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T D Spector

Publications and source records attributed to T D Spector.

At least 199 records · Page 11Linked to original sources
PubMed1991

Clinical signs of early osteoarthritis: reproducibility and relation to x ray changes in 541 women in the general population.

The definition and classification of early clinically apparent osteoarthritis both in clinical situations and in epidemiological surveys remains a problem. Few data exist on the between-observer reproducibility of simple clinical methods of detecting hand and knee osteoarthritis in the population and their sensitivity and specificity as compared with radiography. Two observers first studied the reproducibility of a number of clinical signs in 41 middle aged women. Good rates of agreement were found for most of the clinical signs tested (kappa = 0.54-1.0). The more reproducible signs were then tested on a population of 541 women, aged 45-65, drawn from general practice, screening centres, and patients previously attending hospital for non-rheumatic problems. The major clinical signs used had a high specificity (87-99%) and lower sensitivity (20-49%) when compared with radiographs graded on the Kellgren and Lawrence scale (2+ = positive). When analysis was restricted to symptomatic radiographic osteoarthritis, levels of sensitivity were increased and specificity was lowered. These data show that certain physical signs of osteoarthritis are reproducible and may be used to identify clinical disease. They are not a substitute for radiographs, however, if radiographic change is regarded as the 'gold standard' of diagnosis. As the clinical signs tested seemed specific for osteoarthritis they may be of value in screening populations for clinical disease.

Female↗
PubMed1991

Does estrogen replacement therapy protect against rheumatoid arthritis?

The incidence of rheumatoid arthritis (RA) was compared in 2 cohorts of women aged 35-64. One consisted of 1,075 estrogen replacement therapy (ERT) users and the other was 3,251 women from general practice registers. Screening detected 32 cases; 8 postmenopausal control and 6 ERT women developed RA during the study period 1982-1986. This produced incidence rates of 19.7/10,000 and 12.3/10,000 years of observation for ERT and controls, respectively. The relative risks for ERT was 1.62 (95% CI 0.56-4.74) and reduced towards unity after adjustment for potential confounders. Despite the wide confidence interval, our data do not support the previous observation of a 4-fold reduction in RA incidence in ERT users. Indeed the incidence rate in the exposed group in this study exceeded current population estimates of RA incidence in postmenopausal women. We believe that the high incidence rates could be best explained by the self-selection for estrogen therapy at the menopause of those with undiagnosed joint symptoms. These findings underscore the difficulties in elucidating the relationship between ERT and RA.

Adult↗
PubMed1991

Frequency of osteoarthritis in hysterectomized women.

A previous retrospective study reported a 2-fold increase in hysterectomy rates in women outpatient clinical attenders with osteoarthritis (OA) compared to controls. Our study was undertaken to confirm the findings of a previous case-control study which suggested hysterectomy to be a risk factor for OA. A retrospective cohort study design was used that would reduce the problems of selection bias. One hundred and sixty-two women who had undergone a hysterectomy between 1978 and 1979 (current mean age 53.8) and 164 controls (mean age 54.1) were examined for peripheral joint OA between 1988 and 1989. The screening method was identical for both groups and included a questionnaire, systematic examination of certain joints and radiographs of hands and knees. Women with a previous hysterectomy were found to have significantly higher rates of clinical signs of knee OA and 1st carpometacarpal (CMC) OA than control women without hysterectomy. The results were confirmed when OA was classified by the presence of symptoms alone, and when only radiologically confirmed clinical cases were included. The application of radiological criteria showed significantly smaller medial joint spaces (by digital image analysis) in hysterectomized women, although no differences were found using the Kellgren and Lawrence grading system. The increased risk for knee and CMC persisted after adjustment for possible confounders including age, obesity, parity and smoking status. By contrast frequency of distal interphalangeal and proximal interphalangeal involvement was lower, though not significantly so, than in controls.

Arthrography↗
PubMed1991

Comparison of four articular indices for use in clinical trials in rheumatoid arthritis: patient, order and observer variation.

Using a Latin square design, 4 patients were examined by 4 rheumatologists. Joints were scored for tenderness and inflammation. The Ritchie, the index of the American Rheumatism Association (ARA), the Hart modified Ritchie and a simplified Lansbury index were calculated from the raw data. The results suggest that an articular index consisting of a simple count of tender joints (Hart modified Ritchie) or a simple count of tender or swollen joints (ARA index) are the most reproducible with multiple observers. We suggest that these indices would be most appropriate for multicenter clinical trials.

Arthritis, Rheumatoid↗
PubMed1991

The use of radiographs in assessing the severity of knee osteoarthritis.

Conventional radiographic grading of the knee has been used for 30 years and is based around the presence of osteophytes. About 50% of subjects from the general population meeting traditional radiographic criteria are asymptomatic or have no signs of clinical disease. Recent development in the use of different radiographic grading systems involve more attention to joint space and categorization of discrete radiographic findings. These techniques include new grading scales that use a combination of separate radiographic features; microfocal radiography and digitized image analysis of joint space. It is hoped these might reflect more closely the pathological processes and correlate more closely with clinical severity.

Female↗
PubMed1990

The pill, parity, and rheumatoid arthritis.

We report on a case-control study investigating the relationship of oral contraceptive pill (OCP) use and parity to the development of rheumatoid arthritis (RA). Women with RA were compared with 2 separate control groups, women with osteoarthritis (OA) and women randomly selected from a population-based electoral register. Nulliparity was found to be a risk factor for the development of RA, with age-adjusted odds ratios of 1.82 (95% confidence interval [CI] 1.09-3.03) versus the OA control group and 1.83 (95% CI 1.03-3.06) versus the population control group. Use of OCPs before the age of 35 was negatively associated with RA (odds ratio 0.56, 95% CI 0.29-1.12 versus the OA control group; odds ratio 0.6, 95% CI 0.30-1.17 versus the population control group). Some evidence of a duration-response effect was seen, although the numbers were small. The 2 variables were also multiplicative, with nulliparous non-OCP users having a 4-fold risk of RA compared with parous OCP users. These findings suggest that pregnancy and OCP use have a "protective effect" on the development of RA, although the mechanism remains unclear.

Adult↗
PubMed1990

The protective effect of the oral contraceptive pill on rheumatoid arthritis: an overview of the analytic epidemiological studies using meta-analysis.

The oral contraceptive pill (OCP) has been implicated as having a protective effect on the development of rheumatoid arthritis (RA). The results of 12 studies have now been reported and produced differing results and conclusions. Because of the discrepancy in results and the importance of the issue we undertook a review of the studies and performed a meta-analysis. In all, 9 independent studies satisfied the criteria for selection, 6 case-control design and 3 longitudinal. Using standard meta-analysis techniques, the overall pooled odds ratio for all the studies was 0.68 for the crude results (95% CI 0.58-0.78) and 0.73 for the adjusted results (95% CI 0.61-0.85). The graphical odd-man-out method produced a 94% interval of 0.70-0.72. The pooled odds ratio of the case-control studies was lower than for the longitudinal studies. However, subdividing studies by the type of case source produced a pooled odds ratio for studies using hospital-based cases of 0.49 (95% CI 0.39-0.63) which was considerably less than that of studies using population-based cases: 0.95 (0.78-1.16). This difference was unlikely to have explained by bias due to selection of controls. We suggest that OCP use may not have a "protective effect" on the development of RA but may prevent the progression to severe disease by modifying the disease process.

Arthritis, Rheumatoid↗
PubMed1990

Epidemiology of rheumatoid arthritis: update.

We have highlighted advances and new developments in the epidemiology of rheumatoid arthritis in four major areas. Further research, as suggested by us and others (48) should focus on understanding the mechanisms which underlie the association of etiologic and protective factors with rheumatoid arthritis, and on identifying and modifying prognostic factors associated with long-term morbidity and mortality among patients with rheumatoid arthritis. Major increases in funding provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Arthritis Foundation will be needed to realize such efforts in the United States.

Arthritis, Rheumatoid↗
PubMed1990

Is poor pregnancy outcome a risk factor in rheumatoid arthritis?

Previous work has suggested that prior poor reproductive outcome may be a risk factor in rheumatoid arthritis (RA). A case-control study of 195 women with RA and 462 control women from two different sources is presented here. No increase in rates of spontaneous abortion was seen in the women with RA; indeed a protective effect was seen with an age adjusted odds ratio of 0.6 (95% confidence interval (CI) 0.4 to 0.9). A non-significant increase in stillbirth rates was seen in women with RA, producing an age adjusted odds ratio of 1.5 (95% CI 0.7 to 3.4). No differences in rates of induced abortion were seen. Thus although hormonal and gynaecological factors are undoubtedly important in the aetiology of RA, it was not possible to confirm that prior poor reproductive outcome is a risk factor in RA.

Abortion, Spontaneous↗
PubMed1990

Rheumatoid arthritis.

RA is a common disease with a worldwide prevalence of about 1% with an annual incidence of about 3/10,000 adults. It is two to three times more common in women. There is some evidence that over the last few decades the disease is declining in incidence or severity. Patients with RA have a reduced life expectancy and a one in three chance of becoming disabled, depending on the severity of the disease at onset. The cause of the disease is unknown, although genetic factors account for up to 30% of disease susceptibility. The most important genetic factors are related to HLA-DR4 and DR1, which may have identical regions conferring the risk of disease. Many infectious agents have also been implicated in the etiology of RA, although there is no good epidemiologic evidence to support the laboratory findings. Hormonal and reproductive factors are known to play a major role in disease pathogenesis. Both pregnancy and the oral contraceptive pill are believed to be protective against development of the disease, although they may act by delaying or modifying the course of the disease rather than conferring "immunity".

Arthritis, Rheumatoid↗
PubMed1989

Free and serum testosterone levels in 276 males: a comparative study of rheumatoid arthritis, ankylosing spondylitis and healthy controls.

A cross-sectional study of testosterone levels in 276 males was undertaken. Of these 87 were RA patients, 48 males with AS and 141 were healthy controls. Free and serum testosterone levels were significantly lower in the RA males than in either the AS group or the healthy controls (p less than 0.001). This difference was unaffected by age. No differences were seen in testosterone levels between DR1 or DR4 RA patients compared to those without these antigens. No evidence of hyperandrogenicity was seen in the AS group. The finding that males with RA have lower androgen levels than both normal controls and a disease group with inflammatory spondarthritis supports the hypothesis that male sex hormones may be a protective factor against the development of RA.

Adult↗