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Biomedical subjects

T Pincus

Publications and source records attributed to T Pincus.

At least 163 records · Page 9Linked to original sources
PubMed1988

The importance of age, education, and comorbidity in the substantial earnings losses of individuals with symmetric polyarthritis.

A population-based survey designed to be representative of the entire US population of working age (18-64 years) includes data on pain and swelling of specific joints in each subject. We analyzed these data to estimate work status and disability status, as well as earnings losses, associated with Symmetric Polyarthritis. Subjects identified in the survey as having Symmetric Polyarthritis were similar in age, race, sex, and marital status to rheumatoid arthritis patients seen in clinical settings. Overall, 51% of women with Symmetric Polyarthritis and 47% of men with Symmetric Polyarthritis were severely disabled, compared with 4.5% of women and 3.7% of men with no arthritis. Earnings of women and men with Symmetric Polyarthritis were only 27% and 48%, respectively, of earnings of individuals without arthritis. The total earnings gap between the 2 groups was +17.6 billion (1986 dollars). Econometric regression analyses indicated that about one-third of this earnings gap was explained by the presence of Symmetric Polyarthritis. The remaining two-thirds was explained by differences in age, education, and comorbidity between individuals with Symmetric Polyarthritis and those without arthritis. The earnings of individuals with Symmetric Polyarthritis, therefore, would be expected to be considerably lower than those of the general population, even if these individuals were not affected by arthritis. Nonetheless, earnings losses of at least +6.5 billion annually are explained by Symmetric Polyarthritis.

Adolescent↗
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

HLA-DR4 and other genetic markers in rheumatoid arthritis.

In a new series of RA patients the association with HLA-DR4 was again found to be highly significant. Also increased were the DR4 associated antigens DRw53 and DQw3. Hybridization of a DQ-beta probe to Bg1 II-digested DNA showed that a variant of DQw3, characterized by a 4.3 kb fragment and related to the serological specificity TA10, was markedly increased among DR4 positive RA patients. HLA-DR1 was also increased in RA and appeared to be independent of the increase of DR4. Although the DR1 association was weaker, it was observed in both patients with and without RF. In contrast, DR4 was found to be increased significantly only in the RF positive group of patients, as previously observed. Development of RA in multiple-case families was found to be linked to the inheritance of DR4 positive haplotypes. The possible role of risk factors associated with polymorphic markers of the T-cell receptor genes was investigated. An allelic marker associated with one of the variable gene subfamilies of the beta-chain was found to be associated with RA. The results suggest that susceptibility for development of RA is influenced by alleles of the T-cell receptor in conjunction with the class II HLA factors with which the T-cell receptor interacts in the course of the immune response.

Alleles↗
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

Serositis with autoimmune endocrinopathy: clinical and immunogenetic features.

Twenty patients with autoimmune endocrinopathies experienced 45 episodes of pleural and/or pericardial serositis. Seventeen of these patients were women and 15 had clinical or serologic evidence of 2 or more endocrinopathies. Idiopathic primary hypoadrenalism (10 cases), Graves' disease (8 cases), Hashimoto's disease (4 cases), atrophic thyroiditis with hypothyroidism (3 cases), idiopathic primary hypogonadism (3 cases), transient thyroiditides (2 cases), and type I diabetes mellitus (1 case) were diagnosed at a mean age of 24 years. Serositis recurred after asymptomatic intervals of months to years even in patients treated for endocrine dysfunction. Fourteen of 16 Caucasians had circulating immune complexes, including all 9 patients with a C4AQ0 (C4A null) phenotype and including all 12 patients with HLA antigens B8 and DR3, antigens associated with systemic lupus and with autoimmune endocrinopathies. Serositides associated with autoimmune endocrinopathies can occur with chest pain, fever, and exudative effusions in young Caucasian women with the HLA B8 DR3 C4AQ0 phenotype. These serositides may have a common pathophysiologic mechanism.

Adolescent↗
PubMed1987

Bypass arthritis and the blind intestinal loop.

Arthritis and other inflammatory processes are well established complications of intestinal bypass operations, and recently have been reported after other gastrointestinal procedures. Bacterial overgrowth in blind intestinal loops, actual or functional, appears to be the underlying pathophysiologic mechanism responsible for these systemic inflammatory disorders. In the case we have reported, arthritis was the primary manifestation of blind loop remaining after incomplete reversal of a jejunoileal bypass. Surgical elimination of the blind loop was curative.

Adult↗
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↗