Biomedical subjects

M L Prevoo

Publications and source records attributed to M L Prevoo.

9 recordsLinked to original sources

PubMed2000

No increased mortality in patients with rheumatoid arthritis: up to 10 years of follow up from disease onset.

OBJECTIVE: To investigate mortality, functional capacity, and prognostic factors for mortality in an inception cohort of patients with recently diagnosed RA followed up for up to 10 years. METHODS: The observed mortality of this inception cohort with recently diagnosed RA, was analysed in relation to the expected mortality, calculated with the aid of life tables of the general population of the Netherlands (matched for age and sex). Functional capacity was measured by the Health Assessment Questionnaire. Prognostic factors for mortality were analysed multivariately by the Cox proportional hazards model. RESULTS: Between January 1985 and April 1997, 622 patients entered the study, and were included in the analysis of mortality. The death rate in the first 10 years of the disease was not significantly different from that of the general population. Fifty five patients from the study group died (16% up to 10 years of follow up). The most commonly reported causes of death were of cardiovascular and respiratory origin. The other causes of death could be classified into cancer, sepsis, amyloidosis, leukaemia, renal insufficiency of unknown cause, perforation of the oesophagus, probably related to the treatment with non-steroidal anti-inflammatory drugs, and pancytopenia during aurothioglucose treatment. Functional capacity improved significantly during the first six years compared with the value at start. Statistically significant predictors for death were age at the start and male sex. CONCLUSIONS: In contrast with earlier studies performed, no excess mortality in the first 10 years of an inception cohort of patients with RA was seen. In addition, the functional capacity was relatively constant during the first six years after an initial improvement from baseline. Age at start and male sex were the only statistically significant predictors for death.

Adolescent↗

PubMed2000

Disease associated time consumption in early rheumatoid arthritis.

OBJECTIVE: To quantify the disease associated time consumption of normal activities of daily living and of treatment and monitoring activities in a cohort of patients with early rheumatoid arthritis (RA) with followup of at least 6 years. Comparison was made with a group of patients with asthma and chronic obstructive pulmonary disease (COPD). METHODS: A prospective and retrospective inventory was carried out, by interview and record investigation, of RA related and RA unrelated items covering the period from the start of the disease. Interviews were also performed in a group of patients with asthma and COPD. RESULTS: For patients with RA there was a mean disease associated time consumption of at least 1.9 h/day during the first 6 years of the disease. The time consumption was mainly due to extra time needed for activities of daily living and daily disease related activities. Patients with the greatest progression of radiographic damage, with the most severe disability, and with the greatest cumulative disease activity had the greatest time consumption. For patients with asthma and COPD the consumption of time was comparable. CONCLUSION: RA is a time consuming disease. Recognition of the disease associated time consumption will have implications for work (dis)ability assessments in patients with chronic diseases such as RA.

Adolescent↗

PubMed1999

Socio-economic consequences of rheumatoid arthritis in the first years of the disease.

OBJECTIVE: Few data have been presented to document the impact of rheumatoid arthritis (RA) on socio-economic well-being. In this study, exact figures on socio-economic consequences were assessed. METHODS: The socio-economic consequences were studied in an inception cohort (186 early RA patients, mean disease duration 3 yr) by measuring the change in work capability, income, rest during the daytime, leisure time activity, transport mobility, housing and social support occurring in the first years of the disease. RESULTS: For 89% of the patients, RA had an impact on one of the socio-economic items; for 58%, at least three of these items were affected simultaneously. Work disability appeared to be 4-15 times higher than in the general population. After 3 yr, 42% of the patients were registered as work disabled. Nearly a quarter of the patients experienced income reduction. Over 40% of the patients claimed extra rest during the daytime. Leisure activity changed towards activities with a lower joint load. There was a decline in transport mobility for 52% of the patients. Social support increased strongly. CONCLUSIONS: Socio-economic change already presents in the first years of RA and appears to be influenced by age, gender, marital status and work disability. Furthermore, physical limitation appeared to be predictive for work-related income reduction, reduced transport mobility and development of social dependency.

Activities of Daily Living↗

PubMed1997

Radiographic damage in large joints in early rheumatoid arthritis: relationship with radiographic damage in hands and feet, disease activity, and physical disability.

An assessment of the onset of radiographic damage in the large joints (hip, knees, shoulders, elbows, ankles and tarsus) in patients with early rheumatoid arthritis, and the relationship of the progression of large joint damage with joint damage in hands and feet, with physical disability, and with cumulative disease activity, was performed in a prospective 6 yr follow-up study. Large joint damage appeared to be an early phenomenon with 20% of the patients having some damage in at least one large joint within 1 yr, and 50% of the patients within 6 yr after disease onset. Radiographic damage in large joints was significantly related to the damage in hands and feet, the physical disability index, and the cumulative disease activity. The initial disease activity at study entry was the only prognostic factor that reached significance.

Adolescent↗

PubMed1996

Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria.

OBJECTIVE: To validate the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), and the World Health Organization (WHO)/International League Against Rheumatism (ILAR) response criteria for rheumatoid arthritis (RA). METHODS: EULAR response criteria were developed combining change from baseline and level of disease activity attained during follow up. In a trial comparing hydroxychloroquine and sulfasalazine, we studied construct (radiographic progression), criterion (functional capacity), and discriminant validity. RESULTS: EULAR response criteria had good construct, criterion, and discriminant validity, ACR and WHO/ILAR criteria showed only good criterion validity. CONCLUSION: EULAR response criteria showed better construct and discriminant validity than did the ACR and the WHO/ILAR response criteria for RA.

Adult↗

PubMed1996

Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score.

In a prospective follow-up study of patients with early-onset rheumatoid arthritis, the prevalence of remission according to the 1981 American Rheumatism Association (ARA) preliminary criteria was evaluated. A total of 227 patients with a median follow-up of 3.9 yr and a total of 2832 follow-up visits were studied. The ARA remission criteria were fulfilled in 9.5% of these visits. The percentage of patients with at least one visit fulfilling the ARA criteria was for years 2-6 approximately 25%. Each year, approximately 15% of the patients were in remission for at least two consecutive visits. A comparison was made between the ARA remission criteria and the Disease Activity Score (DAS). DAS < 1.6 corresponded with being in remission according to the ARA criteria. The DAS is being proposed as a tool to define remission because absence of disease activity should be measured using the same method as for higher levels of disease activity, preferably on a continuous scale.

Arthritis, Rheumatoid↗

PubMed1996

Validity and reproducibility of self-administered joint counts. A prospective longitudinal followup study in patients with rheumatoid arthritis.

OBJECTIVE: To investigate the reproducibility and validity of self-administered joint counts (JC), measuring tenderness, swelling and the combination of both, in a longitudinal study. METHODS: At the outpatient department a form self-administered by patients (SAI-form), was used to measure joint involvement. Concurrent joint examinations were performed by an assessor. The JC and scores for groups of joints by assessors were correlated with those by patients. As a retest the form was completed again by the patients within 10 days. Correlations between the JC measured by the test and retest were computed to investigate reproducibility. RESULTS: Correlations between test and retest were high (> 0.7). Correlations between JC and groups of joints measured by the assessors and by the patients were moderate (0.06). Correlations with other disease activity variables did not differ between assessors' and patients' joint examination scores. CONCLUSION: The patient-administered joint examination was reproducible; however, correlation with the assessors' joint examination was moderate. The value of the self-administered joint count needs further examination and cannot yet replace the assessor's joint examination.

Adult↗

PubMed1995

Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis.

OBJECTIVE: The development and validation of Modified Disease Activity Scores (DAS) that include different 28-joint counts. METHODS: These scores were developed by canonical discriminant analyses and validated for criterion, correlational, and construct validity. The influence of disease duration on the composition of the DAS was also investigated. RESULTS: No influence of disease duration was found. The Modified DAS that included 28-joint counts were able to discriminate between high and low disease activity (as indicated by clinical decisions of rheumatologists). CONCLUSION: The Modified DAS are as valid as disease activity scores that include more comprehensive joint counts.

Adult↗

PubMed1993

Validity and reliability of joint indices. A longitudinal study in patients with recent onset rheumatoid arthritis.

This prospective longitudinal study evaluates the validity and reliability of joint indices (JIs) used to measure disease activity in patients with RA. From seven traditional JIs (Ritchie Articular Index (RAI), Modified RAI, Thompson score, 28 JI, 36 JI, total tender and total swollen joints) 37 'new' JIs were computed by considering three different characteristics of joint inflammation, tenderness, swelling and the combination of tenderness and swelling, and by grading for tenderness and/or weighting for surface area of the joints. Several aspects of validity were investigated, the construct (correlation with radiographic damage), correlational (correlation with ESR, general health) and criterion validity (correlation with a Health Assessment Questionnaire, discrimination between high and low disease activity). It was found that the validity and reliability of traditional JIs do not differ substantially. Graded JIs are almost always more valid than ungraded JIs. Weighted JIs are almost always less valid and reliable than unweighted JIs. Therefore no JI proved to be superior for measuring the disease activity under consideration. Taking simplicity into account the 28 JI, not graded and not weighted, was preferable.

Aged↗