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Biomedical subjects

J M Hazes

Publications and source records attributed to J M Hazes.

At least 73 records · Page 4Linked to original sources
PubMed1995

Discordance between objective and subjective assessment of functional ability of patients with rheumatoid arthritis.

The objectives were to investigate whether there is a discordance between observed and reported functional ability in patients with rheumatoid arthritis (RA) as measured by the Health Assessment Questionnaire (HAQ) and, if so, which demographic, clinical and psychological factors contribute to that discordance. Fifty-one consecutive RA patients of the out-patient clinic were included. Self-reported functional ability was compared with the observed performance of tasks as described by the HAQ. The amount of discordance was computed by subtracting reported scores from observed scores. A positive sign stands for overestimation of functional ability by the patient. The average amount of discordance was low, 0.09 (S.D. 0.39), but showed a large range: -0.88 to 1.00. Multiple regression analysis showed that male patients overestimate their functional ability by 0.21 HAQ units compared with female patients. RA patients overestimate their functional ability with increasing disease duration and severity, while RA patients in the early stage of the disease tend to underestimate their functional ability.

Activities of Daily Living↗
PubMed1995

Human leucocyte antigen phenotypes and gold-induced remissions in patients with rheumatoid arthritis.

To assess possible associations between human leucocyte antigens (HLA) and the achievement of remission during gold treatment, HLA typing was performed in 67 rheumatoid arthritis (RA) patients with a gold-induced remission and in 25 control RA patients who discontinued gold therapy because of lack of efficacy. Both groups of RA patients showed a significantly higher frequency of DR4 antigen and lower frequency of DR6 than a control population. There were no significant differences in HLA antigens between remission-responders and non-responders. It is concluded that HLA typing is not helpful in predicting the therapeutic response to parenteral gold therapy.

Adult↗
PubMed1995

In-patient treatment for active rheumatoid arthritis: clinical course and predictors of improvement.

The objective was to determine the clinical course and predictors of clinical response in patients with rheumatoid arthritis (RA) who are hospitalized for active disease and functional deterioration. Sixty-three patients who were admitted to a rheumatology clinic for multidisciplinary treatment were prospectively evaluated at 2-weekly intervals. During the admission period, which lasted for a mean of 47 +/- 24 days, patients improved significantly according to variables of disease activity, functional status and emotional status. The change in the variables appeared to be linear with time. Twenty-seven patients (43%) fulfilled the Paulus 20% criteria for clinical response during treatment. A long disease duration, a high Larsen erosion score, a high level of disease activity at admission and the institution of a disease-modifying anti-rheumatic drug within 3 months before admission were associated with a clinical response. In patients hospitalized for active disease, improvement appeared to be linear with time during admission. Patients with long-standing, destructive disease and a high level of disease activity improved most during hospitalization.

Adult↗
PubMed1994

Early agalactosylation of IgG is associated with a more progressive disease course in patients with rheumatoid arthritis: results of a follow-up study.

The clinical significance of the percentage agalactosyl IgG oligosaccharides [%G(O)] was investigated in serum of a well-characterized cohort of 127 female RA patients who were followed for a mean duration of 6 yr. The %G(O) was determined in the first available serum sample which was obtained at a mean of 3.4 yr after symptom onset. It could be shown that patients with a %G(O) more than 2 S.D. above the mean level of controls (n = 34), had significantly more erosions, disease activity, and were treated with more second-line drugs, than patients without an increased %G(O) (n = 93), both at the time the serum sample was obtained, and during follow-up. These findings suggest that G(O) may serve as an indicator for the disease course in patients with RA.

Adult↗
PubMed1994

Consistency of morning stiffness: an analysis of diary data.

This study aimed to determine the within-individual daily variation in morning stiffness (MS) of RA patients, and to validate the routine clinically derived duration of MS against that recorded prospectively by patients. Forty-nine RA patients, who during a detailed clinical interview reported experiencing MS that week were studied. They were asked to prospectively record, using a diary, daily information on the duration of their MS. The times both of waking and of getting up were noted, as well as the times to first improvement, maximum improvement and complete disappearance of MS, providing six possible estimates of MS duration, three of which, using waking as starting points, could be compared with the interview. The daily variation of MS was assessed by the within-patient range. The median duration of the diary scores was then compared with the MS estimates recorded at the interview. There was a large intra-individual variation in duration of MS, whichever of the six definitions were used. Half of the patients recorded ranges of MS scores of 3 h or more within the same week. There was also marked variation between the median diary derived duration and that ascertained by interview. This variation was at its smallest when the duration of MS was calculated as time until maximum improvement. The routine recording of the 'typical' duration of MS seems to have little clinical value in the face of the large within-patient variation. Of the possible choices for estimating duration, the time from waking to maximum improvement appeared to be the best indicator of the average duration of MS in RA patients.

Aged↗
PubMed1994

Sociodemographic factors and the outcome of rheumatoid arthritis in young women.

OBJECTIVE: To investigate the impact of sociodemographic factors on the outcome of rheumatoid arthritis (RA). METHODS: A group of 138 women with RA of recent onset and a mean duration of follow up of 5.8 years was studied. Additional information on sociodemographic variables at disease onset (level of formal education, marital status and employment status) was related to the initial disease severity and various outcome measures. RESULTS: Patients with lower levels of education showed a trend towards a worse outcome, according to Health Assessment Questionnaire (HAQ) score, erosion score and the patient's and physician's assessment of outcome at the last visit. However, we also found a trend towards an association between lower levels of education and more severe disease at onset, as measured by HAQ score, erosion score and the number of painful and swollen joints. The association between lower levels of education and poorer outcome of RA was weakened after correction for the initial disease severity. Results of other sociodemographic variables were equivocal. CONCLUSIONS: Differences in severity of RA between patients with different levels of education develop or are present in the early stages of the disease.

Adult↗
PubMed1994

Musculoskeletal disorders and disability in persons aged 85 and over: a community survey.

OBJECTIVES: To study the prevalences of musculoskeletal disorders and disability in the elderly, and the relationship between them. METHODS: A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal disorders were classified according to published clinical criteria. The relative effects on disability (a walking distance of < 500 m or dependency in activities of daily living (ADL)) of musculoskeletal disorders and comorbidity were analysed by logistic regression. RESULTS: Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints. A shoulder disorder was found in 27% of subjects, rheumatoid arthritis in 1% and osteoarthritis (OA) of the hand, hip, and knee in five, seven, and 18% of subjects, respectively. Disability was frequent: a walking distance of < 500 m was found in 60% and ADL dependency in 40% of the group. Factors related to one or both of these disability measures included female gender, hip and knee OA, impaired vision, cognitive impairment and neurological disease. CONCLUSION: Musculoskeletal pain and disorders, in addition to disability were frequent in this very elderly population. However, as a cause of disability, other disorders were at least as important as musculoskeletal disorders.

Aged↗
PubMed1994

Low prevalence of rheumatoid arthritis in black-Caribbeans compared with whites in inner city Manchester.

OBJECTIVE: To compare the prevalence of rheumatoid arthritis (RA) in Black-Caribbeans and Whites living in the same urban area. METHODS: Cases of inflammatory joint disease were ascertained initially from a postal screening survey of 1851 Black and 1829 age and sex-matched non-Blacks identified from general practice age-sex registers of seven general practices in the Moss Side and Hulme districts of Manchester. The ethnicity of respondents was confirmed using data from a postal screening questionnaire. Those reporting joint swelling or a history of arthritis were reviewed by a rheumatologist at surgeries held in each practice. The clinical records of the questionnaire non-responders and questionnaire-positive non-attenders at surgery were reviewed. RESULTS: In an adjusted denominator population of 1046 Black-Caribbeans and 997 Whites, the cumulative prevalence of RA was 2.9/1000 in Black-Caribbeans and 8/1000 in Whites, representing a prevalence in Black-Caribbeans of 0.36 times that found in Whites (95% confidence interval 0.1-1.3). CONCLUSIONS: Rheumatoid arthritis occurs less commonly in Black-Caribbeans than in Whites. The findings are consistent with published studies showing a low RA prevalence in rural African Black populations.

Adult↗
PubMed1994

The severity of rheumatoid arthritis: a 6-year followup study of younger women with symptoms of recent onset.

OBJECTIVE: In rheumatoid arthritis (RA), not only outcome measurements taken at a single point in time, but also the severity during the entire disease period is important. In this investigation we measured severity in terms of the course of disease activity. It is the activity of the disease which leads to most suffering in the patient, and which we try to alleviate. METHODS: Patterns of disease activity were investigated in 132 female patients who were followed yearly from an early phase of the disease for a mean duration of 6 years. RESULTS: Sixty-seven patients (50.8%) continuously had < or = 4 swollen joints (low activity), 23 patients (17.4%) continuously had > or = 4 swollen joints (high activity), in 10 patients (7.6%) disease activity decreased from high to low, in 8 patients (6.1%) disease activity increased from low to high, and 24 patients (18.2%) had fluctuating levels of disease activity. The outcome of the disease as measured by the functional ability, the radiological abnormalities, and number of prescribed 2nd line drugs, was best in patients with continuously low levels of disease activity, and worst in patients with continuously high or increasing levels of disease activity. CONCLUSION: For about half of the female patients presenting to a rheumatology outpatient clinic, the severity of RA after 6 years of disease duration is characterized by continuous but low disease activity, and sufficient preservation of functional ability. For the other half of the patients RA is a progressive and disabling disease.

Adult↗
PubMed1993

Evaluation of joint mobility in rheumatoid arthritis trials: the value of the EPM-range of motion scale.

OBJECTIVE: Evaluation of joint range of motion (ROM) is important in the therapeutic approach to patients with rheumatoid arthritis (RA). The reliability, construct validity and sensitivity to change of the Escola Paulista de Medicina (EPM)--range of motion scale that measures 10 distinct movements of small and large joints were examined. METHODS: Fifty patients with active RA who were participating in an inpatient multidisciplinary treatment program were examined by 2 investigators. Twenty-five of the patients were examined both at admission and at discharge from the hospital. RESULTS: The mean EPM-ROM score at study entry was 11.52 (SD +/- 3.80). The intra and inter-observer reliability of the EPM-ROM scale was high, with correlations of r = 0.91 and r = 0.85, respectively. There was a good correlation between the EPM-ROM scale and measures of functional ability. Correlations with measures of disease activity were poor. After a mean duration of the treatment program of 4.2 weeks, patients generally improved in variables of functional status and disease activity. The improvement of the EPM-ROM score (mean difference 1.58, 95% CI 0.84-2.32) was generally larger than improvement in other variables of functional status. CONCLUSION: The EPM-ROM scale is a reliable instrument, and according to its correlation with measures of functional status, relevant to the performance of activities of daily living. It showed a good response to improvement of functional status and disease activity and was more sensitive to changes than other variables of functional status.

Aged↗
PubMed1993

Factors predicting outcome of rheumatoid arthritis: results of a followup study.

OBJECTIVE: To determine prognostic factors in rheumatoid arthritis (RA). METHODS: One hundred thirty-two women with definite RA were followed yearly from an early phase of the disease (symptoms < 5 years) for a mean duration of 6 years. The prognostic value of the first available clinical and laboratory variables and assessments of functional ability was related to several outcome measures (physician's opinion of disease severity, disease activity, radiological abnormalities, functional ability and number of prescribed 2nd-line drugs) by single predictor analysis and by logistic regression. RESULTS: The variables most predictive for one or more of the outcome measures were number of swollen joints, Ritchie score, health assessment questionnaire score, radiographical abnormalities, positive IgM rheumatoid factor (RF), positive IgG-RF, HLA-DR4, and an elevated percentage serum agalactosyl IgG. The accuracy of predicting outcome was calculated from several combinations of these variables, and varied between 70 and 80%. The accuracy based on a combination of the commonly available variables (number of swollen joints, IgM-RF and the erosion score), closely approximated the maximal accuracy that could be achieved. CONCLUSION: The outcome of RA can be predicted by a combination of variables that are commonly available in the clinical setting.

Adult↗
PubMed1993

A reevaluation of the symptom of morning stiffness.

OBJECTIVE: To study, both qualitatively and quantitatively, morning stiffness in consecutive patients attending a rheumatology clinic. METHODS: A detailed interview from 93 patients with rheumatoid arthritis (RA) and 46 patients with noninflammatory joint disease. RESULTS: Occurrence, duration and severity of morning stiffness were similar in both groups, as was its detailed qualitative description. Patients with RA with active disease had higher severity scores of morning stiffness than those with inactive disease. CONCLUSION: Morning stiffness is a poor discriminator between RA and noninflammatory joint disease. Its assessment by a severity score is better than one based on duration.

Adult↗
PubMed1993

Which clinical variables contribute to the physician's assessment of medium term outcome in rheumatoid arthritis?

To investigate the clinical variables that contribute to the physician's opinion of the medium term outcome of rheumatoid arthritis (RA), we compared the physician's opinion with statistical modelling of these clinical variables. In 133 young female patients with RA followed yearly (mean followup duration 6 years) from symptom onset, the physician had to state whether the disease course was mild or progressive. Using logistic regression models we concluded that the physician's opinion could be explained by using a compilation of the erosion score, the number of swollen joints, the Ritchie score as measured at the latest visit, in combination with either the mean number of swollen joints during followup, or the number of prescribed second line drugs. Several different models with a common core were equally close to the physician's opinion.

Adult↗
PubMed1993

Outcome of rheumatoid arthritis in relation to age and rheumatoid factor at diagnosis.

Our retrospective followup study reports the outcome of rheumatoid arthritis (RA) in relation to age (under 60 vs 60 years and over) and rheumatoid factor status at diagnosis. A sample of 130 adult patients with RA was assessed at a mean of 5.6 years after diagnosis. At final evaluation disease activity and radiographic damage in seropositive patients were similar in both age groups, but functional capacity was markedly lower in the older onset group, indicating lower functional reserves in this group. In seronegative patients the outcome was favorable in both age groups, especially in the older patients. Seropositive patients in both age groups had more disease activity, a lower functional capacity and more radiographic damage than seronegative patients; these differences were greater in the older onset patients. The mortality in patients with RA compared to the general population (standardized mortality ratio, SMR) was higher in seropositive patients (SMR 2.78, 95% CI 1.70-4.13) but not in seronegative patients (SMR 0.45, 95% CI 0.08-1.13). The relative risk of dying was 6 times higher in seropositive patients than in seronegative patients (95% CI 1.7-20.9).

Aging↗
PubMed1992

Clinical significance of rheumatoid factors in early rheumatoid arthritis: results of a follow up study.

Serum rheumatoid factors (RF) were measured yearly in 135 women with rheumatoid arthritis by the Waaler-Rose and latex fixation tests and IgM, IgA, and IgG RF were measured by enzyme linked immunosorbent assays (ELISAs). The patients were followed up from an early phase of the disease for a mean duration of six years. Patients with a persistently positive RF test, irrespective of the type of test used, had more radiological abnormalities, more disease activity, worse functional ability, more extra-articular manifestations, and needed more treatment with second line drugs than patients with persistently negative or variably positive and negative test results during the follow up. Increased RF levels, especially a high level of IgA RF within three years of the onset of symptoms, was prognostic for a more severe disease outcome six years after the onset of symptoms.

Adult↗
PubMed1991

Association of HLA-DR4 with a more progressive disease course in patients with rheumatoid arthritis. Results of a followup study.

The association between HLA-DR antigens and rheumatoid arthritis (RA) was investigated in a well-characterized cohort of RA patients who were followed from the beginning of the disease (mean followup 6 years). The frequencies of HLA-DR antigens in patients with possible or probable RA (n = 49) were similar to those in controls. In patients with definite RA (n = 134), the frequencies of DR1, DR4, and DRw53 were increased, whereas the frequencies of DR2, DR3, DRw6, DRw13, and DRw52 were decreased, compared with controls. Comparison of HLA-DR frequencies in patients with definite RA subclassified according to the severity of the disease at the end of the followup period revealed a difference only in the frequency of DR4, which was increased in patients with progressive RA (59.2%) compared with those who had mild RA (34.8%). Further analysis showed that, compared with DR4-negative RA patients, DR4-positive patients had more swollen joints, higher scores on the Ritchie articular index, the Health Assessment Questionnaire, and the Steinbrocker functional classification, more radiologic abnormalities, and more use of second-line drugs. Also, the rate of progression of radiologic abnormalities, functional classification, and use of second-line drugs was higher in DR4-positive patients. We conclude that DR4 is associated with a more severe disease course, and is a prognostic marker in early RA.

Adult↗