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Biomedical subjects

Janet E Pope

Publications and source records attributed to Janet E Pope.

7 recordsLinked to original sources
PubMed2003

Musculoskeletal involvement in scleroderma.

Scleroderma can be accompanied by arthralgias, inflammatory arthritis, flexion contractures, nerve entrapment, myositis, or myopathy. Antibodies in scleroderma can occur in other connective tissue diseases; overlap syndromes between scleroderma and Sjogren's syndrome, lupus, and rheumatoid arthritis are reported. Many of the musculoskeletal symptoms in scleroderma are treated symptomatically; most treatments are not proven in randomized controlled trials in these patients. Musculoskeletal manifestations are a major cause of morbidity and disability in scleroderma.

Humans↗
PubMed2003

Are subjects satisfied with the informed consent process? A survey of research participants.

OBJECTIVE: Letters of information (LOI) for clinical trials are becoming longer and more complicated. We investigated patients' perspectives of their ability to understand the information presented during a clinical trial. Satisfaction with and motivation for participation in clinical trials were also ascertained. Perceptions from various treatment disciplines were compared. METHODS: Participants were chosen from 14 clinical trials (departments of rheumatology, ophthalmology, and cardiology) conducted at the same university. Subjects were asked to complete a written questionnaire that assessed demographic information, recall and understanding of information, subjects' decisions to participate, and perceptions/opinions of the study. The response rate was 75% (rheumatology, n = 74; ophthalmology, n = 32; cardiology, n = 84). RESULTS: The majority of respondents (98%) indicated that they were satisfied with the informed consent process and with their involvement in a trial (97%). Subjects who reported having understood the LOI had better recall of placebo/active drug comparator (p < 0.03), and better understanding of why placebo was used (p < 0.04). No differences were found between those who reported understanding and those who did not on understanding the concept of concealed allocation (blinding). Subjects who felt they had received "the right amount of information" were more likely not to understand concealed allocation. The most frequent reason for trial participation was to help medical science (80%). Subjects with higher education were more likely to understand the reason for placebo use (p < 0.0003), but were not more likely to understand concealed allocation (p < 0.08). CONCLUSION: Subjects reported that they were satisfied with the informed consent process and their experience in a clinical trial, and that they understood trial concepts. Subjects may be able to self-assess their own level of understanding for trial concepts that intrinsically make sense within the context of their beliefs about medical care, but other trial concepts may be misunderstood/misinterpreted regardless of self-assessment of understanding or education level (i.e., concealed allocation). Subjects may prefer to believe that investigators know which treatment they are receiving, and have made a good treatment decision specific to their case, despite having being told about concealed allocation and placebo use.

Adult↗
PubMed2002

Scleroderma overlap syndromes.

Scleroderma is a connective tissue disease that causes fibrosis and vascular abnormalities, but that also has an autoimmune component. Many patients with scleroderma have a positive antinuclear antibody, and there can be family histories of other connective tissue diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis. Some patients have features of scleroderma and other autoimmune conditions. This article will review recent literature to help in the understanding of scleroderma with overlap features. Recent reports of scleroderma overlap with rheumatoid arthritis suggest distinct features of diffuse scleroderma with positive Scl-70, pulmonary fibrosis, and later seropositive erosive rheumatoid arthritis. SLE rarely occurs with scleroderma. Sjögren syndrome symptoms are common in scleroderma. In primary Sjögren syndrome, anticentromere antibody positive patients have more Raynaud phenomenon. Antibodies that occur in scleroderma that are thought to be specific are present in other connective tissue diseases. For instance, Scl-70 antibody is reported in as many as 35% of patients with scleroderma but can be present in 25% of patients with SLE. Myositis or myopathy can be features of scleroderma. Scleroderma overlap with polymyositis is frequently anti-PM Scl antibody positive, whereas anti-Jo-1 does not normally occur in the overlap of scleroderma and polymyositis but is usually exclusively positive in polymyositis with arthritis and alveolitis. A better prognosis is found with PM Scl antibody in myositis. Vasculitis is not a typical feature of scleroderma, but has been reported. Eosinophilic fasciitis is rare, and the onset could be associated with simvastatin.

Arthritis, Rheumatoid↗
PubMed2002

Prescribing trends in disease modifying antirheumatic drugs for rheumatoid arthritis: a survey of practicing Canadian rheumatologists.

OBJECTIVE: To determine the prescribing and monitoring practices of disease modifying antirheumatic drugs (DMARD) for Canadian rheumatologists in their treatment of rheumatoid arthritis (RA). METHODS: A survey questionnaire was mailed to 279 rheumatologists with a 70% response rate after 2 mailings. RESULTS: Antimalarials are prescribed commonly, with the preference being hydroxychloroquine (HCQ). For antimalarials, 78% do not routinely monitor laboratory results. There was wide variability in monitoring for ocular complications. Thirty-eight percent of rheumatologists never do a baseline eye examination and 39% always do. All rheumatologists frequently use methotrexate (MTX) in RA. The reported mean maximum dose for MTX was 25.1 mg/week (range 7.5-50), with 86% routinely using folate. Ninety-eight percent prescribe sulfasalazine (SSZ) for RA. Mean maximum dose prescribed for SSZ was 2.8 g/day. Most never used oral gold, while IM gold was used by 95%. Only 9% frequently use azathioprine in RA, to a mean maximum dose of 185 mg/day. Less commonly prescribed DMARD included cyclosporine (66% frequently; 25% never) and D-penicillamine (2% frequently; 53% never). There was a wide range of what exactly was monitored with respect to laboratory tests, and at what frequency, for many of the DMARD. Nearly all (99%) used combination DMARD, the most popular combination being MTX-HCQ. There were some significant differences in treatment trends when comparing year of fellowship completion, but no sex or type of practice differences were found. Those completing fellowships prior to 1984 were more likely to prescribe azathioprine (p < 0.03), chloroquine (p < 0.01) and chronic steroids (p < 0.1) in RA. There was, however, regional variability in the use of IM gold and newer DMARD--they were most prescribed in Western Canada and least in Quebec. Cyclosporine was prescribed most frequently in Quebec compared to Western Canada and least in Ontario and the Atlantic Provinces. CONCLUSION: Canadian rheumatologists are fairly similar in their use of common DMARD and combination therapies in RA. There is variability in the use of some older medications including azathioprine and chloroquine, depending on when rheumatology training was completed, and use of some drugs varies by region.

Antirheumatic Agents↗
PubMed2002

Increased prevalence of scleroderma in southwestern Ontario: a cluster analysis.

OBJECTIVE: To estimate the prevalence of scleroderma (systemic sclerosis, SSc) in 3 cities, Windsor, Sarnia, and Woodstock, Ontario, within our referral area, which has a referral base population of 1 million. METHODS: To compare the addresses and exposures of referrals with SSc, we performed a case control study using our patients with scleroderma and 2 age and sex matched controls from the same rheumatologist's practice. RESULTS: Sixty-seven of 91 patients with SSc and 87 of 154 controls responded. The mean age of patients with SSc was 53.2 years versus 52.8 years in controls. There was no statistically significant increase in the number of SSc patients from Windsor (population 197,694): 14 patients (15.4%) with SSc versus 18 controls (11.6%) (p < 0.41); or Sarnia (population 72,738): 7 patients (7.7%) with SSc versus 7 controls (4.5%) (p < 0.31). However, there were 9 cases (9.9%) from Woodstock (population 32,086) versus one control (0.64%) (p < 0.0004). The point prevalence of scleroderma was at least 0.71/10,000 in Windsor, 0.96/10,000 in Sarnia, and 2.8/10,000 in Woodstock. There were no significant between-group differences in exposure to industrial toxins or chemicals including vinyl chloride, silica, and benzene, but exposure rates in both groups were low. Occupations and proportion of those who were work disabled were not different. Patients with SSc were not more likely to have smoked cigarettes (p < 0.43); however, they were more likely to drink at least 6 drinks of alcohol per week (p < 0.04) and had more dental fillings (p < 0.05). Patients with SSc knew on average 3.2 others with this disease, and controls knew only 0.25 others with scleroderma (p < 0.00001). Two patients with SSc knew someone with SSc in their workplace versus none of the controls. CONCLUSION: Our a priori expected higher prevalence of scleroderma in Windsor and Sarnia did not reach significance, but the cluster in Woodstock seems statistically validated, and the exact reason for this cluster remains unclear. It is unlikely that all patients with SSc in Woodstock were seen by us, so the prevalence of scleroderma is at least 2.8/10,000, which is a medium to high prevalence compared to other studies. Associations with alcohol and dental fillings require further study.

Adult↗