ABSTRACT
The clinical features, serology behaviour, scintiscan characteristics and the degree of X-ray progression according to the disease duration were compared in two RA groups with a disease onset after 65 years of age (LORA) and before 65 (EORA) respectively. No differences emerged in either the clinical findings or in the scintiscan picture. A sub-group of LORA showed acute flares of the illness presenting with very high ESR values and high fever. The erosive index (EI) evaluated in three areas (carpal-bone and wrist, MCP and PIP joints) revealed an undistinguishable degree of X-ray damage either in seropositive or seronegative patients, whereas seropositive EORA fared clearly worse than seronegative ones. A prospective study in two small sub-groups of LORA and EORA revealed a progression of X-ray erosions despite second line drug treatment in both groups, especially in LORA.
Subject(s)
Arthritis, Rheumatoid/physiopathology , Adult , Aged , Arthritis, Rheumatoid/classification , Arthritis, Rheumatoid/diagnostic imaging , Blood Sedimentation , C-Reactive Protein/analysis , Female , Gold/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Male , Methylprednisolone/therapeutic use , Middle Aged , Radiography , Radionuclide Imaging , Time Factors , Tiopronin/therapeutic useABSTRACT
As the health care delivery system faces increasingly complex issues and changes, the need for an amicable, productive working relationship between the governing board and the administrator grows in importance. Both the chairman of the board and the administrator of a California hospital give their perspective on how they view their own and each other's roles, and the factors that have been decisive in the development of a mutually supportive working relationship.
