The effect of dapsone in steroid-dependent asthma.

We studied the steroid-sparing effect of dapsone in 10 subjects with chronic asthma in a preliminary open trial. Dapsone was chosen because it inhibits neutrophil function and possesses anti-inflammatory effects in a variety of disorders. The study group consisted of 10 subjects with stable, steroid-dependent asthma, aged 23 to 80 years, with normal glucose-6-phosphate dehydrogenase levels. Average daily baseline prednisone dose ranged from 5 to 60 mg. Dapsone, 100 mg, twice daily, by mouth, was started after a 1-month baseline period. Baseline steroid dose, symptom scores, and daily peak flow rates were compared to the latest available 4-week period of dapsone treatment. Average cumulative monthly prednisone dose was reduced from 428 mg to 82 mg (p less than 0.02). Five of 10 patients stopped steroids by month 6 and two additional patients by month 13. Two additional patients demonstrated a coincidental 74% reduction in steroid dose, and one patient demonstrated no response. Clinical parameters remained stable despite steroid reduction. These preliminary data suggest dapsone may have steroid-sparing effects in chronic asthma.

The painful shoulder: diagnosis and treatment.

The shoulder is one of the most complex joints in the body requiring coordinated, functioning muscles and joints to have a fluid, rhythmic motion. The shoulder consists of the glenohumeral (GH) joint, the acromioclavicular (AC) joint, the scapulothoracic (ST) joint, and the sternoclavicular (SC) joint. This article will examine the shoulder anatomy, clinical syndromes, and treatment for common shoulder disorders.

What are we measuring? An examination of self-reported functional status measures.

Functional status questionnaires are being used in various types of studies. To determine factors related to self-reported functional ability for rheumatoid arthritis patients, we examined the relationship between a functional and mental health questionnaire and objective disease-specific measures. Using 3-5 predictor variables, we explained 43-57% of the variance in patients' self-reported functioning. Mental and physical health perceptions were significant predictors for each self-reported functional measure. The relationships among mental health and self-reported functioning should be considered when interpreting studies that use functional status questionnaires.

Measuring disease activity: comparison of joint tenderness, swelling, and ultrasonography in rheumatoid arthritis.

In a prospective study of 6 patients with classic rheumatoid arthritis, we evaluated 3 measures of disease activity: comprehensive joint swelling and joint tenderness counts, and ultrasonography of joints. After baseline data were obtained on these 6 patients, therapy with fenbufen, a new nonsteroidal antiinflammatory drug, was begun. Followup examinations were performed at 4 weeks and 24 weeks after baseline. There were statistically significant differences between joint tenderness and joint swelling findings and between joint tenderness and joint ultrasonography findings (P less than 0.05 by kappa test statistic). In comparisons of joint swelling and ultrasonography, no difference was found (P greater than 0.05). When measures of changes over 6 months were compared, there was a high concordance between improvement in joint swelling and improvement in joint ultrasonography (P less than 0.01). Our results demonstrate that clinical assessment of joint swelling provides an accurate measure of synovial effusion, as confirmed by the more objective ultrasound measurements.

The joint alignment and motion scale: a simple measure of joint deformity in patients with rheumatoid arthritis.

We developed a simple 5 point scale, the Joint Alignment and Motion (JAM) Scale, to estimate joint deformity in patients with rheumatoid arthritis (RA). The scale is based on an estimate of the percent of normal range of motion and joint alignment and requires 5 min to perform when added to a typical joint count. This deformity measure has good interobserver reliability (r = 0.72) and appears stable over time. The JAM score measures joint characteristics distinct from tenderness and swelling and correlates strongly with functional measures (walk time, grip strength and self-reported functional status). Joint deformity should be considered when interpreting functional measures for patients with RA.

Evaluation of an inpatient rheumatoid arthritis patient education program.

We evaluated an inpatient rheumatoid arthritis patient education program to determine whether patient knowledge improved and whether the improvement persisted after discharge. Patient knowledge was assessed by a multiple choice and true-false test given upon admission, after education, and 4 months following discharge. The treatment group increased their knowledge by 40% (p less than .05) on the post-intervention questionnaire and retained most of this knowledge over a 4-month period. A control group of outpatients demonstrated no significant improvement in knowledge. Inpatients particularly demonstrated a marked increase in their knowledge of physical therapy recommendations. This knowledge was acquired and maintained even though the patients were involved in numerous diagnostic and therapeutic interventions that could have distracted from the educational program.

What are we measuring? An examination of walk time and grip strength.

Are walk time and grip strength measures of disease activity or functional ability? Ninety-two patients with rheumatoid arthritis were examined initially and 12 months later for clinical measures including joint deformity, and answered a functional status questionnaire. Walk time and grip strength were strongly related to joint deformity and functional questionnaire measures, and appeared insensitive in showing changes in disease activity over time. They could serve as objective functional measures in studies primarily directed towards changing functional ability, but appeared to be poor major outcome measures for trials aimed at altering disease activity.

Rehabilitation for rheumatoid arthritis patients. A controlled trial.

For 1 year we obtained questionnaire and clinical measures from 2 cohorts of rheumatoid arthritis patients: 49 experimental patients who were admitted for an average of 13 days to a university-based rheumatology rehabilitation unit, and 43 control patients who received care from rheumatologists associated with another teaching hospital. At 1 year, after controlling for groups differences, the experimental patients demonstrated significant (P less than 0.05) improvement compared with control patients in several functional status, mental health, and disease activity measures.

Evaluating self-care activities: comparison of a self-reported questionnaire with an occupational therapist interview.

Accurately evaluating a patient's ability to perform self-care activities is important for clinical and research purposes. We compared assessments of self-care activities obtained from a patient self-administered questionnaire and an occupational therapist interview. Forty-five rheumatoid arthritis patients admitted to a multidisciplinary rheumatology rehabilitation unit were evaluated by both methods for their ability to bathe, dress, perform toileting and general hand activities. Patients reported requiring more assistance with self-care activities in a self-administered questionnaire than they did in an occupational therapist interview. For example, 78% of patients reported requiring no assistance with bathing in the therapist's interview, whereas 31% reported no assistance on the questionnaire. Patients appear more willing to admit difficulties with self-care activities in a self-administered questionnaire than in a personal interview.

Reliability of xerographic reproduction measurements of ulnar deviation.

The lack of a practical validated measure of ulnar deviation in rheumatoid arthritis (RA) has precluded serious consideration of conservative treatments to correct ulnar deviation. The xerographic photocopier provides an available, inexpensive, safe instrument for recording hand positions. Randomized xerographs detected differences in individual finger angles in both RA and normals (p less than .01) when using a standardized method for angle measurements. This method is simple, safe (no radiation), and offers a practical approach to assessing the treatment of ulnar deviation in RA.

Outpatient educational program for rheumatoid arthritis patients.

A patient-education program was designed to meet the expressed needs of clinic rheumatoid arthritis patients. This program consisted of six educational seminars involving various health professionals. A quasi-experimental control group design was employed to evaluate the patients' cognitive and behavioral responses to this program. Responses were assessed through the administration of pretests, posttests, and three-month follow-up tests to treatment and control groups. The treatment group increased its cognitive score 22.5% from initial pretest to long-term follow-up, whereas the control group improved only 5.1% on these questions. The treatment group improved its behavioral score between the administration of the pretest and the posttest and maintained this improvement on the long-term follow-up. Although the control group initially scored somewhat higher on the behavioral measures, it reported a decrease in the performance of self-care activities on the posttest and follow-up.

Arthritic hand response to pressure gradient gloves.

Five women with osteoarthritis and 10 with rheumatoid arthritis and finger joint involvement wore a pressure gradient glove, a control glove, or no glove in a randomly assigned sequence. All were outpatients. Each patient wore the assigned glove nightly for 1 week, after which a battery of subjective and objective data, including number of tender joints, ring size, grip strength, palmar temperature, and hand function were obtained. In all, 105 separate examinaion sessions were completed over 7 visits, with each hand serving as its own control in the experimental design. The palmar skin temperature was elevated in both patient groups when either a pressure gradient or control glove was worn. In patients with rheumatoid arthritis, the only significant difference was that the pressure gradient glove reduced ring size when compared to the control glove or no glove. No differences were detected in the patients with osteoarthritis.