This study investigates the psychosocial aspects of rheumatoid arthritis (RA),a chronic debilitating disease. It explores the quality of life in a low socio-economic group of clinic-based adult RA patients. The aims of the study were as follows: (1) to assess the impact of both socio-demographic and psychosocial factors on RA health outcome, (2) to develop a multivariate, predictive model for RA, and (3) to assess the moderating role (or stress-reducing function) of psychosocial factors between the objective experience of RA and the subjective experience of RA. A sample of 186 RA patients with a mean age of 49.51 years and a mean duration of RA of 10.80 years were subjected to a series of selfadministering questionnaires to assess their subjective experience of the disease. Coping, social support, causal attribution, cognitive illness representation, pain and functional status were assessed. The objective experience of RA was based on those health status measures that included the following: firstly, ESR levels (a laboratory measure), and secondly, class (classified level of disability) and joint status (severity of joint inflammation) which were assessed and recorded by the rheumatologist. The data obtained were subjected to a systematic statistical analysis to assess the following: (1) the relationships between the socio-demographic factors, psychosocial factors and factors representing RA health outcome using correlational analysis (Pearson r), (2) the value of socio-demograhic and psychosocial factors in predicting subjective and objective RA health outcomes using step-wise hierarchical multivariate regression analysis, and (3) the moderating or stress-reducing effect of psychosocial factors between the objective and subjective health status measures using moderated regression analysis. Findings revealed that psychological factors, especially coping, were more significant predictors than socio demographic factors of RA health outcome (quality of life of RA individuals). Furthermore, the psychosocial factors coping, network social support, helplessness and causal attribution were found to play a moderating role in RA health outcome. The results of the study confirm both the health-sustaining and the stress-reducing function of psychological factors. Theoretically this study is located within the stress and coping paradigm of Lazarus and Folkman (1984). / Thesis (Ph.D.)-University of Natal, Pietermaritzburg, 2002.

Thesis (Ph. D.)--Indiana University, 2006. / Includes bibliographical references (leaves 116-132).

Thesis (Ph. D.)--Indiana University, 2006. / Includes bibliographical references (leaves 116-132). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M. Phil.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 214-235).

Rheumatoid arthritis is an auto-immune inflammatory disease that leads to stiff and swollen joints. Patients also have severe bone destruction of the affected joints and another common symptom of rheumatoid arthritis is a generalised bone loss that can lead to osteoporosis. Currently, there are many treatments for rheumatoid arthritis, which provide a recession of the inflammatory symptoms. However, none of these treatments are able to provide a complete protection against the rheumatoid arthritis-induced bone loss. Furthermore, the most effective available treatments such as glucocorticoids or the new biological drugs are not optimal since they either cause severe side effects or are very expensive and difficult to produce. Hence, there is a real need for new cost-effective treatments that can act on both inflammation and bone loss symptoms of rheumatoid arthritis. ABD compounds are small molecules, relatively easy to synthesize at reasonable cost. In this thesis, I discuss the effects of these small molecules on both rheumatoid arthritis-induced inflammation and bone loss. Daily treatments with the ketones ABD328 and ABD345, or with the sulphonamide ABD455 prevent inflammation in an animal model of rheumatoid arthritis. Furthermore, micro-CT and histology analysis showed that these treatments also provide a reliable protection against bone destruction of affected joints and generalised bone loss. In vitro data showed that this protective effect on bone was osteoclast specific. Indeed, Ishow here that treatment of other bone cells (such as osteoblasts or macrophages) with ABD compounds does not affect their biology. The mechanism of action of these compounds has also been studied and I show here that ABD compounds inhibit both inflammation and osteoclastogenesis by inhibiting the signalling pathways that are activated in response to pro-inflammatory cytokines such as TNF . This work led to the design and synthesis of further improved compounds, such as ABD599, that are currently considered as very interesting candidates for clinical trials. In conclusion, the ABD compounds, as small cost-effective molecules, represent a novel class of rheumatoid arthritis treatments by acting on both inflammation and bone loss symptoms of the disease.

No description available.

No description available.

No description available.

No description available.

No description available.