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Biomedical subjects

J W Bijlsma

Publications and source records attributed to J W Bijlsma.

At least 19 recordsLinked to original sources
PubMed1995

Prediction of progression of radiologic damage in newly diagnosed rheumatoid arthritis.

OBJECTIVE: To investigate the extent to which early radiologic damage is predicted by joint inflammation in patients with newly diagnosed rheumatoid arthritis (RA). METHODS: Regression analysis was performed on 1-year progression of total radiologic damage for baseline characteristics and cumulative disease activity measures, and the effects of continued joint inflammation on the progression of damage in separate joint groups were investigated. RESULTS: Odds ratios for progression of total damage were 12 for the presence of rheumatoid factor, 5 for the presence of damage at baseline, and 2 for cumulative joint inflammation. A positive association between continued joint inflammation and progression of damage was found to be statistically significant for most joint groups. CONCLUSION: Progression of radiologic damage in patients with newly diagnosed RA is independently associated with the presence of rheumatoid factor and damage at baseline and with cumulative joint inflammation.

Adult↗
PubMed1995

Effects of methotrexate on human osteoblasts in vitro: modulation by 1,25-dihydroxyvitamin D3.

This study was designed to investigate whether methotrexate (MTX), used in the treatment of rheumatoid arthritis (RA), affects proliferation and differentiation of human osteoblasts in culture. The effects of MTX were assessed by analyzing markers of proliferation and differentiation of human trabecular bone-derived osteoblast-like cells cultured in the presence or absence of 1,25-dihydroxyvitamin D3 (1,25[OH]2D3). Treatment of the osteoblastic cells with MTX resulted in a strong dose-dependent inhibition of cell proliferation with half maximal response at a dose of 30 nM. MTX did not interfere with cellular alkaline phosphatase (AP) activity, the number of cells expressing cytochemical AP, or basal osteocalcin production. Addition of 1,25(OH)2D3 to the cultures caused an enhanced AP expression and osteocalcin production coinciding with a decreased osteoblast proliferation. Coincubation of 1,25(OH)2D3 with MTX in doses > or = 100 nM further inhibited osteoblast growth and induced a significant stimulation of AP expression and activity, and production of osteocalcin above the values reached in the 1,25(OH)2D3 cultures. In conclusion, MTX proved to be a potent inhibitor of osteoblast proliferation but did not affect basal osteoblastic phenotypic expression. In the presence of the osteoblast differentiation-promoter, 1,25(OH)2D3, MTX further inhibited cell growth which was associated with enhanced AP activity and osteocalcin production. Thus, MTX may have profound effects on bone metabolism and remodeling by interfering with bone cell turnover.

Alkaline Phosphatase↗
PubMed1995

Changes in calcium and bone metabolism during treatment with low dose prednisone in young, healthy, male volunteers.

The effect of low dose prednisone on calcium and bone metabolism was evaluated in 8 healthy, young, male volunteers. Sodium and calcium intake were kept stable during the whole study period of 7 weeks. Week 0 was the baseline period; during week 1, 3 and 5 prednisone (10 mg/day) was given, during week 3 together with 500 mg elementary calcium and during week 5 with 4000 IU vitamin D on alternate days. During week 2, 4 and 6 no medication was given. No changes occurred in fasting urinary excretion of calcium or hydroxyproline, nor in serum levels of alkaline phosphatase, 25-Vitamin D, PTH, creatinine and inorganic phosphorus. A rapid decrease of serum osteocalcin during prednisone intake was found (p<0.01). This dip also occurred during prednisone and vitamin D treatment, but did not occur when calcium was added to prednisone, although the baseline value was lower at the start of combined treatment with prednisone and calcium. Serum calcium decreased during prednisone (p<0.05), but when prednisone was given together with calcium, an increase of serum calcium was found (p< 0.05). It is concluded that 10 mg prednisone/day decreases bone formation, as shown by its effect on osteocalcin, while no influence is seen on bone resorption. Thus, prednisone, even when used in low doses, influences bone metabolism by uncoupling bone formation (decreased) and bone resorption (unchanged). These data suggest that the Cs-associated decrease in serum osteocalcin and in serum calcium does not occur during calcium suppletion.

Adult↗
PubMed1995

The effect of cognitive behavior therapy in patients with rheumatoid arthritis.

In order to examine the effectiveness of cognitive behavioral therapy for patients with rheumatoid arthritis (RA) three patients groups were studied: a cognitive behavioral therapy group (CBT), an occupational therapy group (OT), and a waiting-list control group. The CBT received a comprehensive, 10-session treatment package that taught progressive relaxation, rational thinking and the differential use of pain coping strategies. CBT resulted in minor changes in pain coping behavior at posttreatment, while CBT and OT showed an increase of knowledge of RA. No therapeutic effects with regard to health status were demonstrated at posttreatment and at 6 months follow-up. Clinical and laboratory measures of disease activity revealed progressive deterioration of the patients during the course of the study. It is suggested that the ineffectiveness of CBT might be due to the progressive course of RA in the patients studied, as well as to the rather small changes in coping behavior.

Activities of Daily Living↗
PubMed1995

Proinflammatory cytokine production and cartilage damage due to rheumatoid synovial T helper-1 activation is inhibited by interleukin-4.

OBJECTIVES: To investigate the role of T helper-1 cell (Th1) activation in the induction of proinflammatory cytokine production and cartilage damage by rheumatoid arthritis (RA) synovial fluid mononuclear cells (SFMNC) and the subsequent possible beneficial role of the T helper-2 cell (Th2) cytokine interleukin-4 (IL-4) in the inhibition of this process. METHODS: SFMNC were stimulated with bacterial antigen (hsp60) to activate Th1 cells. Th1 and Th2 specific cytokine profiles (interferon gamma (IFN gamma) and IL-4) and proinflammatory cytokines interleukin-1 (IL-1) and tumour necrosis factor alpha (TNF alpha) in the conditioned media were analysed. In addition, the conditioned media were tested for their ability to induce cartilage damage. The same parameters were measured in the presence of IL-4. RESULTS: Stimulation of SFMNC with bacterial antigen resulted in an increase in IFN gamma, IL-1, and TNF alpha production which was accompanied by the induction of cartilage damage. Th1 activation could be inhibited by IL-4 as shown by a reduction of IFN gamma. This was accompanied by a decrease in IL-1 and TNF alpha production and inhibition of cartilage damage. CONCLUSIONS: Th1 activation is a possible mechanism by which inflammation in RA joints is enhanced. The Th2 cytokine IL-4 inhibits this Th1 activity and may diminish inflammation and induction of cartilage damage in RA joints.

Adult↗
PubMed1995

Are tender point scores assessed by manual palpation in fibromyalgia reliable? An investigation into the variance of tender point scores.

To determine the reliability of tender point assessment by manual palpation in patients with fibromyalgia, and to investigate the sources of variance, tender point scores by manual palpation were obtained in 30 fibromyalgia patients by 2 investigators; the assessments were repeated after 1 week. Test-retest stability and inter-observer agreement of tender point scores was moderate to high. The most important sources of variance were inter-individual patient differences in (1) mean tenderness (pain thresholds) and (2) tender point profiles (consistent intra-individual differences between the 14 tender point scores), and (3) residual variance, not attributable to any systematic effect (error). It is concluded that the reliability of tender point assessment by manual palpation is acceptable. It seems to be not less than reliability of assessment by pressure algometer. Tender point scores in fibromyalgia reflect individual differences in mean pain thresholds as well as individual tender point profiles.

Adult↗
PubMed1995

Is it possible to predict the first year extent of pain and disability for patients with rheumatoid arthritis?

OBJECTIVE: To investigate prediction of the extent of suffering during the first year of rheumatoid arthritis (RA) with patient characteristics found to be capable of predicting short term or longterm endpoint disability. METHODS: Ninety-five patients with recently diagnosed RA, participating in a prospective clinical trial, were seen every 3 mo during 1 year. The 12 month and cumulative values of disability (Dutch version of the Health Assessment Questionnaire) and pain (visual analog scale) were related to demographic, clinical, laboratory, and psychological mood variables in correlation and regression analyses. RESULTS: Baseline values of disability and pain were related most strongly to 12 mo and cumulative values of disability; baseline pain was virtually the only important predictor of 12 mo and cumulative pain. Other baseline characteristics had virtually no additional predictive power. CONCLUSION: The short term disease course of RA in terms of disability and pain is most strongly related to the baseline values of these variables, and cannot reliably be predicted with frequently recognized longterm prognostic factors, such as rheumatoid factor status or sex.

Arthritis, Rheumatoid↗
PubMed1995

Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report.

We applied joint distraction using an Ilizarov apparatus in 11 patients with post-traumatic osteoarthritis of the ankle to try to delay the need for an arthrodesis. Distraction for three months resulted in clinical improvement in pain and mobility for a mean of two years, with an increase in the joint space. We considered that these effects may be produced by the absence of mechanical stress on the cartilage combined with the intra-articular hydrostatic pressures during distraction. We measured these pressures during walking with distraction, and found levels very similar to those reported to improve osteoarthritic cartilage when applied in vitro.

Adult↗
PubMed1995

Association of social support and the spouse's reaction with psychological distress in male and female patients with rheumatoid arthritis.

OBJECTIVE: To determine if social support and the reaction of the spouse to the patient's pain are contributing factors to psychological distress in male and female patients with rheumatoid arthritis (RA). METHODS: Physical, social, and psychological aspects of health were assessed in 97 male and 132 female patients who were living with a spouse. Differences between male and female patients were analyzed by means of analysis of covariance while controlling for age and duration of RA. In multiple regression analyses the influence of social support and reaction of the spouse concerning psychological distress was determined after age, duration of RA, and physical functioning had been controlled. RESULTS: Criticism of the spouse significantly contributed to anxiety in male patients and to depression and anxiety in female patients. In addition, male and female patients differed in the social support resources that contributed to psychological distress. A relatively low number of friends was associated with depression in males. A relatively low level of potential support was associated with more anxiety in females. CONCLUSION: High levels of criticism of the spouse and low levels of social support are associated with more psychological distress in male and female patients. The number of friends is a social support resource in male patients and potential emotional support a resource in female patients.

Anxiety↗
PubMed1994

Endpoint measures in rheumatoid arthritis clinical trials: group summary and individual patient analysis.

OBJECTIVE: To evaluate the responsiveness of measures of disability, discomfort, and disease process in rheumatoid arthritis (RA) clinical trials, when used as group summary variables and as variables of individual patient improvement. METHODS: Disease outcome and process measures were assessed in 97 patients with RA of recent onset, who were participating in a prospective trial comparing the effectiveness of several drug treatment strategies. Measurements were done after 3 and 6 months of treatment. Group summary analysis was performed with tests of statistical significance of changes, and by calculating effect sizes (i.e., mean change in an endpoint divided by its standard deviation). Individual patient improvement was defined as improvement of > or = 33% compared to baseline, according to recommendations of the recently held Conference on Outcome Measures in Rheumatoid Arthritis Clinical Trials. RESULTS: Almost all mean group changes in endpoints were statistically significant (p < 0.001). Effect sizes and figures on individual patient improvement provided additional information: physical discomfort measures were rapidly responding measures that did not further improve after 3 months; disease process measures, joint count, erythrocyte sedimentation rate and C-reactive protein also responded quickly and kept improving up to 6 months; the disability measures were relatively unchanged at 3 months, and only the self-report questionnaire score showed considerable improvement at 6 months. CONCLUSION: Effect sizes and data on patients who showed clinical improvement in disease process or outcome measures offset the strongly significant p values of statistical tests for almost all endpoint measures. Although discomfort measures rapidly responded to therapy, disability and disease process measures may not reach optimal improvement within 6 months.

Antirheumatic Agents↗
PubMed1994

Influence of corticosteroid pulse therapy on the serum levels of soluble interleukin 2 receptor, interleukin 6 and interleukin 8 in patients with rheumatoid arthritis.

OBJECTIVE: To investigate the influence of corticosteroid pulse (CP) therapy on soluble interleukin 2 receptor (sIL-2R), interleukin 6 (IL-6) and IL-8 levels in patients with active rheumatoid arthritis (RA). METHODS: Twenty-five patients with active RA were studied before and after treatment with intravenous CP therapy. In 12 patients lymphocyte subsets were also assessed. RESULTS: All patients showed a significant decrease in clinical disease activity variables after 4 to 8 weeks of CP therapy. Baseline levels of sIL-2R were higher among patients with active RA than healthy controls; after CP therapy, sIL-2R levels decreased significantly, but not as much as the erythrocyte sedimentation rate or C-reactive protein. In most cases baseline levels of both IL-6 (n = 23) and IL-8 (n = 17) could be measured and both decreased significantly after CP therapy. Cortisol levels were suppressed shortly after CP therapy but had returned to pretreatment values at 4 weeks. After CP therapy there was a temporary increase in the number of HLA-DR positive cells and a decrease in the number of CD3 positive cells, while the CD4/CD8 ratio and IL-2 receptor (CD25) positive cells remained unchanged. CONCLUSION: High dose corticosteroids influence serum levels of sIL-2R, IL-6 and IL-8 in patients with active RA.

Adult↗
PubMed1992

Pain and disability in osteoarthritis: a review of biobehavioral mechanisms.

Pain and disability are cardinal symptoms in osteoarthritis. The literature is reviewed in order to identify causes of these symptoms at the articular, kinesiological, and psychological level. It is concluded that pain and disability are associated with degeneration of cartilage and bone (articular level), with muscle weakness and limitations in joint motion (kinesiological level), and with anxiety, coping style, attentional focus on symptoms, and possibly depression (psychological level). Biobehavioral mechanisms of pain and disability which explain the observed associations are described and the empirical evidence for these mechanisms is evaluated. Methodological and conceptual deficiencies in the research reviewed are pointed out and suggestions for further research are given.

Adaptation, Psychological↗