Clinical rheumatology
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Clinical rheumatology · Jan 2016
Associations between pre-operative radiographic osteoarthritis severity and pain and function after total hip replacement : Radiographic OA severity predicts function after THR.
Total hip replacement (THR) is an effective procedure for alleviating pain and improving function in majority of patients with end-stage osteoarthritis (OA). Clinically, meaningful improvement in pain and function after surgery is not universal, and the reasons for this are unclear. We investigated whether radiographic OA severity was a determinant of pain and disability experienced by patients after THR. The Harris hip score (HHS) was collected pre-operatively and at 1 and 2 years after primary THR (N = 382). The main independent variable was the modified Kellgren-Lawrence grade, which was assessed from the pre-operative radiographs. The outcome variable was response to surgery at 1 and 2 years. The minimum important difference (MID) in the HHS pain and function scores were used to determine response to surgery. This was based on achieving half the standard deviation in change in scores at 1 year. Regression models were created to assess the relationships between pre-operative x-ray findings and pain and function. Based on the MID, 96.2 and 95.5% of patients demonstrated an improvement in pain, and 81.2 and 78.3% of patients demonstrated an improvement in function at 1 and 2 years. Odds ratios for demonstrating an MID in both pain and functions scores for patients with less severe baseline radiographic changes were significantly lower at 1 and 2 years when compared to those with severe radiographic changes. Patients with less severe pre-operative radiographic hip damage are least likely to have substantial gains in terms of pain relief and improved function as a result of a THR. ⋯ Level III, prognostic study.
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Clinical rheumatology · Jan 2016
Observational StudyInsulin resistance and levels of adipokines in patients with untreated early rheumatoid arthritis.
The aim of this study is to investigate the presence of insulin resistance (IR) in patients with untreated early rheumatoid arthritis (ERA) and its relationship with adipokines, inflammatory cytokines, and treatment. In this prospective study, we enrolled 46 ERA patients with a disease duration of <1 year, and 45 sex-, age-, race-, and body mass index (BMI)-matched controls. Patients and controls with diabetes or a history of glucocorticoid (GC) or disease-modifying antirheumatic drugs (DMARDs) use were excluded. ⋯ Furthermore, adiponectin and resistin concentrations decreased slightly. Our data suggest that IR is not present in ERA patients either at diagnosis or at 6 months after treatment. However, symptom duration and fat mass appear to be related.
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Clinical rheumatology · Jan 2016
Predictive factors of rapidly progressive-interstitial lung disease in patients with clinically amyopathic dermatomyositis.
Clinically amyopathic dermatomyositis (CADM) is a unique subset of dermatomyositis, showing a high incidence of lung involvements. The aim of this study is to identify risk factors, other than melanoma differentiation-associated protein (MDA)-5, for developing rapidly progressive-interstitial lung disease (RP-ILD) in patients with CADM. Forty CADM patients, in whom 11 patients developed RP-ILD, were enrolled. ⋯ Multivariate logistic regression analysis indicated that anti-MDA5 Ab(+), elevated CRP, and decreased counts of lymphocyte were independent risk factors for RP-ILD, which can provide a precise predict for RP-ILD in CADM patients. When anti-MDA5 Ab(+) was removed from the multivariate regression model, using skin ulcerations, elevated serum ferritin and decreased counts of lymphocyte can also precisely predict RP-ILD. Except for MDA-5, more commonly available clinical characteristics, such as skin ulcerations, serum ferritin, and count of lymphocyte may also help to predict prognosis in CADM.