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Gibson KA, Kaplan RM, Pincus T, Li T, Luta G. PROMIS-29 in rheumatoid arthritis patients who screen positive or negative for fibromyalgia on MDHAQ FAST4 (fibromyalgia assessment screening tool) or 2011 fibromyalgia criteria. Semin Arthritis Rheum 2024; 66:152361. [PMID: 38360468 DOI: 10.1016/j.semarthrit.2024.152361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND PROMIS-29 T-scores query health-related quality of life (HRQL) in 7 domains, physical function, pain, fatigue, anxiety, depression, sleep quality, and social participation, to establish population norms. An MDHAQ (multidimensional health assessment questionnaire) scores these 7 domains and includes medical information such as a FAST4 (fibromyalgia assessment screening tool) index. We analyzed PROMIS-29 T-scores in rheumatoid arthritis (RA) patients vs population norms and for positive vs negative fibromyalgia (FM) screens and compared PROMIS-29 T-scores to MDHAQ scores to assess HRQL. METHODS A cross-sectional study was performed at one routine visit of 213 RA patients, who completed MDHAQ, PROMIS-29, and reference 2011 FM Criteria. PROMIS-29 T-scores were compared in RA vs population norms and in FM+ vs FM- RA patients, based on MDHAQ/FAST4 and reference criteria. Possible associations between PROMIS-29 T-scores and corresponding MDHAQ scores were analyzed using Spearman correlations and multiple regressions. RESULTS Median PROMIS-29 T-scores indicated clinically and statistically significantly poorer status in 26-29% FM+ vs FM- RA patients, with larger differences than in RA patients vs population norms for 6/7 domains. MDHAQ scores were correlated significantly with each of 7 corresponding PROMIS-29 domains (|rho|≥0.62, p<0.001). Linear regressions explained 55-73% of PROMIS-29 T-score variation by MDHAQ scores and 56%-70% of MDHAQ score variation by PROMIS-29 T-scores. CONCLUSIONS Scores for 7 PROMIS-29 domains and MDHAQ were highly correlated. The MDHAQ is effective to assess HRQL and offers incremental medical information, including FAST4 screening. The results indicate the importance of assessing comorbidities such as fibromyalgia screening in interpreting PROMIS-29 T-scores.
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Affiliation(s)
- Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305
| | - Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University School of Medicine, Chicago, Ill, 60612, USA.
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA; Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg, DK-2000, Denmark
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Sato-Boku A, Tokura T, Kimura H, Ito M, Kishi S, Tonoike T, Ozaki N, Nakano Y, Hosijima H, Tachi N. The Usefulness of the Short Form-8 for Chronic Pain in the Orofacial Region: A Prospective Cohort Study. Cureus 2023; 15:e45586. [PMID: 37868420 PMCID: PMC10587782 DOI: 10.7759/cureus.45586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background and purpose Given that chronic pain has become a major problem in recent years, affecting approximately 30% of the general population, this study used the Japanese version of the Short Form-8 (SF-8) to investigate (1) the quality of life (QOL) of patients with burning mouth syndrome (BMS) or persistent idiopathic facial pain (PIFP) (compared with a Japanese control group) and (2) whether therapeutic intervention improves the QOL and reduces pain (comparison between 0 and 12 weeks) of patients with BMS or PIFP. Materials and methods A total of 63 patients diagnosed with either BMS (n=45) or PIFP (n=18) were included in this study. The diagnostic criteria for BMS and PIFP were established based on the third edition of the International Classification of Headache Disorders. Results Our study results showed that while Physical Component Summary (PCS) in patients with BMS or PIFP improved with treatment, it did not improve to the national standard value (NSV) after 12 weeks of intervention. In contrast, the Mental Component Summary (MCS) improved to the same level as the NSV after 12 weeks of intervention. Conclusions We found that therapeutic intervention improves MCS and reduces pain; however, improving PCS requires time.
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Affiliation(s)
- Aiji Sato-Boku
- Department of Anesthesiology, Aichi Gakuin University, Nagoya, JPN
| | - Tatsuya Tokura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, JPN
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, JPN
| | - Mikiko Ito
- Department of Oral and Maxillofacial Surgery, Aichi Gakuin University, Nagoya, JPN
| | - Shinichi Kishi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, JPN
| | - Takashi Tonoike
- Department of Psychological and Physical Sciences, Aichi Gakuin University, Nagoya, JPN
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, JPN
- Institute for Glyco-core Research (iGcORE), Nagoya University Graduate School of Medicine, Nagoya, JPN
| | - Yumi Nakano
- Department of Psychology and Human Relations, Nanzan University, Nagoya, JPN
| | - Hiroshi Hosijima
- Department of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, JPN
| | - Naoko Tachi
- Department of Anesthesiology, Aichi Gakuin University, Nagoya, JPN
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Gibson KA, Castrejon I, Descallar J, Pincus T. Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care. J Rheumatol 2019; 47:761-769. [PMID: 31474596 DOI: 10.3899/jrheum.190277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To develop feasible indices as clues to comorbid fibromyalgia (FM) in routine care of patients with various rheumatic diseases based only on self-report multidimensional Health Assessment Questionnaire (MDHAQ) scores, which are informative in all rheumatic diagnoses studied. METHODS All patients with all diagnoses complete an MDHAQ at each visit; the 2011 FM criteria questionnaire was added to the standard MDHAQ between February 2013 and August 2016. The proportion of patients who met 2011 FM criteria or had a clinical diagnosis of FM was calculated. Individual candidate MDHAQ measures were compared to 2011 FM criteria using receiver-operating characteristic (ROC) curves; cutpoints to recognize FM were selected from the area under the curve (AUC) for optimal tradeoff between sensitivity and specificity. Cumulative indices of 3 or 4 MDHAQ measures were analyzed as fibromyalgia assessment screening tools (FAST). RESULTS In 148 patients, the highest AUC in ROC analyses versus 2011 FM criteria were seen for MDHAQ symptom checklist, self-report painful joint count, pain visual analog scale (VAS), and fatigue VAS. The optimal cutpoints were ≥ 16/60 for symptom checklist, ≥ 16/48 for self-report painful joint count, and ≥ 6/10 for both pain and fatigue VAS. Cumulative FAST indices of 2/3 or 3/4 MDHAQ measures correctly classified 89.4-91.7% of patients who met 2011 FM criteria. CONCLUSION FAST3 and FAST4 cumulative indices from only MDHAQ scores correctly identify most patients who meet 2011 FM criteria. FAST indices can assist clinicians in routine care as clues to FM with a general rheumatology rather than FM-specific questionnaire.
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Affiliation(s)
- Kathryn A Gibson
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia. .,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center.
| | - Isabel Castrejon
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
| | - Joseph Descallar
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
| | - Theodore Pincus
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
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Schmukler J, Jamal S, Castrejon I, Block JA, Pincus T. Fibromyalgia Assessment Screening Tools (FAST) Based on Only Multidimensional Health Assessment Questionnaire (MDHAQ) Scores as Clues to Fibromyalgia. ACR Open Rheumatol 2019; 1:516-525. [PMID: 31777833 PMCID: PMC6857971 DOI: 10.1002/acr2.11053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/13/2019] [Indexed: 01/06/2023] Open
Abstract
Objective The study was designed to develop fibromyalgia assessment screening tool (FAST) indices based only on multidimensional health assessment questionnaire (MDHAQ) scores as clues to fibromyalgia (FM), analyzed for possible agreement with the 2011 FM criteria. Methods All patients with all diagnoses complete an MDHAQ at each visit in routine care. The MDHAQ includes scores for physical function, pain, global assessment, fatigue, self-report painful joint count, and a 60-symptom checklist. MDHAQ items similar or identical to the 2011 FM criteria symptom severity scale (SSS) and widespread pain index (WPI) components of a polysymptomatic distress scale (PSD) were compiled into continuous MDHAQ-FM-SSS, MDHAQ-FM-WPI, and MDHAQ-FM-PSD indices. Ten candidate MDHAQ scores were analyzed against the 2011 FM criteria using descriptive statistics, Spearman correlations, kappa statistics, and receiver operating characteristic curves for the area under the curve (AUC). MDHAQ candidate variables with the highest AUC were compiled into cumulative MDHAQ-FAST indices of three (FAST3) or four (FAST4) scores. Results The highest AUCs among MDHAQ scores were seen for symptom checklist, painful joint count, fatigue, and pain, which are included in FAST4; FAST3-F excludes pain, and FAST3-P excludes fatigue. AUCs for FAST3-P, FAST3-F, and FAST4, as well as continuous MDHAQ-FM scores, all were greater than 0.92, indicating excellent criterion validity. Kappa statistics versus the 2011 criteria were 0.63-0.68, higher than 0.41-0.47 versus physician ICD-10 diagnoses. Conclusion Pragmatic FAST3, FAST4, and MDHAQ-FM indices are similar to FM criteria to screen for FM in routine care. It is more feasible to collect the same MDHAQ, which is informative in all rheumatic diseases studied, from each patient than to ask different patients with different diagnoses to complete different questionnaires.
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Affiliation(s)
- Juan Schmukler
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Shakeel Jamal
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Theodore Pincus
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
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Cho SK, Kim D, Won S, Lee J, Choi CB, Choe JY, Hong SJ, Jun JB, Kim TH, Koh E, Lee HS, Lee J, Yoo DH, Yoon BY, Bae SC, Sung YK. Factors associated with time to diagnosis from symptom onset in patients with early rheumatoid arthritis. Korean J Intern Med 2019; 34:910-916. [PMID: 29232938 PMCID: PMC6610196 DOI: 10.3904/kjim.2017.113] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 06/20/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/AIMS To identify the factors associated with time to diagnosis after symptom onset in patients with early rheumatoid arthritis (RA). METHODS Early RA patients with ≤ 1 year of disease duration in the KORean Observational study Network for Arthritis (KORONA) database were included in this analysis. Patients were further divided into two groups according to the time to diagnosis from symptom onset: the early diagnosis group (time to diagnosis ≤ 1 year) and the late diagnosis group (time to diagnosis > 1 year). Using the multivariable regression model, we identified factors associated with early diagnosis. RESULTS Among 714 early RA patients, 401 patients (56.2%) and 313 patients (43.8%) were included in the early diagnosis and late diagnosis groups, respectively. The mean disease duration was 0.47 years in the early diagnosis group and 0.45 years in the late diagnosis group. In multivariable model analysis, greater age at onset (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02 to 1.05), high school education or higher (OR, 1.68; 95% CI, 1.14 to 2.47), higher income (OR, 1.48; 95% CI, 1.05 to 2.08), and initial small joint involvement (OR, 1.42; 95% CI, 1.02 to 1.98) were factors associated with early diagnosis. At diagnosis, disease activity scores using 28 joints on diagnosis (3.81 ± 1.44 vs. 3.82 ± 1.42, p = 0.92) and functional disability (0.65 ± 0.61 vs. 0.57 ± 0.62, p = 0.07) did not different between the two groups. However, hand joint erosion on X-ray (37.8% vs. 25.6%, p < 0.01) was more common in the late diagnosis group than the early diagnosis group. CONCLUSION Older onset age, higher educational level and income, and initial small joint involvement were positive factors for early diagnosis of RA.
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Affiliation(s)
- Soo-Kyoung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Department of Rheumatology, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Dam Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Department of Rheumatology, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Soyoung Won
- Department of Rheumatology, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Jiyoung Lee
- Department of Rheumatology, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Chan-Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Department of Rheumatology, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Jung-Yoon Choe
- Department of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seung-Jae Hong
- Department of Rheumatology, Kyung Hee University Medical Center, Seoul, Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Eunmi Koh
- Department of Rheumatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye-Soon Lee
- Department of Rheumatology, Hanyang University Guri Hospital, Guri, Korea
| | - Jisoo Lee
- Department of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Dae-Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Bo Young Yoon
- Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Department of Rheumatology, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
- Correspondence to Yoon-Kyoung Sung, M.D. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-9207 Fax: +82-2-2298-8231 E-mail:
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Department of Rheumatology, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
- Correspondence to Yoon-Kyoung Sung, M.D. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-9207 Fax: +82-2-2298-8231 E-mail:
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Elfering A, Cronenberg S, Grebner S, Tamcan O, Müller U. Measuring limitations in activities of daily living: a population-based validation of a short questionnaire. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2017; 25:17-26. [PMID: 29016244 DOI: 10.1080/10803548.2017.1388621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE A newly developed questionnaire assessing limitations in activity of daily living (LADL-Q) that should improve assessment of LADL is tested in a large population-based validation study. METHODS This survey was paper-based. Overall, 16,634 individuals who were representative of the working population in the German-speaking part of Switzerland participated in the study. Item analysis was used the final version of the LADL-Q to four items per subscale that correspond to potential problems in three body regions (back and neck, upper extremities, lower extremities). Analysis included tests for reliability, internal consistency, dimensionality and convergent validity. RESULTS Test-retest reliability coefficients after 2 weeks ranged from 0.82 to 0.99 (Mdn = 0.87), with no item having a coefficient below 0.60. The median item-total coefficients ranged between moderate and good. Correlation coefficients between LADL-Q subscales and three validated clinical instruments (Western Ontario and McMaster Universities osteoarthritis index, shoulder pain disability index, Oswestry) ranged from 0.63 to 0.81. In structural equation modeling the three subscales were significantly related with two important outcomes in occupational rehabilitation: self-reported general health and daily task performance. CONCLUSION The new LADL-Q is a brief, reliable and valid tool for assessment of LADL in studies on musculoskeletal health.
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Affiliation(s)
- Achim Elfering
- a Department of Work and Organizational Psychology , University of Bern , Switzerland.,b National Centre of Competence in Research, Affective Sciences , University of Geneva , Switzerland
| | - Sonja Cronenberg
- c Institute for Evaluative Research in Orthopedic Surgery , University of Bern , Switzerland.,d University Hospital, University of Basel , Switzerland
| | - Simone Grebner
- a Department of Work and Organizational Psychology , University of Bern , Switzerland
| | - Oezguer Tamcan
- c Institute for Evaluative Research in Orthopedic Surgery , University of Bern , Switzerland
| | - Urs Müller
- c Institute for Evaluative Research in Orthopedic Surgery , University of Bern , Switzerland
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Almoallim H, Janoudi N, Attar SM, Garout M, Algohary S, Siddiqui MI, Alosaimi H, Ibrahim A, Badokhon A, Algasemi Z. Determining early referral criteria for patients with suspected inflammatory arthritis presenting to primary care physicians: a cross-sectional study. Open Access Rheumatol 2017; 9:81-90. [PMID: 28490909 PMCID: PMC5414613 DOI: 10.2147/oarrr.s134780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Early diagnosis and initiation of treatment for inflammatory arthritis can greatly improve patient outcome. We aimed to provide standardized and validated criteria for use by primary care physicians (PCPs) in the identification of individuals requiring referral to a rheumatologist. Patients and methods We analyzed the predictive value of a wide variety of demographic variables, patient-reported complaints, physical examination results, and biomarkers in order to identify the most useful factors for indicating a requirement for referral. Patients for this cross-sectional study were enrolled from various centers of the city of Jeddah, Saudi Arabia, if they were ≥18 years of age and presented to a PCP with small joint pain that had been present for more than 6 weeks. A total of 203 patients were enrolled, as indicated by the sample size calculation. Each patient underwent a standardized physical examination, which was subsequently compared to ultrasound findings. Biomarker analysis and a patient interview were also carried out. Results were then correlated with the final diagnosis made by a rheumatologist. Results A total of 9 variables were identified as having high specificity and good predictive value: loss of appetite, swelling of metacarpophalangeal joint 2 or 5, swelling of proximal inter-phalangeal joint 2 or 3, wrist swelling, wrist tenderness, a positive test for rheumatoid factor, and a positive test for anti-citrullinated protein antibodies. Conclusion Nine variables should be the basis of early referral criteria. It should aid PCPs in making appropriate early referrals of patients with suspected inflammatory arthritis, accelerating diagnosis and initiation of treatment.
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Affiliation(s)
- Hani Almoallim
- Department of Medicine, Medical College, Umm Alqura University, Makkah.,Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah.,Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah
| | - Nahid Janoudi
- Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah
| | - Suzan M Attar
- Department of Medicine, King Abdulaziz University, Jeddah
| | - Mohammed Garout
- Department of Community Medicine and Public Health, Umm Alqura University, Makkah
| | - Shereen Algohary
- Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah
| | | | - Hanan Alosaimi
- Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah
| | - Ashraf Ibrahim
- Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah
| | - Amira Badokhon
- Administration of Public Health, Ministry of Health, Jeddah
| | - Zaki Algasemi
- Joint Program of Family and Community Medicine, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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Hua C, Daien CI, Combe B, Landewe R. Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis. RMD Open 2017; 3:e000406. [PMID: 28155923 PMCID: PMC5237764 DOI: 10.1136/rmdopen-2016-000406] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To update the evidence pertaining to the diagnosis, prognosis and classification of patients with early arthritis (EA), and to inform the 2016 European League Against Rheumatism (EULAR) recommendations for the management of patients with EA. METHODS MEDLINE, EMBASE and Cochrane databases were searched up to October 2015. The first part of the systematic literature review (SLR) involved a search for studies investigating the recognition and referral of EA. The second part involved a search for studies to identify the place of laboratory and imaging tests in establishing a diagnosis and a prognosis in patients with EA. RESULTS Regarding the issue of referral of patients with EA (1643 hits), 4 studies were included. These studies were in support of early referral for patients with EA. Regarding the issue of diagnosis and prognosis of patients with EA (11 435 hits), 88 studies were included, evaluating mainly the value of rheumatoid factor (RF) and anticitrullinated-peptide antibodies (ACPAs). Sensitivity of these antibodies for a RA diagnosis in patients with EA was moderate (40-80%). Specificity was higher, notably for ACPAs (frequently >80%). ACPAs also showed better prognostic performance than RF (negative predictive values around 80%). We confirmed that structural damage on baseline X-rays is predictive of further radiographic progression in patients with EA. Regarding other imaging modalities, data are sparse. CONCLUSIONS This SLR highlights the importance of early referral for patients with EA and confirms that RF and mainly ACPAs as well as a search for structural X-rays changes may help in the diagnosis and prognosis of patients with EA.
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Affiliation(s)
- Charlotte Hua
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Claire I Daien
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Bernard Combe
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Robert Landewe
- Department of Clinical Immunology & Rheumatology , Amsterdam Rheumatology Center, Amsterdam and Zuyderland Medical Centre , Heerlen , The Netherlands
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Kung TN, Bykerk VP. Detecting the earliest signs of rheumatoid arthritis: symptoms and examination. Rheum Dis Clin North Am 2014; 40:669-83. [PMID: 25437284 DOI: 10.1016/j.rdc.2014.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Signs and symptoms often occur well in advance of a formal diagnosis of rheumatoid arthritis (RA). However, these do not necessarily represent symptoms that are included in classification criteria. Their intensity, frequency, and persistence over time seem to be important in the spectrum from preclinical autoimmunity to classifiable RA. Prospective study of signs and symptoms in individuals at risk for RA will help to determine their onset and relationship with epitope spreading, cytokine evolution, sensitive imaging, and their usefulness in discriminating between individuals patients who will develop incident inflammatory arthritis versus normal controls.
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Affiliation(s)
- Tabitha N Kung
- Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario M5T3L9, Canada
| | - Vivian P Bykerk
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY 10021, USA.
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PINCUS THEODORE, GIBSON KATHRYNA, BERTHELOT JEANMARIEM. Is a Patient Questionnaire Without a Joint Examination as Undesirable as a Joint Examination Without a Patient Questionnaire? J Rheumatol 2014; 41:619-21. [DOI: 10.3899/jrheum.140074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ogawa H, Itokazu M, Ito Y, Matsumoto K, Takigami I. Quality of life evaluated by Short Form-8 in patients with rheumatoid arthritis who were receiving infusion of infliximab. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0113-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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To screen or not to screen: How to find and identify very early arthritis. Best Pract Res Clin Rheumatol 2013; 27:487-97. [DOI: 10.1016/j.berh.2013.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Muquith MA, Islam MN, Haq SA, Ten Klooster PM, Rasker JJ, Yunus MB. Cross-cultural adaptation and validation of a Bengali version of the modified fibromyalgia impact questionnaire. BMC Musculoskelet Disord 2012; 13:157. [PMID: 22925458 PMCID: PMC3493366 DOI: 10.1186/1471-2474-13-157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/17/2012] [Indexed: 11/30/2022] Open
Abstract
Background Currently, no validated instruments are available to measure the health status of Bangladeshi patients with fibromyalgia (FM). The aims of this study were to cross-culturally adapt the modified Fibromyalgia Impact Questionnaire (FIQ) into Bengali (B-FIQ) and to test its validity and reliability in Bangladeshi patients with FM. Methods The FIQ was translated following cross-cultural adaptation guidelines and pretested in 30 female patients with FM. Next, the adapted B-FIQ was physician-administered to 102 consecutive female FM patients together with the Health Assessment Questionnaire (HAQ), selected subscales of the SF-36, and visual analog scales for current clinical symptoms. A tender point count (TPC) was performed by an experienced rheumatologist. Forty randomly selected patients completed the B-FIQ again after 7 days. Two control groups of 50 healthy people and 50 rheumatoid arthritis (RA) patients also completed the B-FIQ. Results For the final B-FIQ, five physical function sub-items were replaced with culturally appropriate equivalents. Internal consistency was adequate for both the 11-item physical function subscale (α = 0.73) and the total scale (α = 0.83). With exception of the physical function subscale, expected correlations were generally observed between the B-FIQ items and selected subscales of the SF-36, HAQ, clinical symptoms, and TPC. The B-FIQ was able to discriminate between FM patients and healthy controls and between FM patients and RA patients. Test-retest reliability was adequate for the physical function subscale (r = 0.86) and individual items (r = 0.73-0.86), except anxiety (r = 0.27) and morning tiredness (r = 0.64). Conclusion This study supports the reliability and validity of the B-FIQ as a measure of functional disability and health status in Bangladeshi women with FM.
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Affiliation(s)
- Mohammed A Muquith
- Rheumatology Wing, Department of Medicine, Bangabandhu Sheikh Mujib, Medical University, Shahbagh, Dhaka, Bangladesh
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ASKANASE ANCADINU, CASTREJÓN ISABEL, PINCUS THEODORE. Quantitative Data for Care of Patients with Systemic Lupus Erythematosus in Usual Clinical Settings: A Patient Multidimensional Health Assessment Questionnaire and Physician Estimate of Noninflammatory Symptoms. J Rheumatol 2011; 38:1309-16. [DOI: 10.3899/jrheum.101091] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To analyze quantitative data in patients with systemic lupus erythematosus (SLE), seen in usual care, from a patient Multidimensional Health Assessment Questionnaire (MDHAQ) with routine assessment of patient index data (RAPID3) scores and from a physician global estimate of noninflammatory symptoms; and to compare results to self-report Systemic Lupus Activity Questionnaire (SLAQ) scores and 4 SLE indices: SLE Disease Activity Index-2K (SLEDAI-2K), British Isles Lupus Assessment Group (BILAG), Systemic Lupus Activity Measure (SLAM), and European Consensus Lupus Activity Measurement (ECLAM).Methods.Fifty consecutive patients with SLE were studied in usual care of one rheumatologist. All patients completed an MDHAQ/RAPID3 in this setting. Each patient also completed a SLAQ. The rheumatologist scored SLEDAI-2K, BILAG, SLAM, ECLAM, and 2 physician global estimates, one for overall status and one for noninflammatory symptoms. Patients were classified into 2 groups: “few” or “many” noninflammatory symptoms. Scores and indices were compared using correlations, cross-tabulations and t tests.Results.The patients included 45 women and 5 men. MDHAQ/RAPID3 and SLAQ scores were significantly correlated. RAPID3 scores were significantly higher in patients with SLE index scores above median levels, and in 34 patients scored by the rheumatologist as having “few” noninflammatory symptoms. MDHAQ/RAPID3 and SLAQ were significantly higher in 16 patients scored as having many noninflammatory symptoms.Conclusion.MDHAQ/RAPID3 and SLAQ subscale scores appear to reflect disease activity in patients with SLE, but not in patients with many noninflammatory symptoms. A physician scale for noninflammatory symptoms is useful to interpret MDHAQ/RAPID3, SLAQ, and SLE index scores.
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Clues on the MDHAQ to identify patients with fibromyalgia and similar chronic pain conditions. Rheum Dis Clin North Am 2010; 35:865-9, xii. [PMID: 19962631 DOI: 10.1016/j.rdc.2009.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patients with fibromyalgia and chronic pain conditions report high levels of pain and fatigue, and multiple symptoms. These phenomena may be recorded quantitatively on a self-report multidimensional health assessment questionnaire (MDHAQ). These responses are likely to differ in people with fibromyalgia or chronic pain conditions compared with people with an inflammatory rheumatic disease, such as rheumatoid arthritis. Data from the MDHAQ provide clues to the presence of fibromyalgia/chronic pain conditions, including patients with inflammatory diseases who also have concomitant fibromyalgia/chronic pain conditions.
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Pincus T, Askanase AD, Swearingen CJ. A multi-dimensional health assessment questionnaire (MDHAQ) and routine assessment of patient index data (RAPID3) scores are informative in patients with all rheumatic diseases. Rheum Dis Clin North Am 2010; 35:819-27, x. [PMID: 19962626 DOI: 10.1016/j.rdc.2009.10.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Although indices have been developed for many rheumatic diseases in usual care, they are rarely used in usual care. In most visits to rheumatologists, the only quantitative data collected are laboratory tests. Patient history data often are more important in management of patients with rheumatic diseases than other diseases. A two-page multidimensional health assessment questionnaire (MDHAQ) can be completed by the patient in 5 to 10 minutes and reviewed by the physician in 10 seconds, with RAPID3 scored in 5 to 10 seconds. The MDHAQ is useful in rheumatic diseases, to improve management documentation and outcomes. MDHAQ data for physical function, pain, global status, and RAPID3 scores appear preferable to no quantitative data.
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Affiliation(s)
- Theodore Pincus
- Division of Rheumatology, Department of Medicine, New York University School of Medicine and NYU Hospital for Joint Diseases, Room 1608, 301 East 17th Street, New York, NY 10003, USA.
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Pincus T, Mandelin AM, Swearingen CJ. Flowsheets That Include MDHAQ Physical Function, Pain, Global, and RAPID3 Scores, Laboratory Tests, and Medications to Monitor Patients with all Rheumatic Diseases: An Electronic Database for an Electronic Medical Record. Rheum Dis Clin North Am 2009; 35:829-42, x-xi. [DOI: 10.1016/j.rdc.2009.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pincus T, Bergman MJ. Quantitative Recording of Physician Clinical Estimates, Beyond a Global Estimate and Formal Joint Count, in Usual Care: Applying the Scientific Method, Using a Simple One-Page Worksheet. Rheum Dis Clin North Am 2009; 35:813-7, x. [DOI: 10.1016/j.rdc.2009.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Theodore Pincus
- Division of Rheumatology, Department of Medicine, New York University School of Medicine and NYU Hospital for Joint Diseases, 301 East 17th Street, Room 1608, New York, NY 10003, USA.
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Pincus T, Oliver AM, Bergman MJ. How to Collect an MDHAQ to Provide Rheumatology Vital Signs (Function, Pain, Global Status, and RAPID3 Scores) in the Infrastructure of Rheumatology Care, Including Some Misconceptions Regarding the MDHAQ. Rheum Dis Clin North Am 2009; 35:799-812, x. [DOI: 10.1016/j.rdc.2009.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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PINCUS THEODORE. Management of Associated Rheumatoid Arthritis and Fibromyalgia. J Rheumatol 2009; 36:2123-4; discussion 2124-5. [DOI: 10.3899/jrheum.090336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ogawa H, Itokazu M, Ito Y, Matsumoto K, Takigami I. Quality of life evaluated by Short Form-8 in patients with rheumatoid arthritis who were receiving infusion of infliximab. Mod Rheumatol 2008; 19:27-32. [PMID: 18712459 DOI: 10.1007/s10165-008-0113-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 07/08/2008] [Indexed: 11/30/2022]
Abstract
In this study, influences of infliximab to health-related quality of life (HRQOL) and active status of RA were assessed. Between 2003 and 2006, 22 patients with rheumatoid arthritis (RA) began receiving infusion of infliximab. Of all the patients, 17 patients who were followed for at least 30 weeks (102 weeks at maximum) after the start of infliximab were included in this study. The mean age was 54.6+/-10 years. HRQOL was evaluated with use of the SF-8trade mark, which is a simple version of the Medical Outcome Study Short Form 36. As an index of active status of RA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were collected. CRP and ESR significantly improved at the final follow-up, but RF did not. All subscales of the SF-8 were significantly improved after the start of infliximab. However, there were three patients whose laboratory data were improved, but HRQOL was not. We should not be prepossessed only with laboratory data in treating patients with RA. We recommend that the SF-8 to evaluate HRQOL of patients with RA in busy outpatient clinics because it is both simple and convenient.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University School of Medicine, and Hirano General Hospital, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
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Pincus T, Sokka T. Can a Multi-Dimensional Health Assessment Questionnaire (MDHAQ) and Routine Assessment of Patient Index Data (RAPID) scores be informative in patients with all rheumatic diseases? Best Pract Res Clin Rheumatol 2007; 21:733-53. [PMID: 17678833 DOI: 10.1016/j.berh.2007.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A multidimensional health assessment questionnaire (MDHAQ) is useful in standard care of patients with all rheumatic diseases in a busy clinical setting. The MDHAQ was adapted from the classical health assessment questionnaire (HAQ) for feasibility in standard clinical care, with reduction of the number of activities from 20 to 10, visual analog scales (VAS) as 21 circles rather than 10 cm lines, availability of all core data set patient self-report measures and scoring templates on the front side, and a review of systems symptom checklist and review of recent medical history on the reverse side of a single page. Scoring templates are also available for routine assessment of patient index data (RAPID) scores, based on a composite of the three patient reported outcome (PRO) measures from the core data set included on the HAQ and MDHAQ, physical function pain, and patient estimate of global status. Flow sheets illustrating use of the MDHAQ in standard clinical care of patients with various rheumatic diseases, including psoriatic arthritis, systemic lupus erythematosus, ankylosing spondylitis, gout, scleroderma, vasculitis, fibromyalgia, inflammatory bowel disease arthritis, Behcet's syndrome, and familial Mediterranean fever, are presented to illustrate use of this simple questionnaire to add to clinical decisions and document patient courses and outcomes in standard clinical care of patients with all rheumatic diseases.
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Affiliation(s)
- Theodore Pincus
- NYU-Hospital for Joint Diseases, 301 East 17 Street, New York, NY 10003, USA.
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Seippel L, Eriksson O, Grankvist K, von Shoultz B, Bäckström T. Physical symptoms in premenstrual syndrome are related to plasma progesterone and desoxycorticosterone. Gynecol Endocrinol 2000; 14:173-81. [PMID: 10923278 DOI: 10.3109/09513590009167679] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Somatic symptoms in the premenstrual syndrome (PMS) may have an etiology separate from that of the mental symptoms. A disturbance in mineralocorticoid action has been discussed, as mineralocorticoids regulate water balance. Desoxycorticosterone (DOC) is interesting, as it has mineralocorticoid effects and is a precursor to the neurosteroid 5 alpha-pregnan-3 alpha,21-diol-20-one (THDOC). THDOC is a steroid with direct benzodiazepine-like effects on the GABA-A receptor in the brain that is metabolized from DOC within the brain and in the periphery. Ten women with PMS having swelling as a major symptom and eight controls were recruited. They marked, on a validated visual-analog scale, three physical symptoms every evening during one menstrual cycle in conjunction with giving blood samples for progesterone and DOC measurements. DOC showed menstrual cycle-linked variation correlating with progesterone. There was no difference in plasma DOC concentrations between patients and controls. The symptoms reached a maximum 1-3 days before the onset of menstruation, with a delay of 3-6 days after the hormone peak. DOC was less strongly correlated with the symptoms than progesterone. These results do not support the hypothesis that DOC is involved in the etiology of physical symptoms in PMS or that physical and mental symptoms have separate etiologies.
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Affiliation(s)
- L Seippel
- Department of Obstetrics and Gynecology, University of Umeå, Sweden
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Pincus T, Swearingen C, Wolfe F. Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. ARTHRITIS AND RHEUMATISM 1999; 42:2220-30. [PMID: 10524697 DOI: 10.1002/1529-0131(199910)42:10<2220::aid-anr26>3.0.co;2-5] [Citation(s) in RCA: 270] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To develop components of a multidimensional Health Assessment Questionnaire (MDHAQ) through the addition of new items in the "patient-friendly" HAQ format, including advanced activities of daily living (ADL), designed to overcome "floor effects" of the HAQ and modified HAQ (MHAQ) in which patients may report normal scores although they experience meaningful functional limitations, and psychological items, designed to screen efficiently for psychological distress in routine care. METHODS The new MDHAQ items, as well as scales for pain, fatigue, helplessness, and global health status on a 2-page questionnaire, were completed by 688 consecutive patients with various rheumatic diseases, including 162 with rheumatoid arthritis (RA), 114 with fibromyalgia, 63 with osteoarthritis, 34 with systemic lupus erythematosus, 20 with vasculitis, 18 with psoriatic arthritis, 16 with scleroderma, and 261 with various other rheumatic diseases, over 2 years at a weekly academic rheumatology clinic. RESULTS The new MDHAQ items have good test-retest reliability and face validity. MHAQ scores were highest in patients with RA, and scores for other scales were highest in patients with fibromyalgia. On the advanced ADL, 58% of patients reported difficulty with errands, 68% with climbing stairs, 79% with walking two miles, 87% with participating in sports and games, and 94% with running or jogging two miles. On the psychological items, 75% of patients reported difficulty with sleep, 63% with stress, 61% with anxiety, and 57% with depression. Normal MHAQ scores were reported by 23% of patients and normal HAQ scores by 16% of patients who completed these questionnaires, while fewer than 5% had normal scores on the MDHAQ. CONCLUSION The MDHAQ items overcome in large part the "floor effects" seen on the HAQ and MHAQ, and are useful to screen for problems with sleep, stress, anxiety, and depression in the "patient-friendly" HAQ format. These data support the value of completion of a simple 2-page patient questionnaire by each patient at each visit to a rheumatologist.
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Affiliation(s)
- T Pincus
- Division of Rheumatology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
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Pincus T, Swearingen C, Wolfe F. Toward a multidimensional health assessment questionnaire (MDHAQ): Assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/1529-0131(199910)42:10%3c2220::aid-anr26%3e3.0.co;2-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wolfe F, Pincus T. Listening to the patient: a practical guide to self-report questionnaires in clinical care. ARTHRITIS AND RHEUMATISM 1999; 42:1797-808. [PMID: 10513792 DOI: 10.1002/1529-0131(199909)42:9<1797::aid-anr2>3.0.co;2-q] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- F Wolfe
- Arthritis Research Center, Wichita, KS 67214, USA
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Gustafsson M, Gaston-Johansson F, Aschenbrenner D, Merboth M. Pain, coping and analgesic medication usage in rheumatoid arthritis patients. PATIENT EDUCATION AND COUNSELING 1999; 37:33-41. [PMID: 10640117 DOI: 10.1016/s0738-3991(98)00100-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The major purposes of this study were to describe pain characteristics and coping strategies used in rheumatoid arthritis (RA) patients. Further purposes were to examine relationships among pain, coping and analgesic medication intake. Sixty-eight consecutively sampled subjects with RA participated in the study. The Pain-O-Meter was used to evaluate pain intensity and quality, and the Coping Strategies Questionnaire (CSQ) to determine coping strategies. The results showed that the patients with RA scored more intense sensory than affective pain although they used more affective pain descriptors. The sensory and total pain components were related to coping self-statements and increased pain activities. There were significant relationships between analgesic medication intake and all coping strategies used in the RA patients. The findings' implication for education and treatment are discussed.
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Affiliation(s)
- M Gustafsson
- Göteborgs University, Department of Rehabilitation Medicine, Sweden
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Griffin KW, Friend R, Kaell AT, Bennett RS, Wadhwa NK. Negative affect and physical symptom reporting: A test of explanatory models in two chronically ill populations. Psychol Health 1999. [DOI: 10.1080/08870449908407329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rice JR, Pisetsky DS. Pain in the rheumatic diseases. Practical aspects of diagnosis and treatment. Rheum Dis Clin North Am 1999; 25:15-30. [PMID: 10083957 DOI: 10.1016/s0889-857x(05)70053-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with rheumatic disease experience pain that can be intense, persistent, and disabling. This pain is frequently multifactorial in origin and has both central and peripheral components. Because of the array of conditions that can cause musculoskeletal pain, patient management must begin with a complete clinical assessment that identifies possible etiologies and measures objective findings against subjective complaints. Especially in patients with known rheumatic disease, the possibility of concurrent pain of central origin must be considered and appropriate treatment given. By applying a comprehensive therapy plan of drugs, physical therapy, and patient education, significant benefits can often be achieved in this prevalent group of painful diseases.
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Affiliation(s)
- J R Rice
- Division of Rheumatology, Allergy, and Clinical Immunology, Duke University Medical Center, Durham, North Carolina, USA
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Abstract
BACKGROUND Symptom control in chronic illness is not merely a matter of medical management as the patient and family must rely on their own judgment, wisdom, and ingenuity for controlling symptoms. The absence in the literature regarding the effects of multiple sclerosis (MS) as perceived by afflicted people and their family members led to the 10-year longitudinal study. OBJECTIVES To study patient self-report data to determine whether particular interventions may be needed to enhance the individual's comfort and functional levels. METHODS The chronic illness trajectory of three groups of people with MS (< or =5 years of diagnosis, n=49; >5 to 10 years, n=36; and >10 years, n=68) was examined over a 10-year period. Serial self-assessments of the subjects' prevalence of MS-related symptoms (motor, brain stem, sensory, elimination, mental/emotional) and level of activities of daily living (ADL) functioning (fine and gross motor activities, sensory/communication, socializing/recreation, intimacy) were obtained annually. Profiles illustrating the subject's symptom and ADL pattern were also returned annually to each subject. RESULTS Using 10-year average scores, study findings indicated no group differences relative to symptoms but showed significant group differences in all ADL functions. Separate group within-year (1, 3, 5, 7, 10) comparisons reflected significant increases in motor, brain stem, and elimination symptoms together with a decline in all ADL functions for specific groups. CONCLUSIONS Medical data suggest, on average, a continuous downward trajectory beginning in the first years of illness or at approximately 36 to 37 years of age. In contrast, in this research, patient self-reports of fine and gross motor ADL, a correlate of neurologically based disability evaluations, reflect that relatively major decline begins after 5 years post-diagnosis and after age 40 for subjects recruited primarily from nonclinical sites.
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Affiliation(s)
- E E Gulick
- College of Nursing, Rutgers, The State University of New Jersey, USA
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Stenström CH, Nisell R. Assessment of disease consequences in rheumatoid arthritis: a survey of methods classified according to the International Classification of Impairments, Disabilities, and Handicaps. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1997; 10:135-50. [PMID: 9313402 DOI: 10.1002/art.1790100209] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C H Stenström
- Department of Physical Therapy, Karolinska Institutet, Huddinge, Sweden
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Stenström CH, Boestad C, Carlsson M, Edström M, Reuterhäll A. Why exercise?: a preliminary investigation of an exercise motivation index among individuals with rheumatic conditions and healthy individuals. PHYSIOTHERAPY RESEARCH INTERNATIONAL 1997; 2:7-16. [PMID: 9238747 DOI: 10.1002/pri.75] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The study was undertaken to investigate the test-retest stability and the criterion-related validity of a modified Swedish version of an exercise motivation index (EMI), and its use with individuals with rheumatic conditions, and with healthy individuals who exercised regularly. The EMI consists of 23 statements divided into three sub-scores for physical, psychological and social motivation. Ninety-five individuals with rheumatic conditions (mean age 60 years, mean symptom duration 15 years, 79% female) and 131 healthy individuals (mean age 52 years, 76% female), all attending exercise classes at least once a week, filled out the EMI. Sub-samples also filled out three visual analogue scales designed to measure physical, psychological and social exercise motivation, and filled out the EMI a second time one week later. The results indicated that psychological and physical exercise motivation was equally important in both samples. Social motivation was less important in both samples, but more pronounced in the rheumatic sample and among older individuals. In the rheumatic sample, physical motivation was more important among women and psychological motivation was more important among younger individuals. Test-retest stability for the EMI was satisfactory in both samples, while criterion-related validity was poor. The results of our preliminary investigation of the EMI suggest that the survey of physical, psychological and social motivation for exercise seems meaningful. Further work on the validity of the EMI is needed.
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Affiliation(s)
- C H Stenström
- Department of Physical Therapy, Karolinska Institutet, Huddinge, Sweden
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Escalante A, Lichtenstein MJ, Ríos N, Hazuda HP. Measuring chronic rheumatic pain in Mexican Americans: cross-cultural adaptation of the McGill Pain Questionnaire. J Clin Epidemiol 1996; 49:1389-99. [PMID: 8970489 DOI: 10.1016/s0895-4356(96)00276-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We performed a cross-cultural adaptation of the McGill Pain Questionnaire (MPQ) from English to Spanish for studying Mexican Americans in South Texas. Each of the 78 single-word pain descriptors in the original MPQ was translated into Spanish by a panel of nine bilingual health researchers, preserving the original structure of the questionnaire. The pain-intensity content (PIC) of the words in each language was then rated on a 100 mm visual analog scale by 8 bilingual health care providers and 10 bilingual health-care consumers. The correlation between Spanish and English average PIC ratings was strong (r = 0.85 for providers, r = 0.80 for consumers). The translated Spanish version was compared to the original English in a group of 50 bilingual Mexican-American patients with musculoskeletal pain, who completed the MPQ in both languages. There was no difference in Average Pain Rating Index between the Spanish and English versions (29.8 +/- 14.7 vs 29.1 +/- 15.8, p = 0.55), and agreement between the two language versions was almost perfect (ri = 0.85). Test-retest reliability was measured in two groups of hospitalized patients (25 per group), one composed of monolingual Spanish speakers and the other of monolingual English speakers. Each subject completed the MPQ, the McGill Pain Map, two 10-cm visual analog scales measuring pain now and within the past week, the bodily pain items of the MOS-SF36 survey, and the Modified Health Assessment Questionnaire, on two occasions one day apart. Test-retest reliability of the Spanish and English components of the MPQ was not significantly different and was comparable to that of the other pain and health status instruments. We conclude that the Spanish MPQ is cross-culturally equivalent to the original English and has similar concurrent validity and reliability. This questionnaire is suitable for cross-cultural studies of pain comparing Spanish-speaking Mexican Americans with English-speaking members of the same and other ethnic groups.
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Affiliation(s)
- A Escalante
- Section of Rheumatology, University of Texas Health Science Center at San Antonio 78284, USA
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Gustafsson M, Gaston-Johansson F. Pain intensity and health locus of control: a comparison of patients with fibromyalgia syndrome and rheumatoid arthritis. PATIENT EDUCATION AND COUNSELING 1996; 29:179-188. [PMID: 9006234 DOI: 10.1016/0738-3991(96)00864-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The major purpose of this study was to determine if 31 patients with fibromyalgia syndrome (FS) reported different pain intensity and Health Locus of Control (HLC) scores than 30 patients with rheumatoid arthritis (RA). Another purpose was to determine the relationship among experienced actual pain (present, usual, worse, least), recalled prior episodes of pain (worse toothache, headache, and stomach ache), HLC orientation, age and the duration of the actual pain. Visual Analogue Scales were used to measure pain intensity. The Health Locus of Control Scale was used to determine external/internal orientation. The results showed that the FS patients reported significantly more intense actual pain, recalled pain for worse toothache and headache, and were more externally oriented than the RA patients. Present pain intensity was significantly correlated to actual intensity ratings, but not to reported earlier experienced pain, except for worse stomach ache in the RA group. The findings' implications for treatment and education are discussed.
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Affiliation(s)
- M Gustafsson
- Göteborgs University, Department of Rehabilitation Medicine, Sweden
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Escalante A, Galarza-Delgado D, Beardmore TD, Baethge BA, Esquivel-Valerio J, Marines AL, Mingrone M. Cross-cultural adaptation of a brief outcome questionnaire for Spanish-speaking arthritis patients. ARTHRITIS AND RHEUMATISM 1996; 39:93-100. [PMID: 8546745 DOI: 10.1002/art.1780390113] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To cross-culturally adapt a brief self-assessment questionnaire to measure outcome among English- or Spanish-speaking patients with arthritis. METHODS A questionnaire containing the following items was translated to Spanish: the 8 activities of daily living (ADL) question of the Modified Health Assessment Questionnaire; a question about the duration of morning stiffness; and a 10-point pain scale. Equivalence to the original English, test-retest reliability, and construct, criterion, and discriminant validity were determined on a population of patients with 4 clinical centers. RESULTS English-Spanish equivalence and test-retest reliability of the questionnaire were almost perfect (intra-class correlation coefficients [ri] > or = 0.90 for each). Construct validity, measured by comparing questionnaire scores with an occupational therapist's evaluation, was also near-perfect in both languages (ri = 0.93 for English and 0.89 for Spanish). Both versions of the questionnaire correlated well with the physician-determined Steinbrocker functional class, as well as with the amount of pain, grip strength, and walking velocity. Patients with systemic lupus erythematosus, rheumatoid arthritis, osteoarthritis, and fibromyalgia differed significantly in their pain:ADL ratios, in both languages. CONCLUSIONS The items of the Spanish questionnaire that we have adapted are equivalent to the original English versions. This questionnaire is suitable for studying Spanish-speaking subjects with arthritis in the US and elsewhere.
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Affiliation(s)
- A Escalante
- University of Texas Health Science Center at San Antonio 78284-7868, USA
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Pincus T. WHY SHOULD RHEUMATOLOGISTS COLLECT PATIENT SELF-REPORT QUESTIONNAIRES IN ROUTINE RHEUMATOLOGIC CARE? Rheum Dis Clin North Am 1995. [DOI: 10.1016/s0889-857x(21)00440-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gulick EE, Cook SD, Troiano R. Comparison of patient and staff assessment of MS patients' health status. Acta Neurol Scand 1993; 88:87-93. [PMID: 8213064 DOI: 10.1111/j.1600-0404.1993.tb04196.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study compared change scores obtained on patient self-reported symptoms (MS-RS) with the neurological examination of the Kurtzke Functional Systems (FS) and change scores obtained on patient self-reported activities of daily living (ADL-MS) with the neurologist-determined Expanded Disability Status Scale (EDSS) that were obtained from two separate times separated by approximately seven months for 100 patients with multiple sclerosis. Percent agreement based on < or = 1 unit difference between patient and neurologists' change scores (Time 2-Time 1) ranged between 73% and 86% for MS-RS and FS measures and was 72% for ADL-MS and EDSS. Together, the ADL and MS-RS patient self-report scales provide health status information from the patient's perspective that can be useful in guiding the physical examination, in making comparisons from visit to visit and/or between visits, in assessing patients' quality of life, and in increasing patient satisfaction with medical care.
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Affiliation(s)
- E E Gulick
- Rutgers, The State University of New Jersey, College of Nursing, Newark 07102
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Burckhardt CS, Clark SR, Bennett RM. A comparison of pain perceptions in women with fibromyalgia and rheumatoid arthritis: relationship to depression and pain extent. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1992; 5:216-22. [PMID: 1489768 DOI: 10.1002/art.1790050406] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Two studies were conducted to characterize the pain of fibromyalgia syndrome (FMS); to compare it to rheumatoid arthritis (RA) pain; and to examine the relationships between depression, pain extent, and pain description. Two methods of administering the McGill Pain Questionnaire (MPQ) were used. When the MPQ was administered in the standard manner, FMS pain could not be distinguished from RA pain. When participants were allowed to select as many words from an adapted MPQ as they wished, significant differences in word choice emerged. Depression and pain extent were major predictors of group differences in the evaluation of pain. However, depression scores contributed only 50% of the explanation for the differences in pain extent, with group membership contributing the other 50%. These findings suggest that the character and extent of pain in FMS are at least partially due to peripheral sensory components and not simply centrally controlled pain amplification secondary to depression.
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Pincus T, Callahan LF. Quantitative measures to assess, monitor and predict morbidity and mortality in rheumatoid arthritis. BAILLIERE'S CLINICAL RHEUMATOLOGY 1992; 6:161-91. [PMID: 1563035 DOI: 10.1016/s0950-3579(05)80343-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The use of quantitative measures to analyse the long-term course of RA appears to have provided new insights into the severe morbidity and increased mortality rates of this disease. Quantitative assessment of RA may be viewed as an expression of clinical rheumatology as a quantitative science designed to assess accurately the long-term course of disease. The description of the joint count, radiographic scores, laboratory tests, questionnaire measures and physical measures of functional status, as well as the importance of socio-economic status, may provide new insights into the pathogenesis, prevalence, morbidity and mortality of RA.
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Varni JW, Bernstein BH. Evaluation and Management of Pain in Children with Rheumatic Diseases. Rheum Dis Clin North Am 1991. [DOI: 10.1016/s0889-857x(21)00140-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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