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R Rau

Publications and source records attributed to R Rau.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

[Development and evaluation of a modified version of the Larsen method for evaluating roentgenologic changes in chronic polyarthritis].

AIM OF THE STUDY: To develop and evaluate a modification of the Larsen scoring method aimed at a clear definition of the different grades and a better correlation of the numerical scale with the amount of joint destruction. DESCRIPTION OF THE METHOD: While the original method described by Larsen is based on a comparison with standard reference films the modification defines the different grades semiquantitatively by the amount of destruction of the joint surface: grade II is a destruction (erosion) of the joint surface of up to 25%, in grade III it is 26-50%, in grade IV 51-75% and in grade V over 75%. Grade I is characterized by soft tissue swelling and in addition subchondral osteoporosis and remains unchanged compared with the original method. 32 joints of the hands, wrists and forefeet are counted summing up to a total score of 0-160. Examples for different joints are given. EVALUATION OF THE METHOD: Standard ap-x-rays of hands, wrists and forefeet of 24 patients with early erosive rheumatoid arthritis at baseline (T0) and after 36 months (T1) were graded by two investigators (G.H. and R.R.). The difference of the scoring between both observers (inter-observer-difference) was related to the difference between the two timepoints (T0 and T1) in the same patient (intra-patient-difference) by means of a hierarchical analysis of variance (ANOVA). The intra-patient variance (from T0 to T1) was 259.3, which is 8 times greater than the inter-observer-variance of 32.1. The square root of intra-patient-standard deviation (16.1) and inter-observer-standard deviation (5.7) is 2.8. These data show that the progression between T0 and T1 is real. The method was easily applicable to patients in a 2-year-DMARD-trial with x-rays at baseline after 6, 12 and 24 months, showing a slowing of radiologic progression after month 6 under treatment with parenteral gold and methotrexate. CONCLUSION: The modification of Larsen's scoring method is a reliable measure to assess radiologic progression in patients with RA. Possibilities for further improvement are discussed.

Adult↗
PubMedDate not supplied

[The self-help groups' need for support as seen by the participants].

BACKGROUND: Since section 20(4) of the revised German Social Code Book V became effective in 2001, German statutory health insurance providers are obliged to support self-help groups (SHG) financially. Additionally, public health services in North Rhine-Westphalia have--according to the "Law for Public Health Services"--to establish district health conferences (DHC) designed to coordinate medical and social care. The DHC of the district of Wesel (population;500,000) decided to choose the "coordination of health-related SHG" as their first topic. In this framework the aim of the study was to quantify the need for development and promotion of health-related SHG from the perspective of SHG. METHODS: Collection of primary data in 120 SHG in the district of Wesel by a questionnaire with a return of 77 analysable answers (Rate 64 %). RESULTS: From the perspective of SHG in the district of Wesel a need for assistance/promotion exists primarily in: Training group leaders, chairman (55% of the entries), recruitment/placement of experts (53% of the entries, and public relation/"Advertisement" (52% of the entries. In the first place, a need for development is seen in an improvement of cooperation with the professional sector, especially with office-based physicians DISCUSSION/CONCLUSION: The results of this study quantify and specify SHGs' need for support on district level from the perspective of SHG. These results can be used for local public health policy and health planning.

Germany↗
PubMedDate not supplied

Combination DMARD treatment with parenteral gold and methotrexate.

INTRODUCTION: Both methotrexate (MTX) and gold sodium thiomalate (GSTM) have been shown to be very effective in the treatment of rheumatoid arthritis (RA) and to slow x-ray progression. The combination of both drugs could be useful because of their different and complimentary mechanisms of action. However, there is only one long-term study comparing this combination with MTX monotherapy. METHODS: In this prospective long-term observational study, all patients who started MTX treatment from 1980 to 1987 in one center were followed for 12-108 (mean 34.1) months. Ninety-seven patients were treated with MTX, while 126 patients received the combination MTX/GSTM, both drugs being given at the full dose. All patients had active disease, most of them long-lasting destructive RA not responsive to previous disease-modifying antirheumatic drug (DMARD) treatment. RESULTS: There were no significant differences in the demographic and baseline data between the two groups, with the exception of higher swollen joint counts (SJC) and C-reactive protein (CRP) in the combination group. In both groups the parameters of disease activity (erythrocyte sedimentation rate [ESR], CRP, SJC) improved significantly. A > 50% improvement in the SJC after 1 and 3 years was seen in 62% and 70% of patients in the MTX group, and in 55% and 85% of the patients in the combination group, respectively. A > 50% improvement in the ESR occurred in 54%/63% (MTX group) and in 49%/68% (combination group) for the same timepoints. There was no difference between the groups regarding the nature, frequency, or severity of side effects. A total of 20.6% (MTX) and 15.1% (combination) of patients were withdrawn for side effects. After 5 years, 54% of the patients in both groups were still being treated. CONCLUSION: This long-term observational study shows that the combination MTX/GSTM is well tolerated and is at least as effective as MTX single treatment. Taking into account the higher disease activity at baseline and the greater x-ray progression before baseline among the patients in the combination group, one may conclude that combination treatment is superior to monotherapy.

Antirheumatic Agents↗
PubMedDate not supplied

Seasonality of birth in nineteenth- and twentieth-century Austria.

We present an analysis of birth seasonality in nine geographical regions within Austria for two time periods, 1881-1912 and 1947-1959. In the early period, geography, climate, and agricultural patterns were related to birth seasonality. By the latter time period, these factors were no longer related to birth seasonality. We propose a "resilience hypothesis," which suggests two levels of causal influences on birth seasonality. First, underlying the three significant features of birth seasonality patterns around the world are only a small number of major causes. But, second, there are a multiplicity of minor causes that result in small perturbations in these otherwise resilient and consistent patterns.

Agriculture↗
PubMedDate not supplied

[Data of two years of the comparative study methotrexate/aurothiomalate in 102 patients].

UNLABELLED: 102 patients (pat.) with active erosive rheumatoid arthritis (RA) with a median disease duration of only 14 months without malalignment or deformities entered a randomized study to compare the effects of 15 mg methotrexate (MTX) and 50 mg gold sodium thiomalate (GST) administered intramuscularly once a week. The study was double blind during the first year and open during the second year. Clinical and laboratory evaluations were made every three months. X-rays of hands, wrists and forefeet in standard a.p.-projection were taken at month 0, 6, 12 and 24. 32 joints were evaluated according to Larsen. 17/52 (MTX) and 21/50 (GST) patients were withdrawn for several reasons. Withdrawals for toxicity were significantly more frequent in the GST group. 35 patients in the MTX group and 26 patients in the GST group were evaluated for efficacy. All clinical parameters, ESR and CRP improved by more than 50% in both groups without significant intergroup difference. The greatest improvement was seen already after six months. An > 50% improvement occurred in 57% of pat. in both groups. The Larsen score (sum of the Larsen grades of 32 joints) deteriorated significantly in both groups during the first six months (MTX = 3.0, GST = +4.3), it remained stable thereafter in the MTX group and decreased in the gold group. The number of erosive joints increased significantly in both groups during the first six months. This increase was slowed down after six months in the MTX group, in the gold group a decrease was seen indicating a healing of erosions. All differences between the groups were not significant, however. CONCLUSION: While tolerability was better with MTX, both drugs were similarly effective in the treatment of RA and slowed down radiologic progression.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Gamma-glutamyltranspeptidase in chronic polyarthritis. I. Comparison with a control group and relationship with alkaline phosphatase].

Gamma-GT, alcaline phosphatase and other parameters of abnormal liver functions were estimated in 54 consecutive in-patients having active RA but without a previous history or clinical signs of liver disease, and compared with a matched control group, suffering from degenerative rheumatic disease. There was a slight to moderate elevation of gamma-GT in 40.4% of the RA-patients (mean value 27.2 IU/l) and in 32.1% (mean value 22.3 IU/l) of the control group, respectively. The difference was not significant. Abnormal values in the control group occurred mainly in patients with peri-arthropathia of the shoulder, before mobilisation under anaethetic (3 of 5) and - coxarthrosis before total hip replacement (4 of 12). Alkaline phosphatase was elevated in 25.9% of the RA-patients (mean value 41.3 +/- 21.9 IU/l) and in 14.8% of the control group (mean value 34.3 +/- 15.9 IU/l). The difference was significant. There was a correlation between gamma-GT and alcaline phosphatase in the RA-group (r = 0.549, p less than 0.001) but not in the control group (r = 0.102). Abnormal values found in the control group were mainly found among patients with osteoporosis, following fractures, and coxarthrosis. The frequency of abnormal results and the value of the means increased with raising disease activity. Two groups of 30 and 32 patients, respectively, were examined at intervals of 2 or 4 weeks over a period of 6-10 and 18 months, respectively, and showed temporary elevations os gamma-GT in 3/4 of all patients, of GOT in 2/3 of alcaline phosphatase in 1/2 and of GPT in 1/3. Compared with other parameters of liver disease gamma-GT did not react in a different but in a more sensitive way. In our opinion it is the most sensitive indicator of reactive changes of the liver in RA.

Adult↗
PubMedDate not supplied

[Gamma-glutamyltranspeptidase in chronic polyarthritis. II. Influence of drugs].

Thirty outpatients with active RA were treated with Sudoxicam, a nonsteroidal antirheumatic drug, for periods of 6-10 months. Gamma-GT, alkaline phosphatase and transaminase were estimated at 2 week intervals. During treatment, the frequently elevated values showed a significant tendency towards normality (time trend analysis). During a second drug trial with Piroxicam in 32 RA outpatients over a period of 18 months, the mean value of gamma-GT and alkaline phosphatase did not decrease significantly. With regards to liver function tests, there was no significant difference between 19 patients receiving and 13 patients not receiving simultaneous gold therapy. During gold treatment periods of 26 patients with a total dose of 3.8 g Fosfocrisolo (0.8 g Au) the mean value of gamma-GT decreased from 26 to IU/l. Cyclophosphamide treatment of 13 patients, with daily doses of 50-150 mg to a total dose auf 48 g, had no significant influence on gamma-GT and alkaline phosphatase. Our results indicate that the very frequent elevations of gamma-GT and of other liver data in RA are caused by the rheumatoid process itself and not induced by drugs.

Alkaline Phosphatase↗
PubMedDate not supplied

Healing of erosive changes in rheumatoid arthritis.

This is an overview over the history and present state of knowledge of radiographic signs of erosion healing. The existence of healing or repair has been confirmed; different observers agree in the identification of healing; it may be identified without knowing the sequence of the films. As healing indicates that inflammation has discontinued for several months in an individual joint, it might represent a good additional outcome measure in RA clinical trials.

Arthritis, Juvenile↗
PubMedDate not supplied

Is remission in rheumatoid arthritis associated with radiographic healing?

The precondition for joint damage in rheumatoid arthritis (RA) is inflammation, and the precondition for healing is absence of inflammation. A systematic search for healing phenomena in RA patients in remission has not yet been undertaken. In reports of patients in whom healing was observed, clinical and laboratory data have not been published in part due to space restrictions. However, this preliminary review of the existing literature about repair supports the thesis that a strong association may exist between remission and repair. Several reports indicate that patients in whom radiographic repair was seen were in clinical remission. In most reports clinical response to treatment was very good, and in groups of patients in which scoring was done, evidence of repair was seen in patients with strong inhibition or halt of radiographic progression. In contrast, healing is unlikely to be detected in patients with persistent clinically active disease and/or moderate or strong radiographic progression. In most reports clinical response to treatment was very good, and in groups of patients in which scoring was done, evidence of repair was seen in patients with strong inhibition or halt of radiographic progression. In contrast, healing is unlikely to be detected in patients with persistent clinically active disease and/or moderate or strong radiographic progression.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Treatment with low-dose methotrexate in chronic polyarthritis. Review of the literature].

The therapeutic effect of low-dose MTX-treatment (10-25 mg/week) in active rheumatoid arthritis can be demonstrated by an improvement in clinical and laboratory parameters of disease activity already after 4-6 weeks. The mode of action is not fully understood. Direct anti-inflammatory effects seem to be more important than the weak immunosuppressive properties. Methotrexate treatment is indicated in all very active cases of rheumatoid arthritis, which do not respond to, or do not tolerate, conventional slow-acting antirheumatic drugs. In severe, rapidly progressing diseases MTX can be given without waiting for the effect of other disease modifying drugs. MTX is administered once a week i.v., i.m. or in one oral dose before breakfast. Absorption is reduced by food. The initial weekly dose is 15-25 mg and can be reduced to a minimum of 10 mg (7.5 mg) according to the clinical effect. A combination with antimalarials or gold salts is possible. The prescription of MTX is contraindicated in cases of renal function disturbances, active liver disease, bone marrow disturbances, active infectious diseases, pregnancy and excessive alcohol consumption. The most common side-effects are nausea and vomiting, stomatitis, transient elevations of transaminases. Rare conditions are leucopenia, thrombocytopenia and lung infiltrations. The side-effects are dose-related and disappear with dose reduction. They can be avoided by administering leucovorin 12 hours after giving MTX. Before starting the treatment total blood count with differential count and platelet count, serum creatinine and liver enzymes should be done. These laboratory studies have to be repeated every week for the first month, every two weeks up to the third month and every 1-2 months thereafter. When contraindications are considered and regular controls are made methotrexate is better tolerated than other cytotoxic agents. The rate of withdrawals is lower than with gold-treatment. In low-dose MTX-treatment drug interactions do not play a major role with normal renal function. Concomitant application of nonsteroidal antirheumatic drugs can delay MTX elimination and increase toxicity. We therefore avoid giving these drugs on the day of MTX-administration as far as possible.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Results of radiosynoviorthesis with yttrium 90 in chronic synovitis: a long-term prospective study. I. Total results and effect of local factors].

The purpose of the presented study was to investigate, whether the results of radiosynovectomy were dependent on different characteristics of the chronic synovitis. In our unit, from October 1978 to April 1981 193 joints--174 knee joints and 19 shoulder joints--of 107 patients underwent radiosynoviorthesis. 93 patients (169 joints) suffered from rheumatoid arthritis of different ARA-stages (I = 16, II = 31, III = 27, IV = 19; 67 seropositive, 26 seronegative), 14 patients with 24 treated joints had chronic synovitis other than rheumatoid arthritis. Only joints with chronic synovitis in the local stages I and II were treated if they did not respond to medical therapy and intraarticular applications of corticosteroids, respectively. Joints with local stage III and IV, respectively, with instability or with a secondary osteoarthrosis were excluded from radiosynovectomy. Every six months the patients were reinvestigated, and pain, swelling, mobility, stability of the joint, frequency of effusions and intraarticular steroid applications were assessed as well as the overall activity of the disease, SR, hemoglobin and effectivity of medical treatment. The overall result was good in 60% of cases after 6 and 12 months, respectively, in 54% of cases after 2 years and in 50% of cases after 3 years, it was fair in about 35% of cases. The results of 20 repeated radiosynovectomies were comparable. The frequency of joint effusions and of necessary intraarticular corticosteroid injections was significantly reduced even in patients showing a "poor" result of synoviorthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Results of radiosynoviorthesis with yttrium 90 in chronic synovitis: a long-term prospective study. II. Effect of general disease parameters].

The results of 193 Yttrium-90 synovectomies in 174 knee joints and 19 shoulder joints, mostly in patients with rheumatoid arthritis, were analysed statistically on the basis of 6 monthly reinvestigations up to a follow up of three years. The results were significantly better in stage I than in stages II-IV of rheumatoid arthritis, which did not differ between each other; they were better in patients with low than in those with high disease activity; the effectivity was better in patients who responded well to medical treatment than in those who responded badly. In the group with "good" results of Y-90 synovectomy a significant fall in sedimentation rate and significant rise of hemoglobin could be registered. On the other hand, there was no difference between seropositive and seronegative patients. In a number of joints the good result of radiation synovectomy was preserved even in patients with overall progression of the disease. Our results show that the results of radiation synovectomy as of all local treatments have to be regarded in relation to the general development of the disease.

Adult↗