Medication adherence in rheumatoid arthritis patients: older is wiser.

Objectives: To create a profile of individuals nonadherent to their medications in an age-stratified sample (ages 34-84) of community-dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed.

Design: A direct observation approach was used in conjunction with structural equation modeling.

IgA multiple myeloma presenting as Henoch-Schönlein purpura/polyarteritis nodosa overlap syndrome.

We report the unusual case of a man with a 5-year history of relapsing Henoch-Schonlein purpura (HSP) and macroscopic polyarteritis nodosa (PAN) as early manifestations of IgA kappa multiple myeloma. The glomeruli contained monoclonal IgA kappa deposits, without other immunoglobulins or lambda light chains. Glomerular deposits lacked the usual electron density but could be demonstrated by immunoelectron microscopy.

Cognitive factors and the use of over-the-counter medication organizers by arthritis patients.

The present study investigated the ability of 45 arthritis patients, all using three or more prescription medications, to correctly load their medications into three types of over-the-counter medication organizers. The results indicated that use of a seven-day organizer with compartments for different times resulted in fewer errors than did an hour-by-hour wheel organizer or a seven-day organizer with only one compartment for each day. It was concluded that the seven-day organizer with compartments for different times appears to have the potential to improve compliance behaviors, but the usefulness of the other two organizers in promoting compliance is uncertain.

Pharmacokinetics of methotrexate administered by intramuscular and subcutaneous injections in patients with rheumatoid arthritis.

The serum concentrations and the pharmacokinetics of low-dose methotrexate (MTX) were compared after both intramuscular (IM) and subcutaneous (SQ) injections in 5 patients with rheumatoid arthritis. Values for the observed peak concentration, the time to the observed peak concentration, and the area under the time versus concentration curve for IM injections were not significantly different from these values for SQ injections. These results suggest that IM and SQ are interchangeable routes of administration.

Acute effects of steroids on immune complex profile of patients with systemic lupus erythematosus. Correlation of profile with development of target organ involvement.

Eleven patients with active systemic lupus erythematosus, previously untreated, were studied to 1) determine the acute effect of corticosteroids on circulating immune complex (CIC) levels and 2) correlate the initial CIC profile with the development of organ system involvement. Using serial measurements of CIC as detected by assays for cryoglobulins and binding to C1q, Raji cells, and rheumatoid factor, we found that levels of CIC change little during the first month of high dose daily steroid therapy, but they uniformly decrease to near normal by 6 to 12 months. High levels of CIC detected by Raji cell assay early in the course of systemic lupus erythematosus and before steroid therapy appear to be predictive of the development of chronic lupus nephritis (P less than 0.

Interaction between rheumatoid factor and antibody/DNA complexes: enhancement of complement fixation.

The influence of rheumatoid factor (RF) on the complement mediated binding of antibody/double-stranded DNA immune complexes to red blood cells has been investigated. Our results indicate that RF enhances this binding reaction, apparently by fixing complement via its own Fc region. These findings suggest that under certain circumstances, RF may play an exacerbating role in the antibody/DNA induced glomerulonephritis of systemic lupus erythematosus.

Renal vein thrombosis associated with nephrotic syndrome and gold therapy in rheumatoid arthritis.

In this case of renal vein thrombosis secondary to a nephrotic syndrome, we postulate renal disease resulted from gold therapy. We know of no previous report relating gold toxicity and renal vein thrombosis. It should be emphasized that with increasing use of gold, proteinuria and nephrotic syndrome may be more common than once suspected and, when present, predispose to the development of renal vein thrombosis.

Self-evaluation, role satisfaction and anxiety in the woman alcoholic.

Compared with a matched group of 100 controls, 100 alcoholic women were found to have a significantly poorer self-concept, to view themselves as less personally competent, to experience greater anxiety, and to be less satisfied with themselves. The alcoholic and nonalcoholic women had similar concepts of other men and women and shared similar views of the roles of women in comtemporary society. The need for research comparing alcoholic women with matched female controls was stressed.