliteten negativt hos personer med RA var smärta, depression, trötthet, sjukdomsaktivitet, övervikt, brist på sömn samt hög ålder. Kunskap om sjukdomen, inställning, stark identitet, hög motståndskraft samt psykologisk rådgivning, socialt stöd, träning, goda relationer, god ekonomi, hög utbildning och arbete sågs kunna påverka livskvaliteten positivt. Sammanfattning: RA påverkar personers livskvalitet i olika dimensioner på flera olika sätt. Sjukdomsaktivitet, information om sjukdomen och socialt stöd sågs vara några av de mest avgörande faktorerna för livskvaliteten. Som sjuksköterskor och omvårdnadsledare är det viktigt att undersöka faktorer som bidrar till bättre/sämre livskvalitet för att kunna främja patientens förmåga till egenvård. Sjuksköterskan bär ett ansvar för att säkra varje patients enskilda rätt till vård, vilket är en förutsättning för ett jämlikt samhälle. / Background: Rheumatoid arthritis (RA) is an autoimmune disease that affects joints, tendons and tissues by causing inflammation in them. There is evidence of the disease having hereditary and immunological factors that contribute to the emergence of Rheumatoid Arthritis, but the cause behind it is still unknown. Care is primarily focused on information about selfcare and exercise as well as medication. Aim: The aim was to describe the factors influencing the quality of life for people with Rheumatoid Arthritis. Method: This paper is a literature review. The inclusion criterias are that the articles are in English, published within the last five years (2016–2021), they are peer-reviewed and participants in studies are adults. The chosen databases were PubMed and Cinahl complete which both focus on nursing and medicine which are relevant for this review. The search method was boolean, and search words were rheumatoid arthritis and quality of life. The articles used for the assignment were chosen based on their abstract, how well the article could serve to answer the aim. Results: The results found that factors that can decrease the quality in life in people with Rheumatoid Arthritis is pain, depression, fatigue, disease activity, overweight, lack of sleep and old age. Knowledge about the disease, positive attitude, clear sense of identity, high resilience as well as therapy, social support, physical activity, marriage, good financial health, high education and employment was seen to improve the quality of life. Conclusion: RA affects people's quality of life in different dimensions and ways. Disease-activity, information about the disease and social support were seen as some of the most crucial factors in determining the quality of life. As nurses and leading care-givers it is important to know what factors can contribute a better/worse quality of life in order to encourage selfcare. Nurses carry a responsibility to ensure every patient’s right to medical treatment and care which is a prerequisite for an equal society.

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

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21630号 / 医博第4436号 / 新制||医||1033(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 古川 壽亮, 教授 髙橋 良輔, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This bachelor thesis is a literature study presenting detected glycan structures of serum IgG, in literature, from rheumatoid arthritis (RA) patients and healthy individuals. It is a systematic literature study. The study involved searching theoretical information about glycosylation, glycans and their functions, the structure of immunoglobulin G (IgG) glycosylation and its functions in the immune defense, rheumatoid arthritis, methods for IgG glycopeptide enrichment, quantification and characterization methods (capillary electrophoresis and mass spectrometry). The method used for the literature study involved searches in databases with keywords, manual research and quality control of the sources. In the result, two different research articles about abnormal IgG glycosylation in RA compared with healthy controls, are presented and compared. The methodology the researchers used are briefly described supported by the theoretical background. It can be stated that identification and detection of abnormal glycan structures of IgG from RA patients have potential to be used as biomarkers. The glycoproteomics field is emerging for sensitive and high throughput quantification and identification methods combined with enrichment methods for efficient analysis. Matrix assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS) has shown good potential for characterization of glycan structures and has been widely used in clinical diagnostics. / Detta examensarbete är en litteraturstudie som presenterar detekterade glykanstrukturer för immunoglobulin G (IgG) från serum, vilka har publicerats i litteraturen, och som kommer från patienter med reumatisk artrit (RA) och friska individer. Det är en systematisk litteraturstudie. Studien behandlade ett sökningsarbete för teoretisk information om, glykosylering, glykaner, och dess funktioner, den strukturella uppbyggnaden av IgG och dess funktioner i immunförsvaret, RA, olika anrikningsmetoder för IgG och kvantifierings - och identifieringsmetoder (kapillär elektrofores, CE och masspektrometri, MS). Metoden involverade sökningar i databaser samt manuella sökningar följt av en kvalitetskontroll. I resultatet presenteras och jämförs två olika forskningsartiklar som handlar om förändrad glykolsylering av IgG hos RA-patienter jämfört med friska individer. Metodologin som forskarna använt beskrivs ytligt, med stöd av grundligare information i den teoretiska bakgrunden. Det kan konstateras att identifiering och detektion av ovanliga glykanstrukturer för IgG hos RA patienter har potential att användas som biomarkörer för sjukdomen. Området glykoproteomik är i behov av känsliga och robusta kvantifierings - och identifieringsmetoder som klarar av höga genomströmningar, vilka kan kombineras med anrikningsmetoder för att uppnå god analyseffektivitet. Matrix assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS) har visat god potential för att karaktärisera glykanstrukturer och användas inom klinisk diagnostik.

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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. / 2031-01-01

付記する学位プログラム名: 霊長類学・ワイルドライフサイエンス・リーディング大学院 / 京都大学 / 新制・課程博士 / 博士(医学) / 甲第24837号 / 医博第5005号 / 新制||医||1068(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 伊藤, 能永, 教授 生田, 宏一, 教授 上野, 英樹 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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