British journal of rheumatology
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The objective was to carry out a clinical assessment of different cervical mobility measurements in ankylosing spondylitis (AS), including two new tape methods for measuring cervical rotation and lateral bending. A range of cervical movements was measured in 52 consecutive male AS patients and the results correlated with detailed radiological changes in the whole spine and sacroiliac joints. Occiput- and tragus-to-wall distance (OWD/TWD), cervical rotation (CR) and lateral flexion (CLF) using a Myrin inclinometer (My) and a tape method (t), cervical flexion-extension (CFl-CExt/My) motion and chin chest distance (CCD) measurements were taken and repeated (test-retest). ⋯ Cervical lateral flexion is a recommendable measurement for clinical trials in AS. The two new tape methods for measuring cervical rotation and lateral bending were as valid and reliable as the inclinometer method (Myrin), but also quick and easy. Chin-to-chest distance was not among the most valid tests in AS.
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Comparative Study
Loss of bone mineral density in Chinese pre-menopausal women with systemic lupus erythematosus treated with corticosteroids.
The adverse effect of disease and chronic corticosteroid therapy on bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE) has been reported in several studies of Caucasian populations. As the factors controlling bone homeostasis may be different in Asian populations, we measured BMD in 52 pre-menopausal Chinese women (mean age 34.1 +/- 8.0 yr) with SLE (mean disease duration 6.4 +/- 4.5 yr) treated with prednisone (mean daily dose 11.4 +/- 10.8 mg/day). Lumbar spine, hip (total and subregions) and total body BMDs were measured in the SLE patients using dual-energy X-ray absorptiometry (DEXA), and compared with those from healthy controls matched for age, sex and body mass index. ⋯ When BMDs were compared between controls and SLE patients, subgrouped according to those not on calcium and those arbitrarily receiving calcium supplements (1 g/day), significantly lower BMDs were found in those not on calcium compared to both controls and SLE patients on calcium. BMDs in SLE patients on calcium were not different from those in controls. The low prevalence of osteoporosis in our SLE patients (4-6%) suggests significant loss of BMD in Chinese SLE patients on corticosteroid therapy is less than that reported in Caucasians (12-18%).
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Comparative Study
Sleep in rheumatoid arthritis: a comparison with healthy subjects and studies of sleep/wake interactions.
Sleep complaints are frequent in patients with rheumatoid arthritis (RA) and sleep disturbances may contribute to pain and other daytime complaints. The aims of the current study were to compare ambulatory sleep recordings from consecutively selected patients with RA to those obtained in healthy controls, and to study the relationships between sleep structure and clinical symptoms. Sleep recordings were obtained from 41 out-patients with RA and 19 matched controls. ⋯ In conclusion, only the increase in PML and alpha-EEG activity distinguished the sleep in RA patients from that of healthy controls. However, the demonstrated interaction between daytime complaints and sleep patterns may increase the understanding and treatment of the disease. In future research, graphical chain models may improve our understanding of complex relationships between multiple variables.
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The 1 yr incidence, prevalence and wages compensation costs of work loss due to medically certified back pain in the working population of Jersey were identified by analysis of the Social Security database for the year 1994. A total of 2291 subjects absenting due to back pain during this period were followed for up to 3 yr to identify return to work rates and subsequent absences. Incidence and prevalence rates were 5.6 and 6.3%, respectively. ⋯ Work loss was greater for the second absence. The rate of return to work was broadly in line with that suggested by the Clinical Standards Advisory Group (CSAG), but the number still absent at 1 yr was less, suggesting that the CSAG figures for long-term absence may have been overestimated. The influence of compensation systems and unemployment on work-related absence due to back pain is highlighted.
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Randomized Controlled Trial Clinical Trial
Combination of sulphasalazine and methotrexate versus the single components in early rheumatoid arthritis: a randomized, controlled, double-blind, 52 week clinical trial.
To compare the efficacy of sulphasalazine, methotrexate, and the combination of both in patients with early rheumatoid arthritis (RA), not treated with disease-modifying anti-rheumatic drugs previously, we conducted a double-blind, double-dummy, controlled, clinical trial. One hundred and five patients with active, early RA, rheumatoid factor and/or HLA DR1/4 positive were randomized between sulphasalazine (SSZ) 2000 (maximum 3000) mg daily, or methotrexate (MTX) 7.5 (maximum 15) mg weekly, or the combination (COMBI) of both, and were followed up by a single observer for 52 weeks. The mean change over time per patient, including all visits, in Disease Activity Score (DAS) was: SSZ: -1.6 (95% CI -2.0 to -1.2); MTX: -1.7 (-2.0 to -1.4); COMBI: -1.9 (-2.2 to -1.6); the difference week 0-week 52 (SSZ, MTX, COMBI respectively); DAS: -1.8, -2.0, -2.3, Ritchie articular index: -9.2, -9.5, -10.6, swollen joints: -9.2, -12.4, -14.3, erythrocyte sedimentation rate: -17, -21, -28. ⋯ In conclusion, there were no significant differences in efficacy between combination and single therapy, only a modest trend favouring COMBI. The results of MTX and SSZ were very comparable. Nausea occurred more often in the COMBI group: the number of withdrawals due to adverse events did not differ significantly.