Biomedical subjects

Bonnie Bruce

Publications and source records attributed to Bonnie Bruce.

13 recordsLinked to original sources

PubMed2005

Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study.

We studied the long term impact of running and other aerobic exercise on musculoskeletal pain in a cohort of healthy aging male and female seniors who had been followed for 14 years. We conducted a prospective, longitudinal study in 866 Runners' Association members (n = 492) and community controls (n = 374). Subjects were also categorized as Ever-Runners (n = 565) and Never-Runners (n = 301) to include runners who had stopped running. Pain was the primary outcome measure and was assessed in annual surveys on a double-anchored visual analogue scale (0 to 100; 0 = no pain). Baseline differences between Runners' Association members and community controls and between Ever-Runners versus Never-Runners were compared using chi-square and t-tests. Statistical adjustments for age, body mass index (BMI), gender, health behaviors, history of arthritis and comorbid conditions were performed using generalized estimating equations. Runner's Association members were younger (62 versus 65 years, p < 0.05), had a lower BMI (22.9 versus 24.2, p < 0.05), and less arthritis (35% versus 41%, p > 0.05) than community controls. Runners' Association members averaged far more exercise minutes per week (314 versus 123, p < 0.05) and miles run per week (26 versus 2, p < 0.05) and tended to report more fractures (53% versus 47%, p > 0.05) than controls. Ever-Runners were younger (62 versus 66 years, p < 0.05), had lower BMI (23.0 versus 24.3, p < 0.05), and less arthritis (35% versus 43%, p < 0.05) than Never-Runners. Ever-Runners averaged more exercise minutes per week (291 versus 120, p < 0.05) and miles run per week (23 versus 1, p < 0.05) and reported a few more fractures (52% versus 48%, p > 0.05) than Never-Runners. Exercise was associated with significantly lower pain scores over time in the Runners' Association group after adjusting for gender, baseline BMI, and study attrition (p < 0.01). Similar differences were observed for Ever-Runners versus Never-Runners. Consistent exercise patterns over the long term in physically active seniors are associated with about 25% less musculoskeletal pain than reported by more sedentary controls, either by calendar year or by cumulative area-under-the-curve pain over average ages of 62 to 76 years.

Aged↗

PubMed2005

Antigen microarray profiling of autoantibodies in rheumatoid arthritis.

OBJECTIVE: Because rheumatoid arthritis (RA) is a heterogeneous autoimmune disease in terms of disease manifestations, clinical outcomes, and therapeutic responses, we developed and applied a novel antigen microarray technology to identify distinct serum antibody profiles in patients with RA. METHODS: Synovial proteome microarrays, containing 225 peptides and proteins that represent candidate and control antigens, were developed. These arrays were used to profile autoantibodies in randomly selected sera from 2 different cohorts of patients: the Stanford Arthritis Center inception cohort, comprising 18 patients with established RA and 38 controls, and the Arthritis, Rheumatism, and Aging Medical Information System cohort, comprising 58 patients with a clinical diagnosis of RA of <6 months duration. Data were analyzed using the significance analysis of microarrays algorithm, the prediction analysis of microarrays algorithm, and Cluster software. RESULTS: Antigen microarrays demonstrated that autoreactive B cell responses targeting citrullinated epitopes were present in a subset of patients with early RA with features predictive of the development of severe RA. In contrast, autoimmune targeting of the native epitopes contained on synovial arrays, including several human cartilage gp39 peptides and type II collagen, were associated with features predictive of less severe RA. CONCLUSION: Proteomic analysis of autoantibody reactivities provides diagnostic information and allows stratification of patients with early RA into clinically relevant disease subsets.

Algorithms↗

PubMed2005

The impact of a moderated e-mail discussion group on use of complementary and alternative therapies in subjects with recurrent back pain.

OBJECTIVE: The purpose was to examine whether or not participation in an e-mail discussion group would affect use of selected complementary and alternative medicine (CAM) modalities during an Internet-based, 1-year randomized, controlled trial on back pain management. METHODS: Intervention subjects (n = 190) participated in a closed, moderated e-mail discussion group; control subjects (n = 231) received usual care. At 1 year, we compared CAM use over the previous 6-month period during which intervention subjects had had interactive discussions about them. Differences in CAM use between groups were compared using Chi-square and t-tests. RESULTS: Subjects did not differ statistically between groups (p > 0.05). They were Caucasian (approximately 91%), male (approximately 60%), in their mid-40s, well educated, had approximately 13 years back pain duration, a disability level approximately 10 (Roland-Morris scale: 0-23; 23 = worst), and >80% had used the Internet for greater than a year before the randomized trial. During the study period, only small proportions in either group had initiated use of glucosamine (13% versus 8%), chiropractic services (5% versus 4%), acupuncture (3%, both), yoga (6% versus 4%), or magnets (6%, both). CONCLUSION: Results suggest that participation in interactive discussions over the Internet about these CAM modalities may not affect their use.

Back Pain↗

PubMed2004

Longitudinal comparison of the Health Assessment Questionnaire (HAQ) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

OBJECTIVE: To compare the measurement properties of the generic Health Assessment Questionnaire (HAQ) and the disease-specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). METHODS: Physical function, pain, and radiographic progression were assessed in knee or hip osteoarthritis patients (n = 271) who had 2 radiographs that were at least 6 months apart from 6 ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) databanks. Data were compared at baseline and after a mean of 3.2 (SE 0.10) years. Correlation coefficients and standardized effect sizes (SES) were used to assess their relationship and responsiveness. RESULTS: The majority of items in the 2 function and pain scales overlapped and were highly and significantly correlated with each other at baseline and last assessments (function at baseline rs = 0.71 and function at last assessment rs = 0.79, P < 0.0001; pain at baseline rs = 0.70 and pain at last assessment rs = 0.76, P < 0.0001). The HAQ disability index and total knee score were more sensitive to detection of disease progression than the WOMAC (SES for HAQ = 0.27; SES for WOMAC = -0.05). CONCLUSION: Both instruments showed favorable measurement properties, with the HAQ having the advantages of being more sensitive to change and adaptable to a wide variety of diseases and conditions, which contribute to the generalizability of findings.

Aged↗

PubMed2004

The rise and decline of nonsteroidal antiinflammatory drug-associated gastropathy in rheumatoid arthritis.

OBJECTIVE: Nonsteroidal antiinflammatory drug (NSAID)-associated gastropathy is a major cause of hospitalization and death. This study was undertaken to examine whether recent preventive approaches have been associated with a declining incidence of NSAID gastropathy, and, if so, what measures may have caused the decline. METHODS: We studied 5,598 patients with rheumatoid arthritis (RA) over 31,262 patient-years at 8 sites. We obtained standardized longitudinal information on the patients that had been previously used to establish the incidence of NSAID gastropathy, and also information on patient risk factors and differences in toxicity between NSAIDs. Consecutive patients were followed up with biannual Health Assessment Questionnaires and medical record audits between 1981 and 2000. The major outcome measure was the annual rate of hospitalization involving bleeding, obstruction, or perforation of the gastrointestinal (GI) tract and related conditions. RESULTS: Rates of GI-related hospitalizations rose from 0.6% in 1981 to 1.5% in 1992 (P < 0.001), and then declined to 0.5% in 2000 (P < 0.001). The fitted spline curve fit the data well (R2 = 0.70). The period of rise was mainly associated with increasing patient age and the GI risk propensity score. The period of decline was associated with lower doses of ibuprofen and aspirin, a decline in the use of "more toxic" NSAIDs from 52% to 42% of patients, a rise in the use of "safer" NSAIDs from 19% to 48% of patients, and increasing use of proton-pump inhibitors, but not with change in age, NSAID exposure, or GI risk propensity score. CONCLUSION: The risk of serious NSAID gastropathy has declined by 67% in these cohorts since 1992. We estimate that 24% of this decline was the result of lower doses of NSAIDs, while 18% was associated with the use of proton-pump inhibitors and 14% with the use of less toxic NSAIDs. These declines in the incidence of NSAID gastropathy are likely to continue.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2004

Attrition bias in rheumatoid arthritis databanks: a case study of 6346 patients in 11 databanks and 65,649 administrations of the Health Assessment Questionnaire.

OBJECTIVE: Patient dropout (attrition) can bias and threaten validity of databank-based studies. Although there are several databanks of rheumatoid arthritis (RA) in operation, this phenomenon has not been well studied. METHODS: We studied the attrition patterns of patients with RA in 11 long-running databanks where patients were followed using semiannual Health Assessment Questionnaires. Attrition rates were calculated as the proportion of living patients who were in active followup at the cutoff date. Mantel-Haenszel methods and Weibull regression were used to model the relationship between attrition and age, sex, race, education, disease duration, functional disability, and other characteristics. RESULTS: Overall, 6346 patients with RA were recruited into the study cohorts and followed for 32,823 person-years with 65,649 observations. The crude attrition rate was 3.8% per cycle. Rates were lowest in community-based databanks. Smaller size of the centers, inner-city location, and university clinic settings were associated with worse attrition. In multivariable analyses, younger age, lower levels of education, and non-Caucasian race predicted attrition. Level of disability and disease duration were not associated with attrition. Conclusion. In terms of person-years of followup and observation-points, this may be the largest study on attrition to date. While it is possible to have very high overall retention rates, certain types of databanks (smaller, inner-city-based, and university-based) are more likely to be biased due to selective retention of older, more educated Caucasian patients.

Adolescent↗

PubMed2003

The Stanford Health Assessment Questionnaire: dimensions and practical applications.

The ability to effectively measure health-related quality-of-life longitudinally is central to describing the impacts of disease, treatment, or other insults, including normal aging, upon the patient. Over the last two decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements, such as erythrocyte sedimentation rate, lipid profiles, or radiographs, to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on generic, patient-centered dimensions. The HAQ was designed to represent a model of patient-oriented outcome assessment and has played a major role in many diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of NSAID gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. Evidenced by its use over the past two decades in diverse settings, the HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It is available in more than 60 languages and is supported by a bibliography of more than 500 references. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. In this article, information regarding the HAQ's development, content, dissemination and reference sources for its uses, translations, and validations are provided.

Activities of Daily Living↗

PubMed2003

Isoflavone supplements do not affect thyroid function in iodine-replete postmenopausal women.

Despite the safety review conducted by the U.S. Food and Drug Administration in the process of awarding a health claim for the cholesterol-lowering properties of soy protein, concerns about the possible goitrogenic effects of soybean isoflavones persist. Concerns are based primarily on in vitro research, animal studies, and older reports of goiter in infants fed soy formula not fortified with iodine. In a randomized, double blind, placebo-controlled study, we investigated the effect on thyroid function of a daily supplement containing 90 mg (aglycone weight) of total isoflavones/day versus placebo in 38 postmenopausal women, 64-83 years old, not on hormone replacement therapy. Serum thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3) were measured at baseline and after 90 and 180 days. In the supplement group, at baseline and 6 months, TSH (micro U/ml), T4 (nM), and T3 (nM) levels (mean +/- SE) were 3.00 +/- 0.44, 149.00 +/- 5.04, and 1.53 +/- 0.13, respectively, and 3.49 +/- 0.52, 154.52 +/- 2.09, and 1.78 +/- 0.12, respectively. In the control group, levels at baseline and at 6 months were 3.35 +/- 0.51, 145.39 +/- 6.69, and 1.55 +/- 0.18, respectively, and 3.63 +/- 0.57, 153.77 +/- 6.64, and 1.75 +/- 0.10, respectively. Intragroup differences for all three measures were statistically indistinguishable at 6 months, and levels were similar between the isoflavone supplement and placebo groups at each measurement. These results indicate that in this group of healthy iodine-replete subjects, soy isoflavones do not adversely affect thyroid function.

Aged↗

PubMed2003

The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation.

Over the last 2 decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on patient centered dimensions. The HAQ was designed to represent a model of patient oriented outcome assessment and has played a major role in diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of nonsteroidal antiinflammatory drug gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. The HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. We review the development, content, and dissemination of the HAQ and provide reference sources for its uses, translations, and validations. We discuss contemporary issues regarding outcome assessment instruments relative to the HAQ's identity and utility. These include: (1) the issue of labeling instruments as generic versus disease-specific; (2) floor and ceiling effects in scales such as "disability"; (3) distances between values on scales; and (4) the continuing introduction of new measurement instruments and their potential effects.

Arthritis, Rheumatoid↗

PubMed2003

Rates of serious gastrointestinal events from low dose use of acetylsalicylic acid, acetaminophen, and ibuprofen in patients with osteoarthritis and rheumatoid arthritis.

OBJECTIVE: The frequency of serious gastrointestinal (GI) complications has been quantitated with chronic high doses of nonsteroidal antiinflammatory drugs (NSAID), but risk at lower dosages remains unknown. We examined the prevalence of serious GI events in patients taking aspirin (ASA), acetaminophen (APAP), or ibuprofen (IBU), focusing on low or intermittent use. METHODS: We studied 5692 patients with rheumatoid arthritis (RA) and 3124 patients with osteoarthritis (OA) from 12 databank centers, with 36,262 patient-years of observation, who had taken one of 3 study analgesics, and examined the frequency of serious GI events requiring hospitalization. RESULTS: Treatment groups were of similar ages and severity. As lower doses of study analgesics were taken, serious GI events tended to be less prevalent. In patients taking a study drug alone, without other analgesics or corticosteroids, only one event occurred in over 900 patient-years of exposure, roughly equivalent to background. Rates of GI events while taking APAP with other concurrent therapy or corticosteroids were higher (p < 0.05) than for the other 2 analgesics. In over-the-counter (OTC) doses, there were no significant differences in GI toxicity among analgesics. RA patients tended to have higher rates than OA patients. The rate of GI events was highly dependent on concurrent therapy, increasing 2 to 6-fold in patients taking other analgesics or corticosteroids. Propensity scores for serious GI events were similar across drugs. CONCLUSION: OTC use of ASA, IBU, or APAP carries little risk of serious GI toxicity for most persons. Most serious problems encountered were in higher-risk patients. Given the low rates of events, at low or intermittent dosage without concurrent treatment, these 3 analgesics cannot be distinguished from each other or from background rates of serious GI toxicity.

Acetaminophen↗

PubMed2002

HLA-DRB1 genotype associations in 793 white patients from a rheumatoid arthritis inception cohort: frequency, severity, and treatment bias.

OBJECTIVE: The HLA-DRB1 "shared epitope" (SE) genotypes are associated with rheumatoid arthritis (RA), but it remains controversial whether the association is with incidence, severity, or both, whether there are associations in seronegative patients, and whether different DRB1 alleles that contain the SE have similar effects on RA susceptibility and/or severity. The present study was undertaken to study these issues in a large cohort of patients with RA. METHODS: White patients with RA of <6 months' duration (n = 793) were enrolled in an inception cohort. HLA-DRB1 typing was performed, and patients were categorized into 21 DRB1 genotype groups. The disability index of the Health Assessment Questionnaire was the primary outcome measure. RESULTS: DRB1 associations in seronegative RA patients closely resembled those in controls. Of seropositive patients, 21% had 2 copies of the epitope, 52% had 1 copy, and 27% had none. However, not all genotypes with 1 copy were associated with increased susceptibility; for example, frequencies of DRB1*0404/X and *01/X did not differ from those in controls. Absolute differences between seropositive RA patients and controls were greatest for DRB1*0401 homozygosity (3.8% versus 0.8%, respectively) and *0401/0404 heterozygosity (4.7% versus 1.0%). DRB1*0404 was increased in frequency in seropositive RA but, unlike *0401, an increased frequency was seen only with 2 epitope copies. The relatively rare DRB1*10 had an unexpected association with seropositive RA, being present in 1.7% of seropositive RA patients and 0.7% of controls, and also showed a trend toward association with greater disease severity. The presence of 2 epitope copies was associated with increased frequency of seropositivity and younger age at disease onset, not with disease severity. Treatment indication bias was substantial and may have accounted for some of these effects. HLA-DRB1*0401/0404 was found much more frequently in men and in patients with a lower age at disease onset, and there was a trend toward a higher frequency of *0404/0401 in women. CONCLUSION: This large inception cohort study confirms previously identified major associations and provides additional insights. Only one dominant association was found: *0401, which differs from other SE alleles in a single Lys-for-Arg substitution. The association of the rare DRB1*10 allele has not previously been postulated. Sex associations were confirmed. Associations with seronegative RA were not seen. Not all genotypes containing an SE copy showed increased susceptibility to RA. The association of SE genotypes found in this study related to disease susceptibility rather than severity.

Alleles↗

PubMed2002

Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis.

OBJECTIVE: To demonstrate the effects of a very low-fat, vegan diet on patients with rheumatoid arthritis (RA). DESIGN: Single-blind dietary intervention study. SUBJECTS AND STUDY INTERVENTIONS: This study evaluated the influence of a 4-week, very low-fat (approximately 10%), vegan diet on 24 free-living subjects with RA, average age, 56 +/- 11 years old. OUTCOME MEASUREMENTS: Prestudy and poststudy assessment of RA symptomatology was performed by a rheumatologist blind to the study design. Biochemical measures and 4-day diet data were also collected. Subjects met weekly for diet instruction, compliance monitoring, and progress assessments. RESULTS: There were significant (p < 0.001) decreases in fat (69%), protein (24%), and energy (22%), and a significant increase in carbohydrate (55%) intake. All measures of RA symptomatology decreased significantly (p < 0.05), except for duration of morning stiffness (p > 0.05). Weight also decreased significantly (p < 0.001). At 4 weeks, C-reactive protein decreased 16% (ns, p > 0.05), RA factor decreased 10% (ns, p > 0.05), while erythrocyte sedimentation rate was unchanged (p > 0.05). CONCLUSION: This study showed that patients with moderate-to-severe RA, who switch to a very low-fat, vegan diet can experience significant reductions in RA symptoms.

Aged↗

PubMed2002

The effects of soy-derived phytoestrogens on serum lipids and lipoproteins in moderately hypercholesterolemic postmenopausal women.

Postmenopausal women are at an increased risk of developing coronary artery disease (CAD). This increase is due primarily to elevated cholesterol concentrations accompanying the loss of endogenous estrogen secretion. Recently, the consumption of soy foods has been shown to reduce serum cholesterol concentrations. Phytoestrogens (PE) have been proposed as the responsible agents of the hypocholesterolemic effect of soy foods. However, few studies have investigated the effect of PE supplementation on serum lipoproteins. The purpose of the present study is to investigate the effects of PE supplementation (150 mg) on serum lipids and lipoproteins in moderately hypercholesterolemic, elderly, postmenopausal women. Thirty-six subjects were randomized into two groups and received either a 150-mg PE supplement/d (n = 20) or a placebo (n = 16). Serum samples obtained at baseline and 2 months were analyzed for total triacylglycerol, total cholesterol, and high density lipoprotein cholesterol using standard Lipid Research Clinic procedures. In addition, total triacylglycerol and cholesterol were measured after 6 months of treatment. The t test and ANOVA were employed to compare the two groups. The results (mean +/- SEM) indicated no significant differences in total triacylglycerol (1.3 +/- 0.2 vs. 1.2 +/- 0.2 mmol/liter), total cholesterol (6.4 +/- 0.4 vs. 6.5 +/- 0.2 mmol/liter), or high density lipoprotein cholesterol (1.0 +/- 0.1 vs. 1.0 +/- 0.1 mmol/liter) between the placebo and the PE groups, respectively, after 2 months of treatment. Moreover, total triacylglycerol and cholesterol remained unchanged after 6 months. Our findings suggest that PE supplementation with 150 mg/d over a 6-month period does not significantly alter serum lipoproteins in postmenopausal women and, therefore, may not effectively reduce the risk of CAD in this population.

Aged↗