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Biomedical subjects

T Pincus

Publications and source records attributed to T Pincus.

At least 127 records · Page 7Linked to original sources
PubMed1992

Quantitative measures to assess, monitor and predict morbidity and mortality in rheumatoid arthritis.

The use of quantitative measures to analyse the long-term course of RA appears to have provided new insights into the severe morbidity and increased mortality rates of this disease. Quantitative assessment of RA may be viewed as an expression of clinical rheumatology as a quantitative science designed to assess accurately the long-term course of disease. The description of the joint count, radiographic scores, laboratory tests, questionnaire measures and physical measures of functional status, as well as the importance of socio-economic status, may provide new insights into the pathogenesis, prevalence, morbidity and mortality of RA.

Activities of Daily Living↗
PubMed1992

Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: I. Nonsteroidal antiinflammatory drugs.

The probability of continuation of a particular nonsteroidal antiinflammatory drug (NSAID) over 5 years was estimated for 1,775 courses taken by 532 patients with rheumatoid arthritis treated in 7 rheumatology private practices. Similar results were seen for 15 different NSAID--48% of courses were continued at 12 months, 36% at 24 months, and 20% at 60 months. Only acetylated salicylates, other than plain aspirin, were continued significantly longer than any of the other NSAID. The probability of continuation of plain aspirin was similar to other NSAID, including nonacetylated salicylates and nonsalicylate NSAID. The first NSAID taken by an individual patient was continued only marginally longer than the 4th NSAID taken by the same patient. While most NSAID courses were not continued for long periods, 20% were continued for longer than 5 years, suggesting effective longterm results in this minority of courses.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: II. Second line drugs and prednisone.

The probability of continuation of 1,077 courses of 2nd line drugs taken by 532 patients with rheumatoid arthritis treated in 7 rheumatology private practices was examined. This probability was that 50% of courses were continued over 10 months for oral gold, 20 months for hydroxychloroquine, 21 months for penicillamine, 25 months for parenteral gold, 27 months for azathioprine, and more than 60 months for methotrexate (MTX). MTX and prednisone were the only drugs continued by more than 50% of patients after 60 months, while about 20% of courses of other 2nd line drugs other than oral gold were estimated to be continued at 60 months. Estimated drug continuation did not differ significantly according to age, duration of disease, or whether the drug was the first, second, or 3rd 2nd line drug used. Some patients took each 2nd line drug for more than 5 years, suggesting a favorable experience, but most courses were not continued beyond 2 years.

Age Factors↗
PubMed1992

Rheumatology function tests: grip strength, walking time, button test and questionnaires document and predict longterm morbidity and mortality in rheumatoid arthritis.

Four quantitative measures of functional status, grip strength, walking time, the button test, and a questionnaire regarding activities of daily living, were assessed nine years apart in 75 patients with rheumatoid arthritis (RA). After 9 years, 20 patients had died; none were lost to followup. Functional status had declined in more than 80% of patients according to each of the 4 measures, and patients with poor values at baseline were most likely to die over the next 5 years, as reported. We report that baseline values of these measures of functional status were predictive of values 9 years later. These measures may be regarded as "rheumatology function tests" to document and predict morbidity and mortality in RA over long periods.

Arthritis, Rheumatoid↗
PubMed1991

HLA-DPB1*0301 is a major risk factor for rheumatoid factor-negative adult rheumatoid arthritis.

HLA-DPB1 alleles were determined using the polymerase chain reaction and allele-specific oligonucleotide probes in Caucasoid patients with rheumatoid arthritis (RA) and in healthy controls. DPB1*0301 was found to be increased in seronegative patients (50.0% versus 10.8% in controls; relative risk = 8.3, P less than 0.0001). With our previous finding that DPB1*0301 is increased in seronegative children with polyarticular-onset arthritis, the results suggest a relationship between this disease and seronegative RA in adults.

Adult↗
PubMed1991

The Beck Depression Inventory, Center for Epidemiological Studies Depression Scale (CES-D), and General Well-Being Schedule depression subscale in rheumatoid arthritis. Criterion contamination of responses.

Three widely used depression scales--the Beck Depression Inventory (BDI), Center for Epidemiological Studies Depression scale (CES-D), and General Well-Being Schedule depression subscale (GWB-D)--were studied in rheumatoid arthritis (RA). Twenty-three rheumatologists identified 19 of the 45 items on these three questionnaires as likely to differ in patients with RA and control subjects because of the presence of RA, regardless of psychological status. Responses to 13 of these 19 individual scale items, designated as "RA-related items," differed significantly in 41 RA patients versus 57 age-matched control subjects. Only three of the other 26 items differed significantly in the two groups. These data extend evidence that responses of people with RA on widely used depression scales might be affected by somatic disease regardless of psychological status.

Activities of Daily Living↗
PubMed1991

Rheumatoid arthritis identified in population based cross sectional studies: low prevalence of rheumatoid factor.

All 5 cross sectional population based studies which included evaluation of all subjects for both rheumatoid factor (RF) and rheumatoid arthritis (RA) were reviewed. RF was found in only 19-33% of individuals who met the 1958 ARA criteria for RA. Many individuals identified in these studies met criteria for only "probable" or "possible" RA according to the 1958 criteria, and might not meet the 1987 criteria. However, RF was found in only 26-60% of subjects who met criteria for "definite" RA in the studies that included this information. Population based studies of RA often have been interpreted as applicable to clinical RA patients, which may explain in part different views of RA as both a mild and a progressive disease.

Arthritis, Rheumatoid↗
PubMed1991

Reliability of grip strength, walking time and button test performed according to a standard protocol.

Excellent interobserver and intraobserver reliability (reproducibility) was seen for the grip strength, walking time and button test measures in 40 patients with rheumatoid arthritis (RA), when measurement was performed according to a standard protocol. Evidence of reliability, coupled with the observation that baseline measures predict longterm morbidity and mortality in individual patients, suggests that these measures might be more widely used in general rheumatologic care.

Arthritis, Rheumatoid↗
PubMed1990

Learned helplessness in systemic lupus erythematosus: analysis using the Rheumatology Attitudes Index.

The Rheumatology Attitudes Index (RAI) was administered to 138 patients with systemic lupus erythematosus (SLE) to determine its reliability and to examine the construct of learned helplessness in patients with this disease. The internal consistency of the RAI was indicated by Cronbach's standardized alpha value (alpha = 0.70). Significant correlations were observed between RAI scores and the Modified Health Assessment Questionnaire Activities of Daily Living difficulty (r = 0.34, P less than or equal to 0.001) and dissatisfaction (r = 0.32, P less than or equal to 0.001) scores, the 10-cm visual analog pain scale (r = 0.42, P less than or equal to 0.001), and the Psychosocial Adjustment to Illness Scale raw total (r = 0.63, P less than or equal to 0.01). These findings support the external validity of the RAI in SLE. In addition, these data suggest that the learned helplessness construct might be relevant to the outcomes of morbidity and mortality in patients with SLE.

Activities of Daily Living↗
PubMed1990

Associations between clinical status questionnaire scores and formal education level in persons with systemic lupus erythematosus.

In a study of 124 systemic lupus erythematosus patients, clinical status, according to 5 questionnaire scales, was poorer in patients with less than or equal to 11 years versus those with greater than or equal to 12 years of formal education. These results were statistically significant when adjusted for age, race, sex, and disease duration, though results on some scales were not significant when adjusted for multiple comparisons. These findings further support observations that formal education level is associated with clinical status in rheumatic and other chronic diseases.

Adult↗
PubMed1990

Association of scleroderma with a T cell antigen receptor gamma gene restriction fragment length polymorphism.

Restriction fragment length polymorphisms (RFLPs) in the T cell receptor (TCR) alpha, beta, and gamma genes were analyzed in 61 scleroderma patients and 150 controls. An association was found between scleroderma and an 11.3-kb Pvu II fragment in the TCR gamma gene; this gene was found in 41.0% of the patients, compared with 21.7% of the controls (P less than 0.01, odds ratio = 2.50). There were no associations between scleroderma and the tested RFLPs in the TCR alpha or beta genes, and no RFLPs were found in the constant region of the TCR delta gene.

Alleles↗
PubMed1990

HLA-DR alleles with naturally occurring amino acid substitutions and risk for development of rheumatoid arthritis.

To determine the HLA-DR4 subtypes associated with rheumatoid arthritis (RA), we performed amplification of DR4 DRB1 genes by the polymerase chain reaction and dot-blots with oligonucleotide probes. In 52 HLA-DR4+ RA patients, Dw4 was the predominant subtype. This subtype was found in 45 of 52 patients (86.5%) compared with 33 of 59 DR4+ controls (55.9%; P less than 0.001). In the whole population, Dw4 also gave the highest relative risk for RA (RR = 5.31). Relative risk was also associated with DR1.1, the common white DR1 (Dw1) type, which has a third hypervariable region amino acid sequence similar to some forms of DR4 and has glycine at position 86. Variants of DR1 (DR1.2) or DR4 (Dw13.1, Dw14.1) with valine at position 86 appeared less able to confer risk for RA. Substitution of residues in the third hypervariable region of the first domain of DRB1 appeared to correlate with relative risk for RA. Among subjects having 0-1 amino acid substitutions, RA developed in 53%, whereas in subjects with 2-4 amino acid changes, RA was present in only 17.4% (P less than 0.00001). DQw7 (formerly DQw3.1) was slightly increased in DR4+ RA patients compared with controls, but a striking excess of Dw4,DQw7 homozygous patients was observed. The results suggest that DQw7 may have an additional effect, possibly with a recessive mechanism, since it was observed only in DR4 homozygous patients.

Alleles↗