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G Stucki

Publications and source records attributed to G Stucki.

At least 91 records · Page 5Linked to original sources
PubMed1998

A new method of scoring radiographic change in rheumatoid arthritis.

OBJECTIVE: To test the reliability and to define the minimal detectable change of a new radiographic scoring method in rheumatoid arthritis (RA). METHODS: Following the recommendations of an expert panel a new radiographic scoring method was defined. It scores 38 joints [all proximal interphalangeal (PIP) and metacarpophalangeal joints, 4 sites in the wrists, IP of the great toes, and metatarsophalangeals 2 to 5], regarding only the amount of joint surface destruction on a 0 to 5 scale for each joint. Each grade represents 20% of joint surface destruction. The method was tested by 5 readers on a set of 7 serial radiographs of hands and forefeet of 20 patients with progressive and destructive RA. Analysis of variance was performed, as it provides the best information about the capability of a method to detect real change and to define its sensitivity according to the minimal detectable change. RESULTS: Analysis of variance proved a high probability that the readers found real change with a ratio of intrapatient to intrareader standard deviation of 2.6. It also confirmed that one reader could detect a change of 3.5% of the total score with a probability of 95% and that different readers agreed upon a change of 4.6%. Inexperienced readers performed with comparable results to experienced readers. The time required for the reading averaged less than 10 minutes for the scoring of one set. CONCLUSION: The new radiographic scoring method proved to be reliable, precise, and easy to learn, with reasonable cost. Compared to published data, it may provide better results than the widely used Larsen score. These features favor our new method for use in clinical trials and in longterm observational studies in RA.

Adult↗
PubMed1998

Can collagen type II sustain a methotrexate-induced therapeutic effect in patients with long-standing rheumatoid arthritis? A double-blind, randomized trial.

OBJECTIVE: Based on the results of two recently published, randomized, double-blind and placebo-controlled studies, a possible improvement in rheumatoid arthritis disease activity after oral tolerization with triple helical collagen type II has been suggested. The goal of this study was to go one step further and ask the question whether collagen type II can sustain the therapeutic effect induced by methotrexate, the most widely accepted disease-modifying anti-rheumatic drug in patients with long-standing rheumatoid arthritis. METHODS: Ninety-two patients with rheumatoid arthritis on stable therapy with methotrexate were enrolled in a 3 month double-blind, randomized and comparative study to examine the efficacy of oral triple helical collagen type II as compared to continuing methotrexate. The dose of methotrexate (or the respective placebo drug) and of concomitant corticosteroids was not changed and intra-articular corticosteroids were not allowed during the 3 months. The primary study endpoint was disease activity as measured by physician and patients. RESULTS: While patients under ongoing therapy with methotrexate had, as expected, no change in disease activity, almost all parameters of disease activity and outcome in patients under a daily oral dose of 0.5 mg triple helical collagen type II worsened significantly (highly significant difference in swollen joints, between the two groups, P < 0.0001). No significant differences in side-effects between the two groups during the study period could be demonstrated. CONCLUSIONS: Substitution of methotrexate with daily 0.5 mg of triple helical collagen type II in patients with rheumatoid arthritis leads to a significant increase in disease activity, suggesting that oral collagen type II at the given dose is not capable of sustaining the methotrexate-induced anti-inflammatory effect in patients with long-standing rheumatoid arthritis.

Administration, Oral↗
PubMed1997

Biodegradation of the pesticide 4,6-dinitro-ortho-cresol by microorganisms in batch cultures and in fixed-bed column reactors.

A mixed culture of microorganisms able to utilize 4,6-dinitro-ortho-cresol (DNOC) as the sole source of carbon, nitrogen and energy was isolated from soil contaminated with pesticides and from activated sludge. DNOC was decomposed aerobically in batch cultures as well as in fixed-bed column reactors. Between 65% and 84% of the substrate nitrogen was released as nitrate into the medium, and 61% of the carbon from uniformly 14C-labelled DNOC was recovered as 14CO2. The mixed microbial culture also decomposed 4-nitrophenol and 2,4-dinitrophenol but not 2,3-dinitrophenol, 2,6-dinitrophenol, 2,4-dinitrotoluene, 2,4-dinitrobenzoic acid or 2-sec-butyl-4,6-dinitrophenol (Dinoseb). Maximal degradation rates for DNOC by the bacterial biofilm immobilized on glass beads in fixed-bed column reactors were 30 mmol day-1 (1 reactor volume)-1, leaving an effluent concentration of less than 5 micrograms l-1 DNOC in the outflowing medium. The apparent Ks value of the immobilized mixed culture for DNOC was 17 microM. Degradation was inhibited at DNOC concentrations above 30 microM and it ceased at 340 microM, possibly because of the uncoupling action of the nitroaromatic compound on the cellular energy-transducing mechanism.

2,4-Dinitrophenol↗
PubMed1997

[Patient-centered evaluation of illness outcome in musculoskeletal diseases: model of illness sequelae and definition of the concept].

Musculoskeletal conditions usually cause pain, physical, psychological and social disability, and consequently reduce a patient's quality of life. Nowadays, it is generally accepted that patients are truly capable to assess disease consequences, if they are questioned with appropriate instruments. Models of disease and the disabling process provide the conceptual background for the measurement of disease consequences. To date, standardized assessment of outcomes with psychometrically sound instruments is commonplace in clinical trials, clinical epidemiology, economic studies, and health services research. However, standardized assessment tools are not yet widely used in clinical practice.

Activities of Daily Living↗
PubMed1997

[Patient-centered evaluation of illness outcome in musculoskeletal diseases: selection and testing of outcome instruments].

Effectiveness research, economic evaluation, epidemiologic studies of disease consequences and clinical quality management all rely on standardized assessment of disease consequences with psychometrically sound questionnaires. For scientific, ethical and economical reasons, careful selection and evaluation of instruments is critical. Selection of instruments includes searches of medical databases (e.g. MEDLINE), testing of face-validity (does the instrument measure what we intend to measure?), and compatibility (is the instrument used internationally?). Evaluation of instruments includes the assessment of reliability, internal consistency and sensitivity. Most important is careful consideration of the practical usefulness (Interpretation of scores and scales, acceptance in the study population). Contact with instrument developers is advisable (Copyright issues, scoring, current version).

Arthritis, Rheumatoid↗
PubMed1997

[Patient-centered evaluation of illness outcome in musculoskeletal diseases: adaptation and revision of outcome instruments].

Assessment of disease consequences (outcome) requires reliable, valid, and sensitive instruments. Psychometrically sound generic health-status instruments such as the SF-36 have been validated for many languages and are available in German. Instead, most disease specific instruments have been developed in English and need to be adapted for the German language. To allow for cross-cultural comparisons and use of results across cultures, for instance, in international multicenter studies, instruments need to have both content and metric equivalence. Thus, adaptation of health-status instruments requires a standarized process including translation, backtranslation, review and assessment of metric properties (reliability, internal consistency, factors), and validity. Developments of new instruments from scratch are time and cost intensive and should only be considered if no current instrument is available. Ideally, newly developed instruments have interval-scale properties.

Activities of Daily Living↗
PubMed1997

[Patient-centered evaluation of the illness sequelae of musculoskeletal diseases: overview of important outcome instruments].

Quality of life and patient-centered health status has received increasing attention during the last decade. Simultaneously, there have been multiple instruments to assess quality of life in a standardized way. There are several possible approaches to assess health status in a more standardized way: (1) the judgement of a health professional, (2) performing standardized activities by the patient, and (3) self report of patients with standardized questionnaires. This paper presents a selection of health status instruments that have been used successfully to assess health-related quality of life in patients with musculoskeletal diseases. The description is restricted to instruments that have sound psychometric properties and that have been published in the scientific literature.

Activities of Daily Living↗
PubMed1997

[Traumatic finger polyarthrosis in judo athletes: a follow-up study].

Osteoarthritis is the most common joint disease. In addition to known risk factors e.g. genetics, age and hormonal status it has been suggested that chronic-repetitive micro- and substantial (macro-) injury may play an important pathogenetic role. In a longitudinal case-study we examined Judo-players for clinical and radiological changes of the finger joints over the course of 16 years. All examined 8 players demonstrated soft tissue changes including Heberden nodes and radiological changes typical for osteoarthritis of the finger joints. Changes were symmetrical and were not restricted to joints with tendon ruptures or fractures in the anamnesis. Degenerative changes were progressive and more pronounced in active players. Subjectively, symptoms were usually mild. Extensive Judo seems to be a risk factor for the development of osteoarthritis of the finger joints due to chronic-repetitive micro- and substantial (macro-) injury.

Adult↗
PubMed1997

Specialist management: needs and benefits.

In increasingly cost-conscious, accountable and integrated health-care systems, the appropriate role of speciality care is under scrutiny. The data on the impact of rheumatologist care on outcomes in patients with rheumatoid arthritis (RA) is limited and inconclusive. However, based on a review of processes of care known to be related to superior patient outcomes it is suggested that rheumatologists should be the lead physicians in patients with RA. Rheumatologists but usually not generalists have the experience necessary to make an early diagnosis and to initiate appropriate disease modifying anti-rheumatic drug (DMARD) treatment. Rheumatologists have an in-depth understanding of new assessment methods to optimize medical treatment and to make best use of and co-ordinate multi-disciplinary care. To avoid delay of diagnosis and initiation of treatment, patients with polyarthritis should be referred to rheumatologists as soon as possible. This requires that access to rheumatologist care is guaranteed.

Arthritis, Rheumatoid↗
PubMed1997

Economic impact of rheumatologic disorders.

Universally, health care systems are currently undergoing tremendous change. It is not sufficient to demonstrate that specific medical interventions and services are effective, as third party payers have become increasingly interested in financial outcomes. Managed care has accelerated this movement and rheumatology is facing new challenges to position itself in a changing health care environment. Studies dealing with the economic burden of musculoskeletal diseases and the economic evaluation of particular services and interventions are reviewed. As the health care system shifts toward managed care, rheumatology is facing tremendous challenges to position itself in new markets.

Canada↗
PubMed1997

Management of rheumatoid arthritis.

There is increasing evidence that reduction of disease activity by disease-modifying drugs alters the disease course of rheumatoid arthritis and that patients benefit from early introduction of disease-modifying antirheumatic drugs. To ensure accurate diagnosis and timely referral, training of medical students and residents in rheumatology and access to a physician experienced in the management of rheumatic diseases is important. Because spontaneous remission is rare, the risk of overtreatment of a few patients is outweighed by the benefits of early treatment for the majority of patients. Also, side effects may be reduced with optimation of titration of disease activity based on standardized, reliable, valid, sensitive, and easily interpretable measures with clear-cut decision rules. A potential solution to the practical problems involving the scoring of patient questionnaires such as the Health Assessment Questionnaire and the Rheumatoid Arthritis Disease Activity index and clinical algorithms such as the Disease Activity Score is the provision of a feedback system similar to a laboratory. To feed back the results of titration of disease activity with the goal of permanently improving health outcomes in an ongoing learning process may be called clinical quality management. From a health care system or political perspective, clinical quality management that demonstrates the commitment of rheumatology toward continuous improvement of rheumatoid arthritis care may become an important activity of rheumatology societies in countries where specialty care is under scrutiny and where specialists are increasingly required to show the benefits of their care.

Arthritis, Rheumatoid↗
PubMed1997

Association of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index with measures of disease activity and health status in patients with systemic lupus erythematosus.

OBJECTIVE: To examine the internal consistency and validity of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) with respect to disease activity, health status, and medication score. METHODS: A prospective cross sectional study of patients with systemic lupus erythematosus (SLE) attending a specialist lupus outpatient clinic between July 1994 and February 1995. The internal consistency of the SDI components was examined using Cronbach's coefficient alpha. The associations of the SDI components with disease activity measured by the British Isles Lupus Assessment Group (BILAG) index, health status measured by the Medical Outcomes Study (MOS) Short Form 20, and with a medication score were analyzed using Spearman's rank correlation coefficient (p). RESULTS: 133 women and 8 men ranging in age from 20.1 to 88.7 years (mean 41.1, SD 12.5) were studied. With few exceptions, the components of the SDI that reflect damage in different organ systems were not associated with each other. We found a significant although weak relationship between some related SDI and BILAG components (p 0.25 to 0.28; p < 0.01). While damage to the musculoskeletal system was associated with limitations in physical functioning measured with the MOS Short Form 20 (p-0.30; p < 0.01) and renal damage inversely with fatigue (p-0.23; p < 0.01) there was no significant relationship of other SDI components with the MOS Short Form 20. Renal and neuropsychiatric damage were associated significantly with the medication score (p 0.27 and 0.23; p < 0.01). CONCLUSION: The components of the SDI are valid in that they are associated with disease activity in the respective organ systems and some of them with a medication score. However, damage in different organ systems in SLE does not follow a common pattern. It is thus suggested that the SDI profile be used in addition to the SDI total score as an endpoint in clinical and epidemiological studies.

Adult↗
PubMed1996

[Is misoprostol effective in NSAID-induced gastrointestinal complications?].

Misoprostol, a synthetic prostaglandin E1, has been shown to reduce both gastric lesions and clinically relevant gastrointestinal events in patients taking NSAIDs. In patients with multiple risk factors gain in quality of life by avoidance of gastric ulcers seems to offset the loss in quality of life due to diarrhea, the most important misoprostol side effect. From a clinical-epidemiological point of view misoprostol prophylaxis thus seems reasonable in patients with multiple risk factors. Since non-use due to diarrhea varies highly among patients, individual preferences should be considered in the decision making process. From an economic point of view misoprostol prophylaxis seems justified in patients with multiple risk factors. In such patients misoprostol prophylaxis may indeed be cost-saving. However, this needs to be confirmed in further economic evaluations based on newly available effectiveness data and better data on patient preferences from large and representative samples.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

[Therapy of rheumatoid arthritis (chronic polyarthritis)].

A continuous and systematic monitoring of disease activity provides the basis for the therapeutic management of rheumatoid arthritis patients. This helps to individually tailor medication and to correctly time physiotherapy, ergotherapy, surgery, and rehabilitative measures. NSAID are the drugs of choice for symptomatic therapy. The dosage is adjusted to the circadian rhythm of the patient's complaints. Systemic glucocorticoids are very efficacious to control inflammation; however, caution is required in their long-term usage. Preventive measures to limit bone loss are mandatory. Disease-modifying antirheumatic drugs (DMARD) are prescribed early, at the time of diagnosis. The choice of sulfasalazine, antimalaric drugs, methotrexate or parenteral gold is based on the clinical presentation, the degree of systemic inflammation and on prognostic parameters. Treatment with DMARD has to be continued for years. If complete remission is achieved, lasting for at least six months, the dosage can be gradually reduced and finally stopped. At late stages of disease, residual joint pain is often due to secondary osteoarthritis.

Anti-Inflammatory Agents↗
PubMed1996

[Gonarthritis: diagnosis and therapy].

The patient presenting with an acutely swollen and tender knee joint is the most frequent rheumatologic emergency in clinical practice. Most important is the exclusion of an infectious arthritis, which requires immediate antibiotic treatment. Synovial fluid analysis for color, clarity, viscosity and cell count is the initial evaluation. In the presence of an opalescent or purulent fluid, cultures and stains with gram and acid-fast methods and polarizing microscopy for crystals should be performed. A noninflammatory, clear (reading test) and highly viscous ("Fadentest') fluid and a white blood cell count of < 2000/mm3 make an infectious arthritis extremely unlikely. The most frequent cause of a noninflammatory fluid is inflammatory osteoarthritis, which usually responds to NSAID treatment. Typical changes of the axial skeleton, tendons, skin and mucosa point to a spondylarthropathy.

Aged↗
PubMed1996

[Physical therapy in low back pain].

We report on physical measures in the treatment of patients with lower back pain due to mechanical factors. Acute low back pain improves mostly without specific measures. Intervention for this condition is useful for prevention of relapses. More demanding and difficult is the treatment of chronic lumbar back pain. After an exact diagnosis, information about the disease, the therapeutic procedure and the prognosis follow in order to agree on a common therapeutic goal. To this goal, a close cooperation between physician, physiotherapist, possibly a psychologist and a social worker, is optimal. The employer should be involved in the rehabilitation on the workplace. Patients should become mobilized inspite of pain, and the return to their workplace should be prepared step by step. The most important physiotherapeutic modalities are demonstrated.

Diagnosis, Differential↗
PubMed1996

Measurement properties of a self-administered outcome measure in lumbar spinal stenosis.

STUDY DESIGN: The measurement properties and validity of a newly developed patient questionnaire for the assessment of patients with lumbar spinal stenosis was tested in an ongoing prospective multicenter observational study of patients undergoing decompressive surgery in three teaching hospitals. OBJECTIVE: The goal of the study was to develop a short, self-administered questionnaire on symptom severity, physical functional status, and patient satisfaction. SUMMARY OF BACKGROUND DATA: The measure is intended to complement existing generic measures of spinal-related disability and health status. The questionnaire includes three scales with seven questions on symptom severity, five on physical function, and six on satisfaction. METHODS: The internal consistency of the scales was assessed with Cronbach's coefficient alpha on cross-sectional data from 193 patients before surgery. The test-retest reliability was assessed on data from a random sample of 23 patients using Spearman's rank correlation coefficient. The responsiveness was assessed on 130 patients with 6-month follow-up data using the standardized response mean. RESULTS: The test-retest reliability of the scales ranged from 0.82 to 0.96, the internal consistency from 0.64 to 0.92, and the responsiveness from 0.96 to 1.07. The direction, statistical significance, and strength of hypothesized relationships with external criteria were as expected. CONCLUSIONS: This short self-administered spinal stenosis measure is reproducible, internally consistent, valid, and highly responsive. It can be used to complement generic instruments in outcome assessment of patients with lumbar spinal stenosis.

Aged↗