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Biomedical subjects

H H Raspe

Publications and source records attributed to H H Raspe.

At least 19 recordsLinked to original sources
PubMed1992

[Measuring work capacity in rheumatic diseases: functional disability, pain, pain-related cognitions and affects].

Rheumatic diseases, particularly those affecting the back, cervical spine, and the joints, are widespread in the general population. The general costs, especially those associated with social medical services, show constant increases. Time and effectiveness lost from work due to back problems in the FRG accounted for most of the days off the job because of disability, time spent in the hospital or at a health spa facility. Therefore, the appropriate evaluation of the degree of disability plays an increasingly important role in the area of social benefits. Yet unambiguous and objective physical measurements of the disease and the degree of associated disability are lacking in most cases of rheumatic diseases. More attempts to address the subjective aspects of the disease should be included in such evaluations. For recent years, models of measurement have been developed and tested, which are suited to the multidimensional nature of rheumatic illnesses. It is recommended that these be introduced in routine use for physical evaluations.

Affect↗
PubMed1992

The outcome of traditional or comprehensive outpatient care for rheumatoid arthritis (RA). Results of an open, non-randomized, 2-year prospective study.

This work presents results of a quasiexperimental prospective cohort study of the medium-term course of chronic rheumatoid arthritis (RA) under two different conditions of care. During 1984-1986 a total of 262 patients was recruited. All were new referrals to a university outpatient department. 121 came from the city of Hannover, FRG, and were assigned to comprehensive team care (cc) provided by two rheumatologists, a nurse, physician's assistant, occupational therapist, psychologist, and social worker; 141 came from outside Hannover and received care from a physician in training for internal medicine/rheumatology and a nurse, supervised by a senior registrar (TC). The patients in the first group were significantly older (57 vs 51 years), had more active disease (ESR 44 vs 31 mm/h), were more disabled (functional capacity 69 vs 78%), more often lived alone (27 vs 10%) and were more depressed compared with patients in the second group. There were no significant differences in gender (80% female), number of Rome criteria (5.2), and disease duration (6 years) between the two groups. 179 patients were followed for 2 years. There was no demonstrable difference between those who dropped out and those who continued in the study. Patients from both groups showed significant and clinically important improvements in ESR and number of swollen joints, whereas functional capacity and pain intensity did not change. Depression and patients' global self-rating improved only in the CC-group. Analyses adjusting for differences between the two groups were unable to show a different efficacy for either form of care.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1992

[Population epidemiologic evaluation of the Hannover Mobile Rheumatoid Health Service].

The aim of the study was the evaluation of a potential selection process for patients with rheumatoid arthritis (RA) referred to the Mobile Service for Rheumatics in Hannover (MSRH). The MSRH is the only referral center for patients with inflammatory rheumatic diseases in Hannover. A comparison of the health status was made between 58 individuals with RA identified in a population study, and 103 RA patients from the MSRH. The following disease parameters were less favorable in the clinical group: duration of morning stiffness, functional capacity, number of swollen joints, rheumatoid factor, ESR, disease activity, and classical RA according to the Rome-criteria. Only 22% of the individuals with RA identified in the population study have been referred to the MSRH. These patients more frequently had definite or classical RA (statistically not significant: p = 0.17, p = 0.11, respectively). It was shown that the clinical group comprised more severe RA cases. Thus, data from such patients may not be generalized for the entire group of RA cases in the population.

Ambulatory Care Facilities↗
PubMed1990

[Fibromyalgia syndrome. Current contributions to the etiology, diagnosis and therapy of so-called "soft tissue rheumatism"].

The fibromyalgia syndrome (FMS) is an extraarticular rheumatic disease. Typical features are the chronic, polytopic pain in the musculoskeletal system and the provocation of pain by pressure on defined tender points. Mainly medium age women are affected by the disease. In histomorphological studies of muscle tissue non-specific changes were demonstrated, which were thought to be due to ischemia. Furthermore, sleep disturbance and a reduced pain threshold, which may be related to psychological factors, are discussed in the etiology. In FMS a primary and a secondary form related to other diseases can be differentiated. The treatment consists mainly of behaviour therapy and physiotherapy.

Adult↗
PubMed1990

Human fibroblasts release reactive oxygen species in response to treatment with synovial fluids from patients suffering from arthritis.

Human fibroblasts in primary culture released reactive oxygen species upon exposure to synovial fluid obtained by joint aspiration from twelve patients suffering from rheumatoid arthritis. The primary radical produced was O2- as determined by ESR spin trapping and cytochrome c reduction. In contrast to the oxidative burst in granulocytes and monocytes, radical formation proceeded continuously for at least four hours. Low-level chemiluminescence was increased upon exposure to inflammatory human synovial fluids. Spectral characteristics and effects of azide and 1,4-diazabicyclo-(2,2,2)-octane led to the conclusion that the photoemissive species were excited carbonyls. Radical production and light emission were not altered either by xanthine or allopurinol, nor by azide, cyanide or rotenone. The O2- production increased in the presence of NADH or NADPH, making an NAD(P)H oxidase a likely source. The liberation of reactive oxygen species correlated with the number of leukocytes present in the inflammatory joint fluids, but not with the concentrations of immunoglobulins and complement factor C3.

Arthritis, Rheumatoid↗
PubMed1989

Early arthritides: nosography, nosology, and diagnostic criteria.

Follow-up studies of patients with early arthritides are sparse and they are usually restricted to certain diagnostic groups. Therefore 141 unselected patients suffering from arthritis since no more than 12 months were entered into a prospective study. The largest group (n = 57, 40%) consisted of patients with definite rheumatoid arthritis. Forty individuals (28%) were judged to have undifferentiated arthritis since they could not be classified according to established diagnostic criteria initially. After 9 +/- 3 months mean follow-up only 21 of 45 patients (47%) fulfilling criteria for definite rheumatoid arthritis at the onset of the study remained in this category, 9 (20%) still suffered from arthritis but they met less than 5 ARA criteria, and 15 (33%) went into remission. Among 50 patients with undifferentiated arthritis or spondylarthropathy an even smaller proportion of 16 individuals (32%) still had arthritis, which could not be classified, whereas 34 (68%) showed no signs of persisting peripheral arthritis. Thus, criteria diagnoses are inadequate for the selection of the patients at the onset of the disease since they are frequently false positive and they omit other arthritides important for differentiation. Further disadvantages of criteria diagnoses are evident: they imply a large spectrum of manifestations of the disease, they overlap with other entities, they do not provide sufficient information regarding the prognosis and adequate treatment. To improve the prognostic value of a nosological classification a concept of descriptive diagnoses is discussed.

Arthritis, Infectious↗
PubMed1989

Activity and severity of rheumatoid arthritis in Hannover/FRG and in one regional referral center.

Between November 1984 and July 1988 a total of 8044 randomly selected German residents of the city of Hannover/FRG, aged 25 to 74, have been screened for rheumatic complaints by means of a postal questionnaire. An average 87% of the probands contacted returned completed questionnaires. Respondents with a "positive" questionnaire, i.e. suggestive of the existence of an inflammatory joint disease were invited for a rheumatological examination at the Hannover Medical School. 72% participated. 45 of a total of 1291 participants were identified as suffering from active or inactive, mostly rheumatoid arthritis. This yields a minimum prevalence of 0.56% (+/- 0.19%). The true prevalence is estimated to be 0.91% (99%-confidence interval 0.64-1.18). In 1985 and 1986 103 German RA sufferers aged 25 to 74, all citizens of Hannover, were referred to our outpatient rheumatology clinic for a first consultation. A comparison between the two groups revealed a higher disease activity in terms of "objective" criteria (joint swellings, ESR, rheumatoid factor) in the group of the referred patients as opposed to RA suffers from the community. Both groups were comparable in respect to "subjective" symptoms (morning stiffness, joint pain, pain intensity), functional capacity and degree of erosive joint lesions. The rheumatological outpatient clinic at the Hannover Medical School, providing the only specialized service in the region, actually covers less than 20% of all RA sufferers within the municipal area of Hannover and less than 50% of those with a "classical" RA according to the ARA-criteria.

Adult↗
PubMed1989

Treatment profiles in different groups of RA-sufferers: description, analysis, evaluation.

(1) 50 to 80% of all rA-sufferers treated by rheumatologists have received second line therapy in contrast to 7 to 27% at the community level. (2) Disease duration and disease activity do not seem to affect the treatment regimens of primary and other physicians working in or around Hannover. The same holds true for social and demographic characteristics of the patients. (3) RA-sufferers are generally undertreated by community based doctors with regard to RiD-therapy and disease activity. Approximately 80% of patients with formal indication for the use of RiDs have not received these drugs, despite the fact that a rheumatological department with an outpatient clinic providing more than 3500 consultations per year has existed for more than 20 years at the Medizinische Hochschule Hannover. This outpatient clinic is utilized by more than 60% of all general practitioners as well as internal and orthopedic physicians working in the city of Hannover. We thus have to admit a rather low community effectiveness of our service. (4) A sensitivity of the formal evaluation-scheme of 0.70 and a specificity of 0.80 imply 30% false-negative and 20% false-positive assessments. In view of the larger number of false-negative judgements one must assume an even greater difference between treatment-reality and rheumatological concepts. (5) Sofar we cannot offer any safe explanation for the reasons underlying this unsatisfactory situation. The predictors we have investigated up to now have not proven to be selective. (6) Nevertheless, practical steps are urgently required, in order to be rheumatologically more effective at the community level--at least in Hannover/FRG.

Adult↗
PubMed1988

[Do patients with active chronic polyarthritis get "basic therapy"?].

The determination of the adequacy of an individual therapeutical regimen is part of the process evaluation of medical care. To evaluate the adequacy of individual antirheumatic therapy, we developed a five step procedure: 1. Assessment of the patient's health status; 2. assessment of his/her former and current therapy; 3. determination of the adequate antirheumatic therapy following an explicit norm; 4. formal comparison of current and adequate treatment; 5. clinical evaluation of possible differences between norm and reality. Due to methodological reasons we concentrated on the current treatment of rheumatoid arthritis (rA) patients with remission inducing drugs (RIDs; e.g. Chloroquine, Gold). The study analyzed the RID treatment of 75 rA-sufferers; 25 patients were referred to our outpatient department for the first time in late 1986; 25 patients were recruited from a social-medical study covering employed but actually disabled members of a major health insurance (AOK) in Hannover; 25 subjects were derived from an ongoing population study ("prevalence and care of rheumatoid arthritis in Hannover"). Only 9 out of 49 (18%) patients with an active disease, formally in need of treatment, were currently treated with RIDs. Thus 40 out of 49 (82%) seemed to be under an inadequate treatment. From the clinical point of view this formal judgement was assumed to be false positive in 5 and false negative in 15 cases. In relation to the clinical judgements we found for the formal procedure a sensitivity of 0.70 with a specificity of 0.80 and an overall agreement of 73% (kappa 0.44).

Adult↗
PubMed1988

[Physician consultation and use of drugs for rheumatic symptoms].

Between May 1986 and November 1987 we asked 4037 randomly sampled 25-74 year old german residents at Hannover (FRG) by a mailed questionnaire for back, neck and joint pain, for joint swelling and morning stiffness. Further we asked for the consultation of a physician during the past 12 months and for the use of drugs during the past 7 days because of rheumatoid complaints. 3426 members of the sample (85%) returned the questionnaire. 1828 (53%) reported at least one symptom "today" (= "the day you fill out this questionnaire"). The highest rate of persons suffering from complaints of the locomotor system was found among middle-aged women, with the maximum of 74% in the age group 50-54 years. For the illness behavior-physician consultation, use of drugs-the extent of complaints was of decisive importance. Sex was without, age of very low influence. The rate of those who reported the consultation of a physician and/or the use of drugs was increasing with the amount of positive answers to the questions on rheumatoid complaints. Nevertheless, of those who had answered in the affirmative all questions on complaints, 10% had denied the question on physician consultation. 41% had denied the question on the use of analgetic/antirheumatic drugs.

Adult↗
PubMed1987

Social and emotional problems in early rheumatoid arthritis. 75 patients followed up for two years.

Seventy-five patients with an early RA (disease duration between 2 and 12 months; 79% female; average age 49 years; 72% with "definite" RA) were followed in a prospective study over a period of 2 years. Within this 24 month observation period there was a drop in the average diagnostic ARA count from 5.0 to 4.2, in the ESR from 48 to 31 mm within the first hour and also in the number of affected joints from 13 to 9. Pain intensity and functional capacity showed a slight decrease in the average score. Despite a consistent antirheumatic therapy (72% on RID's after one year) there was a noticeable increase from 23 to 58% in the prevalence of patients with any erosive changes in the X-ray. Within the two years of this study one third of the patients employed at the onset had to quit their job. The number of patients retired due to RA rose from 0 to 23%. A comparison of two groups of patients (employed versus retired) revealed no significant differences in the initial examination with one exception: The patients eventually retired by the end of the study were significantly older with an average age of 51 versus 39 in the group of still employed patients. On the other hand, by the end of the study the patients remaining employed for the duration of the 2 years were significantly less active and also less severely diseased and handicapped. The number of patients with clinically relevant depression (BDI) or anxiety (STAI) did not change significantly over the 24 month period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1986

[Does seronegative chronic polyarthritis have a special place? Clinical, biochemical and immunogenetic profile of early seronegative seropositive chronic polyarthritis].

In the framework of an early-diagnosis out-patients clinic 100 patients (mean age 51 years), 82 of them female, were identified as highly suspicious of having chronic rheumatoid arthritis of recent onset (2-12 months). Five or more ARA criteria were present in 77 patients. IgM rheumatic factor was present in serum of 51 patients (latex-fixation test). A Waaler-Rose test of greater than or equal to 32 IU/ml was present in 21. After adjusting for alpha errors, there was a significantly higher prevalence of HLA-DR4 among those seropositive in the latex fixation test (64 vs 29%). A further 19 constitutional, anamnestic, clinical, biochemical and psychosocial criteria failed to reveal any different distribution between seropositive and seronegative cases. Using the specific definition of seropositivity in the Waaler-Rose test eliminated HLA-DR4 differences. The latter did not serve as a distinguishing criterion. There was only a marginal difference between DR4-positive and negative patients. These results fail to lend support to recent views of a special position of seronegative chronic rheumatoid arthritis.

Arthritis, Rheumatoid↗