Changing structure and resources in a rheumatology combined unit during 1977-1999.

Objective: The aim was to study the changing structure and resources in a rheumatism hospital during the period 1977-1999 when rheumatology care was decentralized and new treatment strategies were introduced.

Methods: Data on hospital management and production were retrieved retrospectively.

Results: The number of beds was stepwise reduced from 133 to 44 and the average length of stay declined from 48 to 16 days.

Were the patterns of treatment for rheumatoid arthritis during 1977-1992 consistent with modern clinical guidelines?

Objective: Quality assessment of the long-term treatment of patients with rheumatoid arthritis (RA).

Methods: Treatment patterns in a cohort of 70 local and 77 distant RA patients during 1977-1992 were reviewed retrospectively and compared to modern clinical guidelines.

Results: In 1977 disease-modifying anti-rheumatic drugs (DMARDs) were given to 62% of the new, hospitalised patients, systemic corticosteroids to 7%, and corticosteroid joint injections to 24%.

Increased mortality in Dupuytren's disease.

A previous study showed a dip in the prevalence curve of Dupuytren's disease in men over 79 years of age. This may indicate increased mortality. The aim of the present investigation was to study this hypothesis.

Use of a sicca symptoms questionnaire for the identification of patients with Sjögren's syndrome in a heterogeneous hospital population with various rheumatic diseases.

Objective: A six-item questionnaire regarding sicca symptoms recently validated for primary Sjögren's syndrome (SS) was tested on 154 in-patients with a wide range of inflammatory rheumatic diseases. Patients with one or more positive responses underwent objective ocular and oral diagnostic procedures. Of 27 patients thus investigated, 19 could be classified as having SS.

Sjögren's syndrome in inflammatory rheumatic diseases: analysis of the leukocyte protein calprotectin in plasma and saliva.

In a hospital population of 154 patients with a wide range of inflammatory rheumatic diseases, patients with sicca symptoms were subjected to objective ocular and oral tests to establish cases with Sjögren's syndrome (SS). The plasma level of the leukocyte protein calprotectin has been shown to be a good indicator of disease activity and inflammation in various rheumatic diseases. In the present study, calprotectin levels in plasma and whole saliva were analysed and evaluated as potential markers of SS and salivary gland disease activity.

Juvenile chronic arthritis: a biobehavioral disease. Some unsolved questions.

This review presents a multidimensional biopsychosocial model suitable for evaluating medical and psychosocial empirical findings in juvenile chronic arthritis (JCA). The possible predisposing, provoking and modifying variables that have been assessed in studies of JCA are presented, together with suggestions for further research. The model is appropriate for structuring and validating data in future longitudinal studies and may also serve as a frame of reference for a multi-professional team approach in the care of rheumatic children and their families.

Characterization of responders and nonresponders to tiaprofenic acid and naproxen in the treatment of patients with osteoarthritis.

Objective: To characterize responders/nonresponders to 2 nonsteroidal antiinflammatory drugs by a combination of start variables in the treatment of patients with osteoarthritis (OA) of the hip(s)/knee(s).

Methods: Two hundred eight patients participated in a 3-week randomized double blind parallel group trial.

Results: The responder rate to tiaprofenic acid and naproxen was 52 and 59%, respectively.

Nutrient intake and nutritional status in children with juvenile chronic arthritis.

Nutrient intake and nutritional status were assessed in 15 children with juvenile chronic arthritis (JCA) and in 17 healthy controls. Anthropometric measurements were similar in children with pauciarticular JCA and in controls, whereas weight (p = 0.05) and upper arm muscle area (UAMA) (p less than 0.

The L1 protein as a new indicator of inflammatory activity in patients with juvenile rheumatoid arthritis.

L1 is a major granulocyte and monocyte protein with Mr 36.5 kDa. It is released during leukocyte activation and detected in plasma by use of an enzyme immunoassay.

Prediction of short-term prognosis by biopsychosocial variables in patients with juvenile rheumatic diseases.

We describe physical symptoms and signs, laboratory data and psychosocial assessments for 84 children (age 1-17) hospitalized for the first time with suspected or definite rheumatic disease. At 16 months (range 7-28) followup change of disease severity was assessed based on hospital records. The patients were categorized as unchanged/worse (n = 36) or improved (n = 48).

Ibuprofen suspension in the treatment of juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group.

Ninety-two children with juvenile rheumatoid arthritis were randomly assigned to treatment in a multicenter, double-blind, 12-week trial designed to compare the efficacy and safety of a liquid formulation of ibuprofen at a dosage of 30 to 40 mg/kg/day versus those of aspirin at a dosage of 60 to 80 mg/kg/day. No significant intergroup differences in response rates or in the amount of improvement in articular indexes of disease activity were observed. More children treated with aspirin discontinued treatment early because of adverse reactions.

A three-year retrospective study of synovectomies in children.

The aim of this study was to evaluate the results of synovectomies in children with juvenile arthritis. Five hundred twenty-eight synovectomies and tenosynovectomies were performed over a period of 13 years. The patients were followed for one, two, three, five, and ten years postoperatively.

Is onset type evaluated during the first 3 months of disease satisfactory for defining the sub-groups of juvenile chronic arthritis? A EULAR Cooperative Study (1983-1986).

This study represents an attempt to collect observations from co-operating countries to evaluate the previously suggested criteria for juvenile chronic arthritis during the onset periods 0-3 and 3-6 months, preferably studied prospectively. Only 267 of 378 forms returned were satisfactory for inclusion because of failure to observe exclusion criteria or insufficient information. Despite this it was possible to conclude that systemic disease represented 25% of the group and that these features tended to decline during the 6 month period.

The first stay in a pediatric rheumatology ward. Associations between parent satisfaction and disease and psychosocial factors.

To assess parent satisfaction with hospital care and needs for improvement, questionnaires were sent to parents of children participating in a study of bio-psychosocial factors at the onset of juvenile rheumatic diseases. At 16 months follow-up (range 12-22 months) 85 (82%) of 106 parents answered. Twenty-four of these were also interviewed.

Chronic family difficulties and stressful life events in recent onset juvenile arthritis.

The prevalence of chronic family difficulties, recent stressful life events and socioeconomic status were assessed in 106 families of children with juvenile arthritis, divided in 5 groups according to disease course types. Chronic family difficulties were assessed by semi-structured parent interviews and life events by questionnaires and interviews. Both chronic family difficulties and recent stressful life events appeared in about 2/3 of the families, but a correlation between these were found only for the pauci and polyarticular groups.

Temporomandibular joint involvement in juvenile rheumatoid arthritis. Clinical diagnostic criteria.

In 103 patients (mean age 9 years) with the pauciarticular or polyarticular type of juvenile rheumatoid arthritis, clinical aspects of mandibular growth and function and general disease variables were correlated with radiographically observed temporomandibular joint (TMJ) abnormality. Discriminant analysis of the entire group revealed that a combination of disease duration and disease activity was associated with TMJ abnormality; however, a correct classification of the TMJ condition could be made in only 63 patients (63%). Further analyses revealed three effective indicators of TMJ arthritis: reduced maximal mouth opening capacity, vertical difference between the two mandibular angular regions, and deviation of the mandible at maximal protrusion.

Tolerance of cyclosporine A in children with refractory juvenile rheumatoid arthritis.

In an open trial, tolerance and safety of cyclosporine A was studied in 14 patients with refractory juvenile rheumatoid arthritis (JRA). The doses varied from 4-15 mg/kg/day. Treatment lasted for greater than 12 months in 11 and 6 to 9 months in 3 patients.

Reduced mandibular dimensions and asymmetry in juvenile rheumatoid arthritis. Pathogenetic factors.

The pathogenesis of reduced mandibular dimensions and asymmetry was studied in 103 patients with juvenile rheumatoid arthritis. Abnormalities of the temporomandibular joint were intimately related to mandibular growth disturbances. Unilateral joint abnormality resulted in jaw asymmetry and underdevelopment on the affected side.

Agreement between parents and physicians regarding clinical evaluation of patients with juvenile rheumatoid arthritis.

The reliability of disease severity assessed by parents of children with juvenile rheumatoid arthritis was studied by a self-report questionnaire. Parents of 50 patients with a minimum disease duration of 6 months and two physicians participated. Good agreement was achieved between parents and physicians regarding global assessment of disease severity, pain, morning stiffness and activities of daily life.

Methodological problems--juvenile chronic arthritis.

This group of diseases comprises a heterogeneous syndrome with several characteristics different from adult rheumatoid arthritis. They are characterized by joint swelling, pain/tenderness, heat and limitation of motion with or without several extra-articular manifestations. The natural course is fluctuating.

Comparison of synovectomy and no synovectomy in patients with juvenile rheumatoid arthritis. A 24-month controlled study.

Thirty patients with pauciarticular or polyarticular juvenile rheumatoid arthritis entered a randomized, 24-month, parallel trial of synovectomy (n = 15) versus no synovectomy (n = 15). The joints studied were 18 wrists, 8 ankles and 4 knees. The synovectomies were performed as radically as possible.

Azathioprine versus placebo in patients with juvenile rheumatoid arthritis: a single center double blind comparative study.

Thirty-two patients with juvenile rheumatoid arthritis (JRA) entered a comparative, double blind, parallel 16-week clinical trial of azathioprine versus placebo. After 8 weeks of therapy the changes in disease activity measurements indicated an improvement in the azathioprine group compared to the placebo group. At the end of the study, most of the disease activity measurements were changed in favour of the azathioprine group compared to the placebo group, but statistically significant differences between the groups were found for only 2 disease activity measurements.

Radiographic temporomandibular joint abnormalities in patients with juvenile chronic arthritis during a controlled study of sodium aurothiomalate and D-penicillamine.

Sixty-two patients with juvenile chronic arthritis (JCA) were randomized to 50-week treatment with either sodium aurothiomalate (G) or D-penicillamine (PEN) and followed with regard to radiographic changes of the temporomandibular joints (TMJ). The radiographic methods comprised panoramic radiography and oblique lateral transcranial radiography, occasionally supplemented with other methods. The radiographs were read by a single assessor who did not know the type of drug treatment.

Auranofin therapy in juvenile rheumatoid arthritis: a 48-week phase II study.

A 48-week phase II open, uncontrolled study of auranofin (AF) in patients juvenile rheumatoid arthritis (JRA) was conducted to assess efficacy, tolerance and serum gold levels, and to consider the feasibility of further controlled studies (phase III) in such patients. The study group included 25 patients (20 F, 5 M) with active pauciarticular (n = 4) or polyarticular (n = 21) JRA. Median age was 100 months (range 62-176); median disease duration was 55 months (range 13-155).