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Biomedical subjects

J J Rasker

Publications and source records attributed to J J Rasker.

At least 55 records · Page 3Linked to original sources
PubMed1996

Comparison of methotrexate with placebo in the treatment of systemic sclerosis: a 24 week randomized double-blind trial, followed by a 24 week observational trial.

In this study, methotrexate (MTX) was compared with placebo in the treatment of systemic sclerosis (scleroderma, SSc) in a 24 week randomized double-blind trial, followed by an observational trial of 24 weeks duration. Twenty-nine scleroderma patients were allocated to receive weekly injections of either 15 mg MTX or placebo. Patients who responded favourably after 24 weeks continued with the same regimen for a further 24 weeks; those who showed a poor response on placebo were allocated to further treatment with 15 mg MTX weekly, and those who responded poorly to treatment with 15 mg MTX had their doses increased to 25 mg. A favourable response was defined as an improvement of total skin score (TSS) by > or = 30%, of single breath diffusion capacity (DLCO) by > or = 15%, or of the score on a visual analogue scale of general well-being (VAS) by > or = 30%, provided that such improvements were not accompanied by persistent digital ulcerations or worsening of DLCO > or = 15%. Seventeen patients were allocated to MTX treatment and 12 to treatment with placebo. After 24 weeks, a significantly larger number of patients receiving MTX (n = 8, 53%) who completed the first 24 weeks of the study had responded favourably compared to patients receiving placebo (n = 1, 10%, P = 0.03). Comparison of separate variables between the two treatment groups by intention-to-treat analysis at week 24 showed improvement in the MTX group of TSS (P = 0.06) and creatinine clearance (P = 0.07). At week 48, 13 patients received MTX from the start of the study and nine during 24 weeks. From these 22 patients, 15(68%) responded favourably and compared with the start of the study they showed significant improvement of TSS (P = 0.04), VAS (P = 0.02), grip strength of the right hand (P = 0.02) and ESR (P = 0.01). Although the number of patients enrolled in this study is small, these results suggest that in a group of patients with active systemic sclerosis, low-dose MTX seems to be more effective than placebo according to pre-defined response criteria.

Adult↗
PubMed1996

Evaluation of a Dutch version of the AIMS2 for patients with rheumatoid arthritis.

DUTCH-AIMS2, a Dutch version of AIMS2 and successor to DUTCH-AIMS, is an instrument to assess health status among patients with rheumatic diseases. It provides measurements of 12 areas of health status on scales for health status proper, satisfaction, attribution and arthritis impact. We assessed the reliability of its scales in terms of internal consistency and their validity according to both internal standards and external standards. Correctly completed questionnaires were returned by 231 RA patients and 131 controls. Internal consistency coefficients for the health status scales ranged from 0.66 and 0.89, but most exceeded 0.80. Within-scale factor analyses produced single factors in all composite health status scales for both patients and controls, with only two exceptions. Factor analysis also identified a physical, social and psychological dimension among 11 areas of health. External validity was established by strong correlations between DUTCH-AIMS2 health status scales and functional class, laboratory parameters, and self-assessments of fatigue, loneliness, pain, functional disability and social support. DUTCH-AIMS2 is acceptably reliable and valid for use in a variety of settings.

Activities of Daily Living↗
PubMed1996

Spondylodiscitis in ankylosing spondylitis, inflammation or trauma? A description of six cases.

An uncommon, but well recognised complication of Ankylosing Spondylitis (AS) is spondylodiscitis, a destructive discovertebral lesion also called the Andersson lesion. We describe six cases, with variable clinical presentation and radiological appearance. Two had multiple lesions, in one patient spondylodiscitis was the presenting symptom of AS. None had a history of even a minor trauma. Prognosis was good with conservative treatment including NSAID's, rest, and physiotherapy. In two cases histopathology was studied and suggested sterile inflammation as the main etiologic factor. The literature is reviewed regarding the mechanisms that may contribute to these lesions: mainly inflammatory like increasing enthesopathy or mainly mechanical like pseudoarthrosis about a fracture site. It may be that both mechanisms can result in similar destructive intervertebral disc lesions.

Adult↗
PubMed1995

Are tender point scores assessed by manual palpation in fibromyalgia reliable? An investigation into the variance of tender point scores.

To determine the reliability of tender point assessment by manual palpation in patients with fibromyalgia, and to investigate the sources of variance, tender point scores by manual palpation were obtained in 30 fibromyalgia patients by 2 investigators; the assessments were repeated after 1 week. Test-retest stability and inter-observer agreement of tender point scores was moderate to high. The most important sources of variance were inter-individual patient differences in (1) mean tenderness (pain thresholds) and (2) tender point profiles (consistent intra-individual differences between the 14 tender point scores), and (3) residual variance, not attributable to any systematic effect (error). It is concluded that the reliability of tender point assessment by manual palpation is acceptable. It seems to be not less than reliability of assessment by pressure algometer. Tender point scores in fibromyalgia reflect individual differences in mean pain thresholds as well as individual tender point profiles.

Adult↗
PubMed1994

[Spondylodiscitis in Bechterew's disease; inflammation or trauma? Description of 6 patients].

OBJECTIVE: To study the prevalence and nature of sterile spondylodiscitis in patients suffering from ankylosing spondylitis. DESIGN: Descriptive. SETTING: Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. METHOD: Of all ankylosing spondylitis patients suffering from sterile spondylodiscitis, the medical histories and the radiological and histological findings were analysed. RESULTS: Among about 400 patients, 6 cases of sterile spondylodiscitis were found; 4 men and 2 women. The mean time lapse between diagnosis of ankylosing spondylitis and onset of spondylodiscitis symptoms was 7 years; in I patient discitis was the first symptom. Discitis changed the nature of the backache: it worsened during exercise and improved on resting. There was no history of trauma. Symptomatic and asyptomatic radiological abnormalities were seen at the same time in 2 patients. Symptoms disappeared 3-36 months after start of conservative treatment. Histological examination was performed in 2 cases and showed inflammatory changes. CONCLUSION: Spondylodiscitis in ankylosing spondylitis has a highly variable presentation and in general a good prognosis. Our findings support an inflammatory rather than a traumatic pathogenesis.

Adult↗
PubMed1994

Effects of local heat and cold treatment on surface and articular temperature of arthritic knees.

OBJECTIVE: To evaluate and compare the effects of locally applied heat and cold treatments on skin and intraarticular temperature in patients with arthritis. METHODS: Thirty-nine patients with arthritis of the knee were divided at random into 4 treatment groups (ice chips, nitrogen cold air, ligno-paraffin, and placebo short wave). A temperature probe was inserted into the knee joint cavity and another placed on the overlying skin, and changes in temperature over 3 hours were recorded for each treatment group. RESULTS: The mean temperature of the surface of the skin dropped from 32.2 degrees C to 16.0 degrees C after application of ice chips and from 32.6 degrees C to 9.8 degrees C after application of nitrogen cold air; the mean intraarticular temperature decreased from 35.5 degrees C to 29.1 degrees C and from 35.8 degrees C to 32.5 degrees C, respectively, after these treatments. Treatment with ligno-paraffin increased the surface temperature by 7.5 degrees C and the temperature in the joint cavity by 1.7 degrees C. No significant changes were observed with placebo short wave diathermy. CONCLUSION: The traditional model, that intraarticular temperature is decreased by superficial heat and increased by superficial cold, must be discarded. In arthritis patients, intraarticular temperature is increased by superficial heat and decreased by superficial cold. This has clear consequences for treatment policy.

Adult↗
PubMed1994

Treating arthritis with locally applied heat or cold.

The scientific for the treatment of arthritis with locally applied heat or cold is reviewed. Experimental studies in vitro, in animals, in healthy subjects, and in patients are considered. Results of investigations of the effects of locally applied heat or cold on the deeper tissues of joints and on joint temperature in patients are not consistent. In general, locally applied heat increases and locally applied cold decreases the temperature of the skin, superficial and deeper tissues, and joint cavity. Most studies dealing with the effects of heat and cold on pain, joint stiffness, grip strength, and joint function in inflamed joints report beneficial effects. In vitro studies show that higher temperatures increase the breakdown of articular cartilage and tissues that contain collagen. Therefore, one goal of physical therapy should be to decrease intraarticular temperature in actively inflamed arthritic joints.

Animals↗
PubMed1993

Effect of therapy for thyroid dysfunction on musculoskeletal symptoms.

Our purpose was to assess the long-term effect of treatment for thyroid dysfunction on musculoskeletal symptoms. Forty-six patients (37 with hypothyroidism, 9 with hyperthyroidism), who visited the outpatient clinic of rheumatology and had abnormal thyroid function tests on their first visit, cooperated in the study. They were interviewed with a structured questionnaire about their past and current musculoskeletal complaints. Thyroid dysfunction was considered the only explanation for the original musculoskeletal symptoms in 24 patients (Group I); in 19 patients an additional (rheumatological) diagnosis was made (Group II), and in 3 patients no apparent relation between musculoskeletal complaints and thyroid dysfunction was found. After treatment for thyroid dysfunction, the original complaints decreased in 52% and 47% of the patients in Group I and II, respectively. At the time of the follow-up study (mean follow-up duration 67 months) 91% of the patients had musculoskeletal symptoms, 80% of the patients said their present complaints were similar to their original symptoms. Treatment for thyroid dysfunction resulted in a temporary effect on musculoskeletal symptoms.

Adult↗
PubMed1993

Health status, adherence with health recommendations, self-efficacy and social support in patients with rheumatoid arthritis.

A study was performed in 86 patients with rheumatoid arthritis (RA) to assess their health problems, the problems they experience in adhering to health recommendations and the relationships of these problems with self-efficacy and social support. Feeling dependent, disability and pain were the most important health related problems. The results showed self-efficacy to be related to the subjective experience of health status as measured by DUTCH-AIMS. Social emotional support was not related to health status, and contrary to what we expected social instrumental support was positively related to health status. The majority of the patients (55%) experienced adherence problems with health recommendations. These problems were not related to functional incapacity, pain or other aspects of health status but to the patient's self-efficacy expectations about coping with arthritis. Our conclusion is that to improve the self-management of disability and pain and adherence to health recommendations, patient education should be aimed at strengthening self-efficacy expectations in which social emotional support might be a motivating factor.

Activities of Daily Living↗
PubMed1993

Measurement of functional ability and health status in the arthritic patient.

Chronic arthritis may have great impact on the patient but also on his or her family, relatives and friends. The assessment of the consequences of chronic arthritis and the effect of therapy not only in terms of physical, but also psychological and social dimensions deserves more attention. Functional ability and health status can be measured using a questionnaire or 'instrument', high-lighting important aspects not quantified with more traditional measurements. In this paper, arguments to apply such instruments more frequently are given. Health status instruments can be used not only to assess beneficial but also deleterious (side-) effects of therapeutic interventions. The properties are summarized of the most frequently used instruments assessing functional ability and health status. Many of these instruments have been evaluated sufficiently for validity and reliability; their sensitivity to detect change seems to be satisfactory. Therefore it is advisable to choose an internationally accepted, frequently used instrument, reflecting the area of interest.

Activities of Daily Living↗
PubMed1993

Group education for patients with rheumatoid arthritis.

Patients with rheumatoid arthritis must learn to adjust their exercise, rest and medication to the varying activity of the disease. Patient education can help patients in making the right decisions about adjustments in their treatment regimen and in attaining "self-management" behaviors. We developed a group education program based on social learning theory and the 'Arthritis Self-Management Course' developed in the USA by Lorig. Goal of the program is the strengthening of self-efficacy, outcome expectations and self-management behaviors of RA patients which may lead to better health status. The program has been evaluated in an experimental design. We established significant positive effects of the group training on functional disability, joint tenderness, practice of relaxation and physical exercises, self-management behavior, outcome expectations, self-efficacy function and knowledge. After 14 months we still found effects on practice of physical exercises, self-efficacy function and knowledge.

Adult↗
PubMed1992

[Only limited effect of treatment of thyroid gland diseases on symptoms of musculoskeletal system].

In order to assess the long term effect of treatment for thyroid dysfunction on musculoskeletal symptoms, 102 patients were traced by a computer search; these patients visited two outpatient clinics of rheumatology and were known to have thyroid disorders. Of these 102 patients, 58 patients met the study criteria of having abnormal thyroid function tests at first visit to the outpatient clinic; 46 patients participated in the study. They were interviewed with a structured questionnaire about their past and current musculoskeletal complaints. The 46 patients (45 females, 1 male) had a mean age at interview of 58 years (range 21-81); 37 and 9 patients had been treated for hypothyroidism and hyperthyroidism respectively. The thyroid dysfunction was considered the only explanation of the original musculoskeletal symptoms in 24 patients (group I), in 19 patients an additional (rheumatological) diagnosis was made (group II), and in 3 patients no apparent relation between musculoskeletal complaints and thyroid dysfunction was found. After treatment for thyroid dysfunction the original complaints decreased in 52% and 47% of the patients in group I and II, respectively. At the time of the follow-up study (mean follow-up duration 67 months) 91% of the patients had musculoskeletal symptoms, 80% of the patients said their present complaints were similar to their original symptoms. Treatment for thyroid dysfunction resulted in a temporary beneficial effect on musculoskeletal symptoms in 50% of the patients; in 91% symptoms persisted.

Adult↗
PubMed1992

The effect of local heat and cold therapy on the intraarticular and skin surface temperature of the knee.

OBJECTIVE: To evaluate the effects of local application of ice chips, ligno-paraffin, short-wave diathermy, and nitrogen-cold air on skin and intraarticular temperature. METHODS: Forty-two healthy subjects were divided into 4 treatment groups. A temperature probe was inserted into the knee joint cavity and another placed on the overlying skin, and changes in temperature over 3 hours, by treatment group, were recorded. RESULTS: The mean skin surface temperature dropped from 27.9 degrees C to 11.5 degrees C after application of ice chips, and from 28.8 degrees C to 13.8 degrees C after application of cold air. The mean intraarticular temperature decreased from 31.9 degrees C to 22.5 degrees C and from 32.9 degrees C to 28.8 degrees C, respectively, after these 2 treatments. Shortwave diathermy increased skin temperature by 2.4 degrees C; intraarticular temperature was increased only 1.4 degrees C by short-wave diathermy. Treatment with ligno-paraffin increased the skin surface temperature 8.9 degrees C; the temperature in the joint cavity was increased 3.5 degrees C. CONCLUSION: The use of short-wave diathermy and superficial heat packs in the treatment of patients with arthritis may potentially cause harm by increasing intraarticular temperature. This may have major implications regarding treatment policy for patients with arthritis.

Adult↗
PubMed1992

Bacterial arthritis in a district hospital.

Between 1977 and 1988 in the Enschede hospital 72 patients were seen with bacterial arthritis of one or more joints. Staphylococcus aureus was most frequently the causative agent (52%) and the knee was the most frequently infected joint (42%); the mortality rate was 11%. Complete restoration of pre-existent function was seen in 52% of the affected joints. In patients with severe deterioration of joint function after the bacterial infection, the period between the first symptoms and start of treatment (mean 30 days) was significantly longer than in patients with no or moderately deteriorated joint function (mean 10 days). The primary focus was mostly a skin infection, predominantly localized on the lower extremities. Half of all cases of bacterial arthritis occurred in patients with rheumatoid arthritis (RA). We therefore conclude that patients with RA and skin infections, especially if localized on legs or feet, should be treated without delay and that one should not hesitate to prescribe antibiotics. Erythrocyte sedimentation rate (ESR) was less than 20 mm after one hour in 13% and blood leucocyte count less than 10 x 10(9)/liter in 55% of all patients, showing that a normal ESR and/or blood leucocyte count do not exclude bacterial arthritis. In 4 out of 9 patients with infected prosthetic joints the infection resulted in loosening of the joint, before antibiotic treatment was started. In the other 5 patients bacterial arthritis recurred, in one patient resulting in loosening of the joint, only shortly after stopping long-term successful antibiotic treatment (6-24 months). Thus, we feel that lifelong treatment with antibiotics is a reasonable alternative in cases, where the risk of surgery is very high.

Adolescent↗