[Work disability work in the first year of chronic polyarthritis. A comparison with members of the legal health health insurance]. / Arbeitsunfähigkeit im ersten Jahr der chronischen Polyarthritis. Ein Vergleich mit Pflichtmitgliedern der gesetzlichen Krankenversicherung.

Even though sick-leave (SL) is a direct consequence of the reduction of work capacity due to the disease, this has not gained much attention in early rheumatoid arthritis (RA). Therefore, the occurrence and duration of SL (defined as the history of SL as certified by a physician) was determined in a cross-sectional multicenter study of early RA (< or = 12 months duration) and compared to the members of the compulsory health insurance. One hundred and thirty four gainfully employed consecutive outpatients fulfilled > or = 4 of 7 ACR 1987 criteria of RA: 85 females (63% of 134 patients), age 50 years (median), disease duration 7 months (median). SL due to RA occurred in 102 of 134 patients (76%). The duration of SL because of RA was 11 days per month (about one-third of the disease duration) in males and 8 days per months (one-quarter of the time since the onset of RA) in females. SL due to RA was five times longer than expected from controls. In addition to SL because of RA, SL due to other causes occurred with a similar duration as in controls. Already in the first year of RA the large proportion of patients with SL due to RA and the long SL duration indicate the extent of substantial handicap concerning gainful employment.

[Deficiencies in rehabilitation measures in the course of early chronic polyarthritis]. / Defizite rehabilitativer Massnahmen im Verlauf der frühen chronischen Polyarthritis.

It was the objective of this descriptive cohort study with prospective and retrospective data collection to examine whether measures of rehabilitation medicine and of vocational rehabilitation are too rare during the course of early rheumatoid arthritis (RA). Seventy three gainfully employed consecutive outpatients with early RA at the first examination (time one -T1) (> or = 5 ARA 1958 criteria, disease duration < or = 12 months) were reexamined at time two (T2) after a mean follow-up of 6 years (S.D. +/- 2 yrs.). Of the 73 patients 27 persons received a social security pension at T2 because of work disability (WD) due to RA. This group was analysed separately from the 34 patients who were still working at T2. Even though the 27 patients with WD had severe disease (functional capacity, ESR, radiological erosions) at T2, only 17 (63%) had participated in inpatient rehabilitation programmes. Despite frequent strenuous job-related physical requirements in 44-70% of the patients with WD measures of vocational rehabilitation had been taken in only 26%: vocational retraining in 4%, adaptation of the workplace because of RA in 8%, reduced working-time in 22%. No patient had changed the job. At least one of these measures of vocational rehabilitation had been taken in only 7 of 34 of the persons working at T2 (21%). Of these 34 patients 21-39% reported continued difficulties with different physical requirements of their jobs. In the early phase of RA significant shortcomings regarding the measures of rehabilitation medicine and vocational rehabilitation could be demonstrated. The early initiation of rehabilitation programmes aims at an improvement of the patient's physical abilities and an adjustment of the job requirements.

[Indicators of work incapacity in the first year of chronic polyarthritis]. / Indikatoren der Arbeitsunfähigkeit im ersten Jahr der chronischen Polyarthritis.

Already in the early phase of rheumatoid arthritis (RA) sick-leave (SL) frequently indicates a severe handicap with respect to work capacity. However, the significance of demographic, disease and work characteristics for SL are not known in early RA. Therefore, the indicators of SL (defied as the history of SL as certified by a physician) were sought in a cross-sectional multicenter study of early RA (< or = 1 year duration). One-hundred-and-thirty-four employed consecutive outpatients fulfilled > or = 4 of 7 ARA 1987 criteria of RA: 85 females (63%), age 50 years (median), disease duration 7 months (median). At the time of the examination 74 of the 134 patients (55%) were on SL because of RA (dependent dichotomous variable of the analyses). In order to identify the most important indicators of SL all variables with p < or = 0.10 in univariate analyses were entered into a multivariate logistic regression (stepwise forward analysis, p < or = 0.10). Parameters included in two different regression models (somatic variable and depression, job characteristics, respectively) were analyzed together in order to find the final model (p < or = 0.05). The following variables were included in the final logistic regression model of SL (p < or = 0.05): higher values of age, pain, and number of swollen joints, frequent overhead work, frequent pressure of time at work. Other indicators of SL in univariate analyses (p < or = 0.10) were not included in the model: male sex, low functional capacity, walking time, control over the pace and activities of work, occupational qualification, elevated ESR and depression. Significant indicators of SL are work conditions, disease activity, pain and age. Thus interventions focusing on the amelioration of the work capacity and thereby on the reduction of SL should concentrate on both the control of the disease and the improvement of the work conditions.

Prediction of permanent work disability in a follow-up study of early rheumatoid arthritis: results of a tree structured analysis using RECPAM.

The objectives of this study are: (a) to determine the occurrence of permanent work disability (PWD) in early rheumatoid arthritis (RA); (b) to identify prognostic groups of patients; (c) to assess the employment rates for these groups over time. Seventy-three gainfully employed consecutive out-patients with early RA (> or = 5 ARA 1958 criteria, disease duration < or = 12 months) at time one (T1) were re-examined at time two (T2) after a mean follow-up of 6 yr (S.D. +/- 2 yr). Potential risk factors, identified at T1, for PWD at T2 were entered in a tree structured survival analysis using RECPAM (RECursive Partition and AMalgamation). Cumulative 3 yr employment rates (3-yrER +/- S.E.M.) were computed from the resulting Kaplan-Meier curves. At T2, PWD occurred in 27 of the 73 patients (37%). The fastest decline in the employment rate was found within the first 3 yr of the disease onset, with a 3-yrER reduced to 73 +/- 5%. The group with the poorest prognosis (n = 14; 3-yrER 14 +/- 9%) was defined by age > or = 50 yr with either ESR > or = 60 mm/h or the combination of modified functional class (1-7) > or = 4 with a disease duration > or = 7 months. An intermediate group (n = 38; 3-yrER 79 +/- 6%) was defined by (a) age > or = 50 yr and low or moderate disease activity, (b) age < 50 yr and more strenuous job-related physical requirements, (c) age < 50 yr and less strenuous work, but joint count > or = 15. No case of PWD occurred in 21 individuals aged < 50 yr with a joint count < 15 and less physically demanding jobs. PWD occurs early in a substantial number of patients with RA. RECPAM defines risk profiles that can readily be applied in actual clinical situations and allow an estimation of the risk of PWD at different time points using the resulting Kaplan-Meier curves.

[The mobile rheumatoid health unit--an ambulatory consultation from the viewpoint of the physician and patient]. / Die Mobile Rheumahilfe--eine Ambulanzsprechstunde aus der Sicht von Arzten und Patienten.

The acceptance of a university-based outpatient department (Department of Rheumatology, Hannover Medical School, FRG) has been investigated. Ninety-five former patients with RA, previously treated in the department were interviewed by phone. 312 general practitioners from the city of Hannover received a mailed questionnaire. Patients were asked why they had left outpatient department care; questions for general practitioners dealt with types of referral. Despite high satisfaction with the outpatient unit in both groups, we found several shortcomings which possibly might influence discontinuation of treatment and non-utilization of the department: patients and physicians criticized the scheduling system and waiting times. Both groups complained of frequently changing doctors. The general practitioners wanted more contact with the department and more information about the unit. A small group of patients and referring physicians expressed resignation.

[Coping with stress and pain in migraine patients.]. / Streß- und Krankheitsbewältigung bei Migräne.

During a semi-structured interview 82 migraine patients were asked biographical and illnessrelated questions. They completed psychological instruments on coping behavior (Stressverarbeitungsfragebogen), self-concept (Frankfurter Selbstkonzeptskalen), attributional style (IE-SV-F), illness behavior, and illness-related attributions (Tübinger Attributions-fragebogen). The theoretical background of this research is a cognitive model of coping with stress and illness. The results support the interrelations between coping with stress and coping with illness assumed in the model. They justify considering coping with illness to be scopespecific coping behavior. Furthermore, the results emphasize the importance of cognitive processes for stress-coping in general, as well as for illness-related coping behavior. With regard to personality variables, migraineurs, as compared with healthy persons, show to a larger extent coping strategies that are apt to maintain rather than to reduce stress, such as resignation, withdrawal, and avoidance behavior. They also have a more unfavorable selfconcept of achievement, emotional stability and selfassertiveness, lower self-esteem and a more external pattern of causal attributions. Some of the pain behavior strategies could be identified as being focused on illness (guarding behavior, avoidance and social withdrawal, resignation and complaint); only the attempt to relax is regarded as being focused on health. Migraine patients show a preference neither for medical nor psychological causal attributions of their illness but score significantly higher on medical than psychological control attributions. The results have implications for psychological therapy.

Standardization of radiorenography in dehydrated and rehydrated primates under laboratory conditions.

Radiorenography with 99mTc-labelled diethylenetriaminepentacetic acid ( [99mTc]-DTPA) was performed on chacma baboons (Papio ursinus) and vervet monkeys (Cercopithecus pygerythus) to establish the effects of various states of hydration on the data obtained from the DTPA-renogram. The renogram parameters, which can be related to certain aspects of kidney function, varied significantly with the degree of hydration. It is therefore imperative for clinically directed animal research projects on the urinary system to standardise the experimental procedure for radiorenography. A dehydration of 6 h followed by an hour IU rehydration period using 200 ml of a 0.9% NaCl solution on baboons under thiopentone sodium anaesthetic, was found to be the most suitable procedure for radiorenographic investigations in this primate model.