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P S Helliwell

Publications and source records attributed to P S Helliwell.

At least 19 recordsLinked to original sources
PubMed2006

Polyarticular psoriatic arthritis is more like oligoarticular psoriatic arthritis, than rheumatoid arthritis.

BACKGROUND: and objective: Since the original description of psoriatic arthritis (PsA) subgroups by Moll and Wright, there has been some discrepancy in the precise prevalence of the different subgroups and in particular the proportion of patients with polyarthritis. The higher prevalence of the polyarthritis subgroup may be due to the inclusion of patients with seronegative rheumatoid arthritis with coincidental psoriasis. The classification of psoriatic arthritis (CASPAR) study database provided an opportunity to examine this question. METHODS: The CASPAR study collected clinical, radiological and laboratory data on 588 patients with physician-diagnosed PsA and 525 controls with other inflammatory arthritis, 70% of whom had rheumatoid arthritis. Patients with PsA were divided into two groups: polyarthritis and non-polyarthritis (which included the Moll and Wright subgroups of spinal disease, distal interphalangeal predominant and arthritis mutilans) and were compared with patients with rheumatoid arthritis. Comparisons were made between all three groups and, if a significant difference occurred, between the two groups with PsA. RESULTS: The three groups differed significantly with regard to all clinical and laboratory variables except duration of disease. Significant differences were also found between the two groups of PsA in terms of age, sex, total number of involved joints, disability score and symmetry. However, no differences were found between the groups of patients with PsA in terms of seropositivity for rheumatoid factor and antibodies to cyclic citrullinated peptide, enthesitis, and spinal pain and stiffness. Further, dactylitis was commonly seen in patients with PsA (57% in the polyarticular group and 45% in non-polyarticular group), and uncommonly found in patients with rheumatoid arthritis (5%). With the exception of entheseal changes, syndesmophytes and osteolysis, typical radiological features of PsA could not be used to distinguish between the PsA subgroups. CONCLUSIONS: The evidence suggests that the changing prevalence of the polyarticular subgroup of PsA is not because doctors include patients with seronegative rheumatoid arthritis with coincidental psoriasis.

Arthritis↗
PubMed2005

Provision of foot health services in rheumatology in the UK.

OBJECTIVES: To determine the provision of foot health services in rheumatology for the UK and Northern Ireland. METHODS: Two hundred and sixteen rheumatology departments were surveyed by postal questionnaire. Questions covered the contribution of various disciplines to rheumatology out-patient clinics, and opinions on existing and potential services, with emphasis on foot health provision. Inter-regional variations were explored for eight UK regions. RESULTS: Valid responses were received from 170 respondents (78.7% response rate). More than 80% of out-patient departments reported having rheumatology nurse specialists included in the staff mix but fewer than half used other allied health professionals, such as podiatrists. One quarter of the departments had access to a podiatrist and in 18% there was a foot health service dedicated to rheumatology. Awareness of guidelines for referral or of standards of foot care provision was very low (6%). There was high satisfaction with the adequacy of provision of footwear and insoles (81-87%) but low satisfaction with the adequacy of basic foot care (48-52%). Regional variation was extremely high for the provision of basic foot care (0-73%), the non-English regions reporting poorer provision of service. CONCLUSIONS: Regional variation in the adequacy of foot health services was high and the non-English regions especially are failing to meet the foot health needs of rheumatology patients. Multidisciplinary care is generally well developed despite the composition of teams being highly variable. Fewer than half of rheumatologists reported that basic foot care needs were being met, although adequacy of provision of more advanced foot services is perceived to be better. The absence of nationally agreed standards and poor awareness of local standards may be detrimental to care in this patient group.

Cross-Sectional Studies↗
PubMed2005

A novel device for the measurement of proprioception in the hand.

BACKGROUND: Together with visual information, awareness of limb position and movement is essential for limb coordination. A proprioceptive deficit has been demonstrated in a number of rheumatological disorders. There is a lack of a portable device for measuring hand proprioception in the field. METHODS: A compact portable device for measuring joint position sense in the metacarpophalangeal joint of the index finger of either hand was constructed. This device was manually operated and required the subject to match the position of the hidden finger with a surface-mounted silhouette. Reliability studies were performed over three consecutive days in 12 normal volunteers. RESULTS: Intrasubject variability [95% confidence interval (CI)] was 0.86 degrees (0.04-1.76) between days 1 and 2, and 1.23 degrees (1.04-3.50) between days 2 and 3. The intraclass correlation coefficient (95% CI) between all 3 days was 0.92 (0.85-0.96). Average proprioceptive error (95% CI) in the sample population was 5.72 degrees (1.23-10.2) over the 3 days. This value was 5.94 degrees , 5.79 degrees and 5.42 degrees on days 1, 2 and 3, respectively. No difference was found between sexes but dominant hands gave smaller errors (mean dominant error 5.11 degrees , mean non-dominant error 6.35 degrees ; t = -3.4, P = 0.002). CONCLUSIONS: This report describes a new portable device for measuring proprioception in the hand. Reproducibility was shown to be good on an individual and group basis. These results are promising and warrant larger age- and sex-related studies. The ease and portability of the device make it ideal for use in epidemiological studies of rheumatological disorders involving the hands, including joint hypermobility.

Adult↗
PubMed2005

Psoriatic arthritis clinical registries and genomics.

To understand better a complex disease such as psoriatic arthritis (PsA), collection of a large amount of information on clinical, laboratory, and radiological features is required over an extended period of time. Longitudinal data can be effectively collected and stored in clinical registries and databases. This article reviews current databases in PsA and proposes a structure for an international PsA registry. Careful collection and analysis of patient data through collaborative efforts will likely advance our knowledge of pathogenesis and provide new and much needed insights about the course and prognosis of the disease.

Arthritis, Psoriatic↗
PubMed2005

Classification and diagnostic criteria for psoriatic arthritis.

BACKGROUND: The study of psoriatic arthritis is difficult and has lagged behind the study of other arthropathies in that there are no universally agreed or properly validated case definitions. METHOD: This paper examined the validity and practicality of the original Moll and Wright criteria and subsequent criteria sets. Key features discriminating between psoriatic and other arthropathies were reviewed. A comparative study involving patients with psoriatic arthritis and rheumatoid arthritis was used to contrast the different classification methods. RESULTS: Although the Moll and Wright criteria continue to be widely used, they have been shown to discriminate poorly between psoriatic and rheumatoid arthritis. In comparison, the most sensitive criteria were those of Vasey and Espinoza, McGonagle et al, and Gladman et al (99%), whereas the others were significantly less sensitive (between 56% and 94%). The specificity of all methods was high and statistically similar (between 93% and 99%). Models that had reasonably good accuracy even without such key variables as psoriasis or rheumatoid factor were developed. Spinal involvement continues to be a key feature of psoriatic arthritis, but dissimilarities with classic ankylosing spondylitis have been highlighted. CONCLUSIONS: Further work is required to produce classification criteria for psoriatic arthritis. A prospective study collecting clinical, radiological, human leucocyte antigen (HLA) and immunological data from both psoriatic and non-psoriatic cases should provide agreed criteria for use in psoriatic arthritis studies in the future.

Arthritis, Psoriatic↗
PubMed2004

Debridement of plantar callosities in rheumatoid arthritis: a randomized controlled trial.

OBJECTIVE: To compare forefoot pain, pressure and function before and after normal and sham callus treatment in rheumatoid arthritis (RA). PATIENTS AND METHODS: Thirty-eight RA patients were randomly assigned to normal (NCT group) or sham (SCT) scalpel debridement. The sham procedure comprised blunt-edged scalpel paring of the callus which delivered a physical stimulus but left the hyperkeratotic tissue intact, the procedure being partially obscured from the patient. Forefoot pain was assessed using a 100 mm visual analogue scale (VAS), pressure using a high-resolution foot pressure scanner and function using the spatial-temporal gait parameters measured on an instrumented walkway. Radiographic scores of joint erosion were obtained for metatarsophalangeal (MTP) joints with and without overlying callosities. The trial consisted of a randomized sham-controlled phase evaluating the immediate same-day treatment effect and an unblinded 4-week follow-up phase. RESULTS: During the sham-controlled phase, forefoot pain improved in both groups by only 3 points on a VAS and no statistically significant between-group difference was found (P = 0.48). When data were pooled during the unblinded phase, the improvement in forefoot pain reached a peak after 2 days and gradually lessened over the next 28 days. Following debridement, peak pressures at the callus sites decreased in the NCT group and increased in the SCT group, but there was no statistically significant between-group difference (P = 0.16). The area of and duration of contact of the callus site on the ground remained unchanged following treatment in both groups. Following debridement, walking speed was increased, the stride-length was longer and the double-support time shorter in both groups; however, between-group differences did not reach levels of statistical significance. MTP joints with overlying callus were significantly more eroded than those without (P = 0.02). CONCLUSIONS: Treatment of painful plantar callosities in RA using scalpel debridement lessened forefoot pain but the effect was no greater than sham treatment. Localized pressure or gait function was not significantly improved following treatment.

Adult↗
PubMed2004

Repetitive strain injury.

Pain in the forearm is relatively common in the community. In the workplace forearm pain is associated with work involving frequent repetition, high forces, and prolonged abnormal postures. Nevertheless, other factors are involved in the presentation and the continuation of the pain. Notable among these factors are psychosocial issues and the workplace environment-the attitude to workers and their welfare, the physical conditions, and design of the job. Primary prevention may be effective but active surveillance is important with early intervention and an active management approach. Physical treatments have not been extensively evaluated. In the established case, management should be multidisciplinary, addressing physical aspects of the job but also addressing the "yellow, blue, and black flags" which should be viewed as obstacles to recovery. For the worker "on sick" a dialogue should be established between the worker, the primary care physician, and the workplace. Return to work should be encouraged and facilitated by medical interventions and light duty options. Rehabilitation programmes may be of use in chronic cases.

Attitude to Health↗
PubMed2003

Ethnic differences in responses to disease modifying drugs.

BACKGROUND AND OBJECTIVE: The UK has a growing South Asian population. In the South Asian population of Bradford people appear to be less tolerant of disease-modifying anti-rheumatic drugs (DMARDs). One reason for this may be poor communication during patient education, which is generally designed for white North European people. Our objective was to obtain information on DMARDs that were used, the duration of their use and reasons for their discontinuation between ethnic groups. METHODS: Retrospective data were obtained from the inception of a clinical database in August 1993 to July 2001 using 'DMARD' as the main search item; a total of 5479 DMARD prescriptions were represented in the data. A subset of the data so obtained was cross-checked against the patient records. Inaccuracies in start and stop dates prior to January 1997, together with other reasons (such as incomplete data), resulted in a final data set of 2356 drugs. The drugs had been given to 1391 patients. Overwhelmingly, the two main ethnic groups were North European (1191 patients) and South Asian (193 patients). RESULTS: The final data set was based on the following drugs: azathioprine (179); antimalarials (chloroquine and hydroxychloroquine) (407); corticosteroids (648); D-penicillamine (61); methotrexate (459); sulphasalazine (493); and sodium aurothiomalate (96). Survival analysis showed that age and drug type were important variables influencing the duration of time spent on a drug before discontinuation. For age, drug survival was better for the older age group [log rank test, chi2(3) = 29.1, P < 0.0001]. For drug, survival was best for steroids, followed in decreasing order by sulphasalazine, methotrexate, sodium aurothiomalate, azathioprine, antimalarials and D-penicillamine [chi2(6) = 99.3, P < 0.00001). For all drugs, the main ethnic groups differed, with a 12-month survival rate of drugs in the North European group of 0.742 (95% confidence interval 0.693-0.791) and the South Asian group of 0.665 (95% confidence interval 0.645-0.684) [log rank test, chi2(1) = 18.19, P < 0.00001]. As the two main ethnic groups differed with respect to age and drug type, further survival analysis adjusting for these variables confirmed a significant difference between the two ethnic groups. The main reasons for terminating the DMARD differed between the groups: people of South Asian origin were more likely to discontinue the drug because of rashes, lack of efficacy and worry about the potential side-effects of the drug. CONCLUSIONS: People of South Asian ethnic status terminate DMARD therapy sooner than North Europeans. The reasons for this difference are not clear but may concern problems with effective communication, cultural differences in attitudes to chronic illness or genetic polymorphisms in drug metabolism.

Adolescent↗
PubMed2003

Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis.

BACKGROUND: Although disease-specific health status measures are available for ankylosing spondylitis (AS), no instrument exists for assessing quality of life (QoL) in the condition. OBJECTIVE: To produce an AS-specific QoL measure that would be relevant and acceptable to respondents, valid, and reliable. METHODS: The ASQoL employs the needs-based model of QoL and was developed in parallel in the UK and the Netherlands (NL). Content was derived from interviews with patients in each country. Face and content validity were assessed through patient field test interviews (UK and NL). A postal survey in the UK produced a more efficient version of the ASQoL, which was tested for scaling properties, reliability, internal consistency, and validity in a further postal survey in each country. RESULTS: A 41 item questionnaire was derived from interview transcripts. Field testing interviews confirmed acceptability. Rasch analysis of data from the first survey (n=121) produced a 26 item questionnaire. Rasch analysis of data from the second survey (UK: n=164; NL: n=154) showed some item misfit, but showed that items formed a hierarchical order and were stable over time. Problematic items were removed giving an 18 item scale. Both language versions had excellent internal consistency (alpha=0.89-0.91), test-retest reliability (r(s)=0.92 UK and r(s)=0.91 NL), and validity. CONCLUSIONS: The ASQoL provides a valuable tool for assessing the impact of interventions for AS and for evaluating models of service delivery. It is well accepted by patients, taking about four minutes to complete, and has excellent scaling and psychometric properties.

Adult↗
PubMed2002

Three-dimensional kinematics at the ankle joint complex in rheumatoid arthritis patients with painful valgus deformity of the rearfoot.

OBJECTIVE: To evaluate the three-dimensional (3D) kinematics of the ankle joint complex (AJC) in rheumatoid arthritis (RA) patients with painful valgus deformity of the rearfoot. METHODS: Fifty patients with RA underwent gait analysis using electromagnetic tracking techniques to measure 3D kinematics at the AJC under barefoot and shod walking conditions. Three axial rotations (dorsiflexion/plantarflexion, inversion/eversion and internal/external rotation) were measured during the gait cycle, and the angular positions at key gait events, range of motion and the motion: time integral were measured. Descriptive and analytical comparisons were made with normative data derived from a sex- and age-matched population (n=45). RESULTS: AJC dysfunction in RA was characterized by excessive eversion motion (within an eversion range) and no inversion motion through the neutral joint position for the subtalar component of the joint complex, in both barefoot and shod walking conditions. Motion was coupled such that internal rotation of the leg relative to the rearfoot was greater than normal. AJC motion was different for all rotations between barefoot and shod conditions, but in both situations there were statistically significant between-group differences in the motion:time integral for inversion/eversion (barefoot, P<0.0001; shod, P<0.0001) and external/internal rotation (barefoot, P<0.0001; shod, P<0.0001). There were no statistically significant differences between RA and normative data for dorsiflexion/plantarflexion motion under barefoot (P=0.16) and shod (P=0.50) walking conditions. CONCLUSION: Painful valgus deformity of the rearfoot is associated with changes in the 3D kinematics affecting eversion at the AJC and internal rotation of the leg, both when walking barefoot and in shoes.

Adult↗
PubMed2001

Evaluating the cutaneous involvement in scleroderma: torsional stiffness revisited.

OBJECTIVE: The pace, progression and extent of the skin lesions in scleroderma may parallel the risk of new internal organ involvement and the progression of existing internal lesions. Accurate assessment of cutaneous change permits an evaluation of patient prognosis and the response to therapy. The aim of this study was to assess a simple device for measuring skin stiffness for its ability to measure sclerodermatous skin in a quantitative and reproducible manner. Materials and methods. Torsional skin stiffness was measured in 56 normal subjects and 42 scleroderma patients (31 of whom had the limited form and nine the diffuse form, and two had mixed connective tissue disease). Data for the scleroderma patients were compared with data obtained by the use of the modified Rodnan clinical skin scoring technique. Intraclass correlation coefficients (ICCs) were calculated as a measure of intraobserver and interobserver variability. RESULTS: For the left and right hands respectively, the ICCs for intraobserver variability were 0.908 and 0.906 and those for interobserver variability were 0.871 and 0.628. There was a significant difference in mean angular rotation obtained by normal subjects compared with scleroderma patients (15.1 vs 11.3 degrees, P<0.001). There was a significant difference in the angular rotation with increasing severity of skin involvement (skin score 0, median rotation 16.3 degrees; score 1, 10.5 degrees; score 2, 8.5 degrees; score 3, 8.0 degrees; P<0.00001). CONCLUSIONS: The measurements obtained with the skin stiffness device are highly reproducible and are consistent with the current clinical method of assessment of skin involvement. The significant difference in angular rotation obtained by normal subjects and scleroderma patients indicates that the device can distinguish normal from sclerodermatous skin. The torsional stiffness measurements derived from the device may also be useful in longitudinal studies.

Adult↗
PubMed2001

Comparison of disability and quality of life in rheumatoid and psoriatic arthritis.

OBJECTIVE: There is controversy about the severity of peripheral psoriatic arthritis (PsA) compared to rheumatoid arthritis (RA). Early reports found PsA to be a milder disorder, excepting the mutilans form. Recent reports suggest that PsA can be as severe as RA. We compared severity, disability, and quality of life in patients with PsA and RA matched primarily for disease duration. METHODS: Data relating to the extent and severity of disease were recorded in a hospital clinic setting. Recent radiographs of hands and feet were read blinded to diagnosis, and information on function and quality of life was collected with the Health Assessment Questionnaire (HAQ) and EuroQol-5D, respectively. RESULTS: Forty-seven patients were matched for disease duration (median PsA 5 yrs, RA 7 yrs). The male/female ratio was 24/23 for PsA, 16/31 for RA, and median ages were 45 and 51 years, respectively. Patients with RA had significantly more joint involvement of metacarpophalangeal joints and wrists, whereas distal interphalangeal joints, spine, sternoclavicular joints, and sacroiliac joints were significantly more involved in PsA. No difference was found regarding Ritchie Articular Index, inflammatory markers, HAQ score, or EuroQol-5D. Patients with RA had significantly more damage on radiographs of hands and feet: median (range) Larsen score hands PsA 8 (0-91), RA 38 (0-125); feet PsA 4 (0-34), RA 11(0-56). Patients with RA were taking significantly more disease modifying drugs. CONCLUSION: Peripheral joint damage is significantly greater in RA than in PsA after equivalent disease duration, but function and quality of life scores are the same for both groups. The additional burden of skin disease in PsA may account for this.

Adolescent↗
PubMed2000

Joint symmetry in early and late rheumatoid and psoriatic arthritis: comparison with a mathematical model.

OBJECTIVE: To establish a mathematical model to predict the probability of symmetry of joint involvement as a function of the number of joints involved and to compare expected with actual probabilities in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) and in early and late disease. METHODS: Random involvement of joints was assumed, and the binomial theorem was used to give the frequency distribution of involved joints as a function of each joint count. Ten joint pairs were included: shoulder, elbow, wrist, metacarpophalangeal joints, proximal interphalangeal (PIP) joints of the hands, hip, knee, ankle, metatarsophalangeal joints, and PIP joints of the feet. Observed probabilities were obtained from subjects with early (duration < or =12 months) and late PsA and RA. RESULTS: The number of subjects in each of the disease subgroups was as follows: early PsA n = 33, late PsA n = 77, early RA n = 61, late RA n = 93. Observed probabilities of symmetry exceeded predicted probabilities for all disease subgroups. The median number of involved joints in each group was as follows: early PsA 4, late PsA 8, early RA 8, late RA 15 (chi2 = 95.3, 3 degrees of freedom, P = 0.0001, by Kruskal-Wallis test). After correcting for the discrepancy in the number of involved joints, no difference in joint symmetry was found between the groups (chi2 = 1.77, P = 0.62 by Friedman two-way analysis of variance). Similar results were obtained when individual hand and foot joints were analyzed separately. CONCLUSION: The pattern of joint involvement is often used to distinguish between rheumatoid and psoriatic arthritis. This study confirms that symmetry is largely a function of the total number of joints involved and that, in terms of joint pattern, differences between these disorders are more quantitative than qualitative. Both disorders have high absolute values of symmetry, particularly in the joints of the wrist and hand.

Adolescent↗
PubMed2000

Preliminary investigation of debridement of plantar callosities in rheumatoid arthritis.

OBJECTIVE: To determine the effect of expert debridement of foot callosities on forefoot pain and plantar pressure distribution in rheumatoid arthritis (RA). METHODS: Plantar callosities on 14 feet of eight RA patients were debrided by a single podiatrist. Measurements of subjective pain severity in the forefoot and global arthritis pain were undertaken using a visual analogue scale, repeated at 7-day intervals to the next treatment (28 days). Plantar pressures were recorded at the lesion sites using an in-shoe flexible transducer insole before and after lesion debridement. RESULTS: Following debridement, all patients reported symptomatic relief with an average change in pain score of 48% (P = 0.01) but the treatment effect was lost by 7 days. Immediately following scalpel debridement, peak pressures were elevated in 10 of 14 feet, whilst contact time was reduced and peak force increased. None, however, reached statistical significance. CONCLUSION: Scalpel debridement of forefoot plantar callosities reduces forefoot pain for about 7 days, but pressure distribution is not significantly altered.

Aged↗