Welfare benefit promotion within a district general hospital rheumatology centre: a joint project with the local Citizens Advice Bureau

OBJECTIVES

The Health Assessment Questionnaire (HAQ), used in arthritis provides an overall disability index and has been used previously to indicate those patients with arthritis who may be eligible for welfare benefits such as Attendance Allowance (AA) or Disability Living Allowance (DLA) (Langley et al., 2004, Memel et al., 2002, Powell et al., 2004). The aim of this study was to assess the effectiveness of the HAQ in this local population as a tool for identifying patients who may be eligible for benefits, and to assist those identified in claiming benefits with the help of a Citizens Advice Bureau benefits advisor.

METHOD

HAQ forms were sent to patients attending the Rheumatology Centre, all those patients with a HAQ score of <or=1.5, indicating moderate to severe disability were contacted initially by telephone by the CAB advisor. Those whom were considered eligible were invited to attend the Rheumatology Centre to determine their suitability to apply for benefit. Suitable patients were invited to complete a department of Work and Pensions claim pack either with the advisor in the Rheumatology Centre, with a CAB form completion volunteer within the patient's home or fill the forms in themselves.

RESULTS

Of the 86 patients contacted by the CAB advisor, 48 were already on benefits, 8 of these patients were advised to have their benefits reviewed. 38 were not in receipt of any benefits. 29 (63%) were awarded benefits.

CONCLUSIONS

The HAQ was found to be a useful tool in this local population for identifying patients with arthritis who may be entitled to AA or DLA. The CAB advisor was central to the identification and application process for eligible patients for AA and DLA, which in some cases led to the award of other entitlements.

A pooled data analysis on the use of intermittent cyclical etidronate therapy for the prevention and treatment of corticosteroid induced bone loss

OBJECTIVE

To conduct a pooled data analysis in a group of patients defined by sex, menopausal status, and underlying disease in order to examine the effect of intermittent cyclical etidronate in the prevention and treatment of corticosteroid induced osteoporosis.

METHODS

We selected 5 randomized, placebo controlled studies that examined the efficacy of intermittent cyclical etidronate therapy in which the raw data were available for analysis. Three were prevention studies and 2 treatment studies. The primary outcome was the difference between treatment groups in the percentage change from baseline in lumbar spine bone density. Secondary outcomes included the difference between treatment groups in the percentage change from baseline in femoral neck and trochanter bone density, and vertebral fracture rates.

RESULTS

Results are separately pooled for the prevention and treatment studies. The prevention studies had significant mean differences (95% CI) between groups in mean percentage change from baseline in lumbar spine, femoral neck, and trochanter bone density of 3.7 (2.6 to 4.7), 1.7 (0.4 to 2.9), and 2.8% (1.3 to 4.2) after one year of treatment, in favor of the etidronate group. The treatment studies displayed a mean difference between groups in mean percentage change from baseline in lumbar spine bone density of 4.8 (2.7 to 6.9) and 5.4% (2.5 to 8.4) after one and 2 years of therapy. In the prevention studies, a reduced fracture incidence was observed in the etidronate group compared with the placebo group (relative risk 0.50; CI 0.21 to 1.19).

CONCLUSION

Etidronate therapy was effective in preventing bone loss in the prevention studies and in preventing or slightly increasing bone mass in the treatment studies. A fracture benefit was observed in postmenopausal women treated with etidronate in the prevention studies.

Non-invasive assessment of bone density in primary biliary cirrhosis

BACKGROUND/AIMS

Low bone mass is an important complication of primary biliary cirrhosis (PBC), resulting in an increased risk of fractures and reduced mobility. In the present study, we sought to determine the frequency of low bone mass in PBC, and its relationship to disease severity and non-invasive markers of bone turnover.

METHODS

In 36 women with PBC, bone mineral density of the lumbar spine and hip was assessed by dual emission X-ray absorptiometry. Serum and urinary markers of bone turnover were compared with those from age- and sex-matched controls.

RESULTS

Spinal osteopenia (T score, -1.5 to -2.5) was present in 15 of the 36 patients (42%), while six others (16%) had established osteoporosis (T < -2.5). Osteopenia of the femoral neck was found in 17 patients (47%), and osteoporosis in five (14%). The severity of liver disease, as determined by Mayo Clinic R score and histological stage, correlated negatively with both regional bone mineral density and total bone mineral content expressed as a ratio to lean body mass. There was a strong positive correlation between serum levels of the procollagen degradation peptides, PICP and PIIINP (r = 0.65, P < 0.001), and both peptides correlated significantly (P < 0.001) with histological stage and Mayo Clinic R score. Fasting urinary pyridinoline and deoxypyridinoline to creatinine ratios were also significantly raised.

CONCLUSIONS

Low bone mass in PBC correlates positively with disease severity, and is associated with a net increase in bone resorption, as assessed by urinary collagen cross-link excretion. These markers of bone turnover may be of value in controlled clinical trials aimed at improving bone mass in PBC.

The diagnostic challenge of acute polyarthritis

Images

Biochemical markers of bone turnover in women with surgically treated carcinoma of the breast

Biochemical markers of bone turnover were measured in fasting urine and blood samples obtained from 38 postmenopausal women with previous surgical treatment of breast cancer combined with adjuvant chemotherapy, tamoxifen, or placebo. Significantly elevated urinary pyridinoline as nmol mmol-1 creatinine (47.5 and 42.5 in tamoxifen and placebo treated patients compared with 26.3 in normal controls, both P < 0.001) and deoxypyridinoline (11.9 and 10.5 compared with 6.3, P < 0.001 and P = 0.002 respectively) were found with unchanged urinary hydroxyproline, serum alkaline phosphatase and procollagen I carboxyterminal peptide (PICP). These findings suggest enhanced bone resorption resulting from the humoral osteoclast activating effect of the previous breast cancer or underlying carcinoma recurrence. Alternatively the raised pyridinium excretion might indicate an altered crosslinking composition of bone collagen. No specific effect on bone metabolism was found with tamoxifen treatment as all measured parameters were similar in both tamoxifen ex-users and non-users. This confirmed the safety of tamoxifen therapy with respect to bone.

Association between azathioprine therapy and lymphoma in rheumatoid disease

Three out of 41 patients treated with azathioprine and low-dose corticosteroids from 1976 to 1983 developed non-Hodgkin's lymphoma. This strikingly high incidence of lymphoma may be a reflection of long-term use of azathioprine.