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Biomedical subjects

J J Rasker

Publications and source records attributed to J J Rasker.

At least 73 records · Page 4Linked to original sources
PubMed1992

Rheumatologists and their patients who seek alternative care: an agreement to disagree.

Alternative treatment, such as homoeopathy, acupuncture and spiritual healing, are popular among patients with rheumatic diseases. Rheumatologists are therefore likely to be confronted with patients who make use of less orthodox health care. Patients' and rheumatologists' views on the subject and on the rheumatologists' role, however, have not yet been assessed. A questionnaire on alternative medicine was sent to all 101 practising Dutch rheumatologists (response rate: 70%). After the results had been analysed 17 rheumatologists, seven rejecting alternative medicine and ten accepting it, handed out a questionnaire to a sample of their patients: 1466 patient questionnaires were distributed (response rate: 80%). Of the respondents 43% had visited an alternative practitioner at least once for their rheumatism and 26% in the year before the survey was held. Hand healers, homoeopaths and acupuncturists were most often visited. Rheumatologists, on their part, were not too enthusiastic about these visits. Only patients' visits to spa treatment centres were welcomed by a majority of them; visits of their patients to manipulative therapists, acupuncturists and homoeopaths were judged positively by a large minority, whereas other therapies were strongly disapproved. Nevertheless, most patients informed their rheumatologist about their visiting an alternative practitioner. A surprisingly low percentage of these patients noticed that the rheumatologist did not sympathize with it. Although many patients paid a visit to an alternative practitioner because regular care did not really help them, their satisfaction with the alternative treatment turned out to be less than their satisfaction with the rheumatologists' help.(ABSTRACT TRUNCATED AT 250 WORDS)

Acupuncture Therapy↗
PubMed1992

Opinions of patients with rheumatoid arthritis about their own functional capacity: how valid is it?

Self assessment health status questionnaires are increasingly used to measure health status or the effect of treatment in patients with rheumatoid arthritis (RA). Most of these questionnaires measure functional (physical) disabilities. The question arises, however, as to how well self assessment questionnaires reflect the true functional status of patients or whether they only reflect their imaginary functional capacities. How valid is the opinion of patients with RA about their own functional capacity? To answer this question an investigation was performed in 80 patients with RA. Forty Dutch and 40 Belgian patients with RA completed the functional items of the DUTCH-AIMS, the Dutch version of the Arthritis Impact Measurement Scales (AIMS), a self assessment questionnaire specific to arthritis. Their scores on the functional scales were compared with the scores on the same scales completed by two experienced physiotherapists after evaluation of the functional ability of these patients. This was achieved by observing the patients perform the tasks given in the questionnaire. Correlation coefficients between the scores of the patients and the physiotherapists were highly significant for all the scales. No significant differences were found between the patients' and physiotherapists' mean scale scores except for the mobility scale in the Dutch patients. The strength of agreement (Cohen's kappa) of most scale scores of the patients and physiotherapists was substantial. The estimates of the overall functional capacity (the mean of the five scale scores) of the Belgian and Dutch patients show high correlations between the patients and the physiotherapists. It is concluded that patients' opinion about their functional ability is valid in that it is in agreement with their real functional abilities. This study provides further evidence for the validity of the DUTCH-AIMS as a measure of functional disability and health status in Dutch and Belgian patients with RA.

Activities of Daily Living↗
PubMed1992

Kates forefoot arthroplasty in rheumatoid arthritis. A 5-year followup study.

The longterm results of Kates forefoot arthroplasty in 74 feet of 41 patients with rheumatoid arthritis (RA) after a mean followup of 5.2 years was considered to be good by 38 patients and poor by 3 patients. The average walking distance had doubled. The mean hallux valgus angle was reduced from 46 to 27 degrees. Surgical results proved to depend on the quality of the arc of the remaining stumps, and not on the severity or activity of RA. Reoperations were necessary in 16 feet of 10 patients because of too prominent distal metatarsal stumps. Despite the absence of pain, 28 patients were not satisfied with the function of the hallux. This might be improved by performing arthrodesis of the first metatarsophalangeal joint.

Adult↗
PubMed1991

[Alternative treatment methods in rheumatic diseases; a literature review].

To evaluate the effectiveness of several types of complementary medicine in patients with rheumatic diseases, a literature search was performed. Clinical trials, blind or open, comparing the effectiveness of forms of complementary medicine with that of placebo or another control therapy in patients with rheumatoid arthritis, osteoarthritis, soft tissue rheumatism and the fibromyalgia syndrome were selected until half of 1989, using electronic databases. Abstracts and summaries were excluded. The investigation was performed at the department of rheumatology of the Medisch Spectrum Twente hospital at Enschede in cooperation with the department of internal diseases of the Sint Radboud hospital at Nijmegen. For each type of complementary treatment, the results of all the clinical trials were summarized. Furthermore, the placebo-controlled trials were graded according to convincing trials or trials that seemed to be less valid and/or difficult to interpret. Data concerning acupuncture, balneotherapy, dietary measures, enzymic therapy, Seatone, homeopathy, manual therapy and fever few were found. Of these types of complementary medicine in rheumatic diseases, we found no convincing prove that they are more effective than the control or placebo treatment. A considerable number of the studies however can be criticized. It is necessary to perform further studies on the effect of frequently used types of complementary medicine in patients with rheumatic diseases, by or in cooperation with the physicians or paramedics who prescribe or perform these kinds of treatment. This is nearly always possible; directives are given to realize further studies of this kind. If a particular treatment proves to be no more effective than placebo treatment, its use should be discouraged.

Clinical Trials as Topic↗
PubMed1991

Methotrexate versus azathioprine in the treatment of rheumatoid arthritis. A forty-eight-week randomized, double-blind trial.

We conducted a double-blind, randomized trial comparing azathioprine (AZA) and methotrexate (MTX) in the treatment of patients with rheumatoid arthritis in whom parenteral gold and/or D-penicillamine treatment had been unsuccessful. Patients were randomly assigned to receive either AZA (100 mg daily) or oral MTX (7.5 mg weekly). After 8 weeks, the dosage was increased depending on the clinical improvement. Sixty-four patients were followed up for 48 weeks (33 AZA, 31 MTX). Comparison of values at week 24 with baseline values revealed significant improvement in 12 of 13 disease variables in the MTX group and in 6 of 13 in the AZA group. Comparison between the 2 treatment groups at 24 weeks, by area-under-the-curve analysis, showed significantly more improvement in the MTX group in terms of the swollen joint count, pain score, erythrocyte sedimentation rate, C-reactive protein level, hemoglobin level, thrombocyte level, and disease activity score. A significant overall clinical improvement (disease activity score) was found in 7 of 20 patients treated with AZA and 18 of 30 patients treated with MTX after 24 weeks of therapy, and in 6 of 12 AZA-treated patients and 19 of 25 MTX-treated patients after 48 weeks. The number of withdrawals due to side effects was significantly higher in the AZA group. After 48 weeks, only 12 patients from the AZA group (36%), but 25 from the MTX group (81%), were still using the initial drug. These results demonstrate MTX to be superior to AZA in the treatment of rheumatoid arthritis, with a more rapid clinical improvement which is sustained after 1 year, accompanied by a lower rate of serious adverse reactions.

Adrenal Cortex Hormones↗
PubMed1991

Rheumajecta and vasolastine in the treatment of rheumatoid arthritis--the results of a placebo-controlled, double-blind trial of a complementary treatment.

The so called "enzymatic preparations" Rheumajecta and Vasolastine (R & V) belong to the complementary treatments. The preparations have been used for many years in the treatment of patients with rheumatic conditions such as rheumatoid arthritis (RA) in the Netherlands and other countries of Europe, although a proper study showing efficacy was never performed. Therefore a double-blind, placebo-controlled, modified cross-over trial during two periods of 3 months was performed in 34 patients with RA. They were allocated at random to R & V or to placebo injections, all intramuscular. After 3 months of therapy each patient could opt for cross-over in the event of lack of subjective improvement. Clinical assessments including Ritchie's articular index, grip strength, the DUTCH-AIMS questionnaire, ESR and CRP were performed. R & V did not prove to be more effective than placebo. No serious side-effects were seen.

Adolescent↗
PubMed1990

[Rheumajecta and Vasolastine treatment of primary fibromyalgia; results of a randomized placebo-controlled double-blind study].

Rheumajecta and Vasolastine (R and V) are preparations belonging to complementary medicine. They are applied in rheumatic conditions such as primary fibromyalgia. In this double-blind, modified cross-over trial, the effect of R and V injections was compared with that of placebo over two periods of three months in 30 patients with primary fibromyalgia. No significant differences in effectiveness between R and V and placebo were seen. There were no serious side-effects. R and V are not indicated for primary fibromyalgia unless no more effect than that of placebo is intended.

Adult↗
PubMed1990

The effect of pressure gradient and thermolactyl control gloves in arthritic patients with swollen hands.

In this study the effect of pressure gradient gloves was compared with that of control gloves by eight patients with rheumatoid arthritis (RA) and diffusely and symmetrically swollen hands. In the morning at fixed times, grip strength, circumference of PIP joints and proximal phalanges, nocturnal pain and morning stiffness in the hands were measured. Significant improvement of circumference of PIP joints (P less than 0.001) and proximal phalanges (P less than 0.01) were found. On wearing the control gloves, some improvement was also found, but only the circumference of PIP joints decreased significantly (P less than 0.05). Nocturnal pain and morning stiffness diminished significantly on wearing both types of glove. Grip strength improved, but not significantly with both. No significant differences were detected between the effects of wearing the two types of glove. No correlation was found between the decreased swelling in the hands as measured by PIP joint circumference or circumference of the proximal phalanges and the decreased nocturnal pain or morning stiffness. This study provided no explanation for the beneficial effect of the gloves. It was shown that for some patients with painful and swollen hands, wearing gloves at night may give relief.

Aged↗
PubMed1990

Mortality and survival in rheumatoid arthritis: a 25 year prospective study of 100 patients.

One hundred patients with classical (52) or definite (48) rheumatoid arthritis (RA) at one year after onset were followed up for 25 years. By then 63 had died, in one third of whom RA had either directly caused or contributed to death. These patients, at one year after onset of arthritis, had a higher proportion with classical RA and more functional impairment than the rest. Thirty five of the surviving 37 patients were seen for review. Eleven were well with no functional impairment. At one year after onset they had a lower erythrocyte sedimentation rate (ESR) and higher haemoglobin than the others, in whom a poorer outcome was associated with a persistently raised ESR and lower haemoglobin. The initial Rose-Waaler titre was a poor prognostic guide, but a better functional outcome was associated with conversion to seronegativity or a marked fall in rheumatoid factor level.

Adolescent↗
PubMed1990

Sjögren's syndrome in systemic sclerosis. A clinical study of 26 patients.

Features of Sjögren's syndrome were sought in 26 patients with systemic sclerosis and in age- and sex-matched control subjects. The assessments included a structured history to establish symptoms of dry eyes and dry mouth. Schirmer's I and II tear tests. Rose Bengal staining with slit lamp microscopy of the eyes, measurement of basal and stimulatory salivary secretion. We measured sweat secretion rates from the skin. Salivary scintigraphy and skin biopsies were performed on the patients. Only one patient showed the complete picture of Sjögren's syndrome with both clinical and investigational evidence of lacrimal and salivary gland involvement. A further patient had an abnormal Schirmer's II test and xerostomia with reduced salivary secretion and an abnormal scan, but no ocular symptoms and no keratoconjunctivitis sicca on ophthalmological examination. Two patients had reduced salivary flow and a dry mouth. A number of patients and control subjects showed various individual symptoms and signs of lacrimal and salivary disorders. These features alone are not sufficient for the diagnosis of Sjögren's syndrome. There is a clear need to adopt strict criteria for diagnosing the condition. The association of Sjögren's syndrome with systemic sclerosis seems doubtful and if it does occur it is very much less common than previously suggested.

Adult↗
PubMed1989

Evaluation of the Dutch Arthritis Impact Measurement Scales (DUTCH-AIMS) in patients with rheumatoid arthritis.

The Arthritis Impact Measurement Scales (AIMS) have been used to measure health status in patients with rheumatic diseases in North America. In this study, a Dutch version of this self-assessment questionnaire named the DUTCH-AIMS was evaluated in 73 Dutch patients with rheumatoid arthritis. Significant correlations between scores from the DUTCH-AIMS on the one hand and ARA functional class, haemoglobin, erythrocyte sedimentation rate, self-assessments of functional impairment and perceived overall health on the other hand indicate that the scales are valid and provide good estimations of various components of the health status of the Dutch arthritic patient.

Activities of Daily Living↗
PubMed1989

Course and prognosis of early rheumatoid arthritis.

Lessons learned from a 20 year prospective study of 100 Rheumatoid Arthritis (RA) patients are considered. Forty six had died and the causes of death are discussed and correlations with early features; the findings in the survivors and the patterns of the course of arthritis and treatment are described. A loss of life expectancy was observed: the 9 patients whose deaths were due to RA or its systemic complications, died some 15 years prematurely; the 8 in whom RA contributed to death died some 10 years prematurely and in the 29 in whom death was unrelated to RA, death was premature by about 5 years. Already after 1 year of arthritis the functional capacity was reduced in those patients who later died due to RA or in whom RA or its treatment contributed to death. The men died earlier than the women and overall mortality in men was higher despite a younger age at onset. Patients with persistently high ESR and strong seropositivity for rheumatoid factor also did badly. Of the patients, who had died, the functional capacity at last review before their deaths was noted. It appears that already 1-8 years before their deaths 35% of the patients were confined to chair or bed (Steinbröcker grade IV) and 24% markedly restricted (grade III). These figures show that prognosis of RA patients referred to a rheumatologist is probably worse than generally suggested. Rheumatoid arthritis is a severely disabling and potentially lethal disease.

Actuarial Analysis↗
PubMed1989

Sternocostoclavicular hyperostosis or pustulotic arthroosteitis.

We describe a 68-year-old woman who had suffered pain, swelling, heat, and redness in the region of both clavicles for the last 2 years. Her erythrocyte sedimentation rate was markedly elevated; tests for rheumatoid factor were negative. At surgical exploration, ankylosis of the sternoclavicular joints, especially on the left side, was found. Biopsy revealed chronic nonspecific inflammation with new bone formation, consistent with the diagnosis of sternocostoclavicular hyperostosis or pustulotic arthroosteitis.

Aged↗