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Biomedical subjects

L F Callahan

Publications and source records attributed to L F Callahan.

At least 73 records · Page 4Linked to original sources
PubMed1989

A simplified twenty-eight-joint quantitative articular index in rheumatoid arthritis.

We describe a joint index that includes only 28 joints: 10 proximal interphalangeal joints of the fingers, 10 metacarpophalangeal joints, and the wrists, elbows, shoulders, and knees. These joints are evaluated for swelling, tenderness, and limited motion, with the findings scored as abnormal or normal. The 28-joint index is considerably easier to use than traditional methods, and appears to yield as much information in terms of correlation with other measures of clinical status, including hand radiograph scores, American Rheumatism Association functional class, grip strength, walking time, and activities of daily living questionnaire scores (r = 0.25-0.53, P less than 0.001). Simplified joint counts might facilitate acquisition of quantitative articular data in research and clinical rheumatologic settings.

Arthritis, Rheumatoid↗
PubMed1989

Self-report questionnaires in five rheumatic diseases: comparisons of health status constructs and associations with formal education level.

Self-report questionnaire scales to assess various constructs of health status were compared in 602 patients with five rheumatic diseases, including 134 rheumatoid arthritis (RA), 216 osteoarthritis (OA), 84 fibromyalgia, 124 systemic lupus erythematosus (SLE), and 43 scleroderma patients. RA patients showed significantly higher degrees of difficulty, dissatisfaction, and pain in performing eight activities of daily living (ADL) compared to patients with the other four diseases (P less than 0.01), while SLE patients reported the least difficulty, dissatisfaction and pain. Fibromyalgia patients showed significantly higher scores on a visual analog pain scale than patients with the other four diseases (P less than 0.05), followed by OA patients. Fibromyalgia patients reported significantly higher levels of learned helplessness, assessed according to a rheumatology attitudes index (RAI), than patients with all other diseases, and scleroderma patients showed significantly lower RAI scores (P less than 0.05). Patients with all five diseases who had not completed high school showed poorer clinical status than patients who had completed high school on all six scales. Significant differences in questionnaire scores were seen for 24 of 30 comparisons (five diseases and six scales) according to formal education level, versus only two according to age, and none according to duration of disease.

Activities of Daily Living↗
PubMed1989

Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease.

Quantitative radiographic scores for joint space narrowing erosion, and malalignment in the hands and wrists of 200 patients with rheumatoid arthritis (RA) were significantly correlated with duration of disease. Nonetheless, most of the 42 patients who reported disease for less than 2 years had evidence of radiographic damage, including 35 with joint space narrowing, 28 with erosions but only one with malalignment. Significant radiographic damage in the absence of malalignment may be seen in many patients within the first 2 years after presentation of RA.

Age Factors↗
PubMed1989

Clinical use of multiple nonsteroidal antiinflammatory drug preparations within individual rheumatology private practices.

The clinical use of nonsteroidal antiinflammatory drugs (NSAID) was studied in 15 rheumatology private practices in the USA (in California, the District of Columbia, Florida, Idaho, Minnesota, Pennsylvania and Tennessee). Among 1,423 patients with rheumatoid arthritis (RA) under care in these 15 practices, the most extensively used NSAID preparation within any of the 15 individual practices was taken by a median of 19.5% of patients (mean 20.7%, range 8-36%), and the 3 most extensively used preparations by a median of 45.9% (mean 47.7%, range 34.7-63.5%). The median number of NSAID preparations used (singly) in each of the individual practices was 15 (range 8-20), including a median of 7 (range 4-10) used by more than 5% of the patients with each practice. The NSAID usage of these patients with RA seen in private practice settings was met by 8 preparations for 70%, by 10 preparations for 80%, and by 14 preparations for 90% of the 1,423 patients.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1988

Radiographic and joint count findings of the hand in rheumatoid arthritis. Related and unrelated findings.

Radiographic and physical joint count findings of the hands and wrists of 148 patients with rheumatoid arthritis (RA) were analyzed in a cross-sectional study. Quantitative radiographic scores for joint space narrowing, erosion, and malalignment were correlated highly with joint count scores for limitation of motion and deformity, and were correlated at considerably lower levels with joint swelling scores. Radiographic scores, however, were not correlated at all with joint count tenderness scores. That 2 of the most widely used indices of RA disease activity, radiographic erosion scores and joint count scores for tenderness, were independent of one another at a selected timepoint, should be considered in the design of clinical trials and long-term observation of patients with RA.

Arthritis, Rheumatoid↗
PubMed1988

In vitro rheumatoid factor synthesis in patients taking second-line drugs for rheumatoid arthritis. Independent associations with disease activity.

Rheumatoid arthritis (RA) patients whose unstimulated peripheral blood mononuclear cells produce high levels of IgM rheumatoid factor (IgM-RF) in vitro have more severe disease activity. RA patients being treated with second-line agents, including gold salts, penicillamine, or methotrexate, tend to be low producers or nonproducers of IgM-RF in vitro. The possibility that low production or nonproduction of IgM-RF in vitro may be explained by treatment with second-line agents alone, irrespective of disease activity, was analyzed in 133 RA patients whose disease status was assessed by multiple laboratory and clinical measures. The results indicate that treatment with second-line agents and in vitro IgM-RF synthesis are independently associated with disease activity.

Anti-Inflammatory Agents↗
PubMed1988

Formal education level as a significant marker of clinical status in rheumatoid arthritis.

Clinical status was assessed in 385 patients with rheumatoid arthritis, according to erythrocyte sedimentation rate, joint count, grip strength, walking time, and other quantitative measures. All measures indicated substantially poorer clinical status in patients who did not complete high school, compared with those who had completed high school. In general, the poorest results were seen in patients with only a grade school education. Progressively better results were seen in patients with some high school education, high school graduates, and patients with some college education. No differences in clinical status were seen among patients who had attended college, graduated from college, or had postgraduate education. Although patients seen at the Veterans Administration Medical Center had lower levels of formal education than those seen at a university clinic and private practices, trends in clinical status according to formal education level were similar in all three clinical settings. Differences in clinical status according to formal education level are not explained by age, sex, duration of disease, clinical setting, or multiple comparisons. Formal education level may identify an important marker of clinical status in rheumatoid arthritis.

Age Factors↗
PubMed1988

Associations of HLA-DR4 with rheumatoid factor and radiographic severity in rheumatoid arthritis.

Possible associations between HLA-DR4 and laboratory, radiographic, joint count, functional, and demographic measures of clinical status were analyzed in 154 white patients with rheumatoid arthritis. Overall, 65 percent of the patients were HLA-DR4 positive, similar to other series. HLA-DR4 was associated significantly with the presence of rheumatoid factor and more severe radiographic changes. HLA-DR4 was not associated with significant differences in demographic, joint count, or functional measures of clinical status. HLA-DR1 was not associated significantly with differences in the presence of rheumatoid factor, radiographic changes, or other measures of clinical status. Selective associations of HLA-DR4 with rheumatoid factor and radiographic scores were more marked in men than in women. Patients who were putatively homozygous for HLA-DR4 were all seropositive and had more severe radiographic changes than patients who were heterozygous for HLA-DR4.

Activities of Daily Living↗
PubMed1988

Further analysis of learned helplessness in rheumatoid arthritis using a "Rheumatology Attitudes Index".

A Rheumatology Attitudes Index (RAI) has been modified from the Arthritis Helplessness Index to assess the psychological construct of learned helplessness. The validity of the RAI was established in comparisons to the Arthritis Helplessness Index. The external criterion validity of the RAI was established by identification of statistically significant correlations between RAI scores and physical measures of disease status, including joint count, grip strength, walking time, and button test, as well as with questionnaire self-report scores for difficulty, dissatisfaction and pain in activities of daily living (ADL). Any variation in RAI scores which could be explained by available disease status measures was explained entirely by ADL self-report scores, with no additional explanation by traditional physical measures. Responses to individual RAI statements were significantly correlated with either questionnaire or physical measures of disease status for only 6 of the 15 RAI statements.

Activities of Daily Living↗
PubMed1987

Immunologic studies of rheumatoid arthritis patients treated with methotrexate.

Immunologic functions of peripheral blood mononuclear cells were studied in rheumatoid arthritis (RA) patients treated with methotrexate (MTX). Spontaneous IgM rheumatoid factor (IgM-RF) synthesis by unstimulated cultured blood mononuclear cells was seen in only 3 of 18 MTX-treated patients, compared with 31 of 54 RA patients who were not receiving long-acting drugs. Total IgM production by unstimulated cultured mononuclear cells, pokeweed mitogen-induced antibody synthesis, and plasma levels of IgM-RF were also lower in MTX-treated patients than in other RA patients. The numbers of circulating B cells, T4 and T8 cells, the T4:T8 cell ratio, and mitogen-induced proliferation indices were similar in MTX-treated and non-MTX-treated patients. Eleven additional patients were studied prospectively after initiation of MTX therapy. All showed significant decreases in spontaneous IgM-RF synthesis, with declining IgM-RF:IgM ratios, including all of the 9 who were studied during the first 24 hours of treatment. The results indicate that MTX has rapid effects on IgM-RF synthesis, and this action might be associated with its therapeutic efficacy in RA.

Arthritis, Rheumatoid↗
PubMed1987

Quantitative pain assessment for routine care of rheumatoid arthritis patients, using a pain scale based on activities of daily living and a visual analog pain scale.

Pain was assessed quantitatively as a component of routine visits of 385 outpatients with rheumatoid arthritis, using a pain scale based on activities of daily living (ADL) and a visual analog scale. The ADL pain scale met psychometric criteria for validity and reliability. Scores on the 2 pain scales were correlated significantly with one another and with other measures of disease status, including joint count, grip strength, walking time, button test, morning stiffness, erythrocyte sedimentation rate, global self-assessment, ADL difficulty, and ADL dissatisfaction scales. Correlations of ADL pain scale scores with other measures were higher than were correlations of visual analog scale scores with other measures, in both unadjusted and adjusted analyses. Significantly more patients completed the ADL pain scale without assistance than the number of those who completed the visual analog pain scale. The ADL pain scale was more sensitive to problems in ADL than were the ADL scales for difficulty and dissatisfaction. The ADL and visual analog pain scales appear to provide useful data for quantitative assessment of pain in the routine care of rheumatoid arthritis patients.

Activities of Daily Living↗
PubMed1987

Most chronic diseases are reported more frequently by individuals with fewer than 12 years of formal education in the age 18-64 United States population.

Data from the 1978 Social Security Survey of Disability and Work indicate that most chronic diseases in the age 18-64 population are reported significantly more frequently by individuals with fewer than 12 years of formal education. Of the 23 health conditions reported by more than 1% of the population, 19 differed significantly in reported frequencies according to formal educational level. The relative frequencies of any reported condition in individuals with 1-8, 9-11, 12 years, and more than 12 years of formal education, were 3.6, 2.3, 1.4 and 1.0 respectively. Significant trends according to formal educational level were seen for all types of chronic diseases, including cardiovascular, gastrointestinal, musculoskeletal, neoplastic, psychiatric, pulmonary and renal diseases. These trends remained significant for all categories except neoplastic disease when formal education was controlled for age, sex, race and smoking, suggesting that formal educational level may identify a marker in the pathobiology of disease of importance comparable to these other demographic variables.

Adolescent↗
PubMed1987

Observer variation in quantitative assessment of rheumatoid arthritis Part II. A simplified scoring system.

A new and more comprehensive simplified scoring system to provide quantitative assessment of radiographic findings in rheumatoid arthritis was studied by six observers with different levels of expertise. Since the observers, film set, and joints scored were the same as in a prior study of a more detailed scoring method, a precise comparison of the results was made. Interobserver variation with the simplified scoring system was small; there were highly significant correlations of the total radiographic scores for all observers (R = .898-.978, P less than .001). There were highly significant correlations between scores obtained with the simplified scoring system and those obtained with the more detailed method (R = .920-.955, P less than .001). When the same joints were evaluated by the two methods, a significantly greater number of possible observations could be scored with the simplified scoring system than with the more detailed method (X2 = 131.07, P less than .001). The simplified scoring system required 2.3 times less time to use in the hands of experienced observers.

Arthritis, Rheumatoid↗
PubMed1987

Rheumatoid arthritis: explanatory power of specific radiographic findings for patient clinical status.

Radiographs of the hands and wrists of 201 patients with rheumatoid arthritis (RA) were scored for erosion, joint space narrowing, and malalignment. The explanatory power of these findings for measures of clinical status was studied with stepwise multiple linear regression analyses. Radiographic scores explained 59.2% of variation in physical joint count deformity scores, 58.5% of variation in limited motion scores, 22.5% of variation in grip strength scores, 20.5% of variation in button test scores, and 13.5% of variation for the American Rheumatism Association (ARA) Functional Class. Malalignment scores best explained variation in physical deformity, limited motion, and button test scores; joint-space-narrowing scores best explained variation in grip strength; erosion scores best explained variation in ARA Functional Class. When age, duration of disease, erythrocyte sedimentation rate, and rheumatoid factor titer were included in the regression analyses, results were similar to those without these variables. Therefore quantitative scores of specific radiographic findings are in themselves explanatory for measures of clinical status.

Arthritis, Rheumatoid↗
PubMed1987

Bony ankylosis in rheumatoid arthritis. Associations with longer duration and greater severity of disease.

Hand and wrist radiographs of 203 patients with rheumatoid arthritis were examined for bony ankylosis. Forty-eight patients (23.6%) showed ankylosis, including 34 with more than one joint fused. The distribution of ankylosed joints was 32.4% midcarpal, 29.5% common carpometacarpal, 15.8% radiocarpal, 15.8% proximal interphalangeal, and 6.5% metacarpophalangeal. Patients with ankylosis had significantly higher radiographic erosion, joint space narrowing, and malalignment scores than those without ankylosis (all P less than .001). Patients with ankylosis had significantly longer duration of disease (P less than .001) and physical examinations showed more limited motion and deformity (both P less than .001). More patients with ankylosis had subcutaneous nodules (P less than .05). Functional testing with grip strength and the button test revealed poorer performance in patients with ankylosis (both P less than .001). Questionnaires revealed patients with ankylosis had more difficulty with activities of daily living (P less than .001) and had more limited activity (P less than .01); physicians estimated more limited functional capacity (P less than .001). Thus, radiographic bony ankylosis was a relatively common feature of rheumatoid arthritis, and a marker of patients whose disease was clinically, radiographically, and functionally more severe.

Age Factors↗
PubMed1987

Questionnaire, walking time and button test measures of functional capacity as predictive markers for mortality in rheumatoid arthritis.

Mortality over 9 years in rheumatoid arthritis was studied according to baseline demographic, disease, therapy and comorbidity variables, and measures of functional capacity variables. Significant differences between patients who survived and died over the next 9 years were seen for 8 variables: age, joint count, oral corticosteroid use, presence of concurrent heart disease, formal educational level, and 3 quantitative measures of functional capacity, questionnaire responses regarding activities of daily living, modified walking time and the button test. Five-year survivals of 50% or less were seen in patients with severely dysfunctional values for the 3 quantitative measures of functional capacity. Increased relative risk of mortality according to functional capacity measures was not explained by age, sex, duration of disease, smoking history, joint count, hand radiograph score, grip strength, morning stiffness, formal educational level, oral corticosteroid or parenteral gold use, or various comorbidities, and was not expected by a majority of physicians.

Actuarial Analysis↗