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ABSTRACT: A 31-year-old Chinese lady presented with severe SLE with nephrotic syndrome, anemia, leucopenia and thrombocytopenia, skin lesions, and joint inflammation after failing previous standard therapy. After treatment with three infusions of rituximab she showed immediate improvements regarding clinical and laboratory parameters. She received no cytotoxic drugs and remained well for at least 7 months, despite stopping prednisolone.
Clinical Rheumatology 01/2009; 28 Suppl 1:S27-30. · 2.00 Impact Factor
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ABSTRACT: To examine the efficacy of short-term intensive exercise training (IET) directly following hospital discharge.
In the Disabled Arthritis Patients Post-hospitalization Intensive Exercise Rehabilitation (DAPPER) study, patients with rheumatoid arthritis or osteoarthritis were eligible when they needed hospitalization for either a flare-up in disease, elective hip or knee arthroplasty. The intervention group received IET for 3 weeks immediately after discharge; the control group was treated with the usual care (UC). The intensive exercise was provided in a resort. Outcomes were assessed at baseline, after 3, 13, 26 and 52 weeks. Range of motion was measured using the Escola Paulista de Medicina-Range of Motion scale (EPM-ROM), disability was measured using the HAQ and the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), and for health-related quality of life (HRQoL), the Research and Development 36-Item Health Survey (RAND-36) was used.
The IET showed a better and faster improvement than UC on all outcome measures except for HRQoL. Up to 52 weeks after baseline, the EPM-ROM and the MACTAR remained favourable in IET compared with UC. At 3 weeks, the MACTAR improved significantly more in the IET compared with the UC: mean difference -5.5 (95% CI -8.4 to -2.2). At 26 weeks, the mean difference remained significant (-5.2; 95% CI -10.0 to -0.34). At 52 weeks, the effect was not significant; however, the mean difference in improvement between the groups can be considered clinically relevant. At 3 weeks, the IET had improved significantly more on the HAQ walking and rising subscales.
Intensive short-term exercise training of arthritis patients, immediately after hospital discharge results in improved regain of function. The DAPPER programme has a direct effect, which lasts up to 52 weeks.
Rheumatology 12/2007; 46(11):1712-7. · 4.06 Impact Factor
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ABSTRACT: In this study we examine which factors are related to compliance with medication in patients suffering from rheumatoid arthritis (RA). Patients: persons suffering recently developed, active RA, who cooperated in a randomized study on the effect of patient education. We analyzed the relation between adherence to Sulphasalazine therapy and personal factors, environmental influences, demographic factors, disease-related factors, and barriers to compliance. Moreover, a logistical regression analysis was performed on these factors, considering > or = 80% a high compliance, both with compliance as dependent factor. Only self-efficacy correlated with compliance (r = 0.58; P < 0.001). The logistical regression analysis identified self-efficacy as the only factor determining > or = 80% adherence (P = 0.01). Self-efficacy regarding the use of prescribed medication is related to compliance with this treatment. Further study is needed to determine the test characteristics of self-efficacy as a predictor for compliance with medication.
Patient Education and Counseling 02/1999; 36(1):57-64. · 2.31 Impact Factor
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ABSTRACT: This study was performed to determine the compliance with the basic treatments for rheumatoid arthritis (RA; medication, physical therapy, and ergonomic measures), to study psychological factors that influence compliance in light of the social learning theory, to learn whether patient education positively influences compliance and health, and to find an approach to patient education that improves compliance.
A MEDLINE search of the English language literature was performed.
Few studies have dealt with compliance in RA patients; levels of adherence are generally low. According to the social learning theory, human function involves a continuous interaction between behavior, personal factors, and external environment. Self-efficacy is a personal factor that refers to the belief in one's capabilities and opportunities for being compliant with treatment advice. Patient education may improve ergonomic performance and compliance with physical exercise programs.
Compliance with medication was infrequently studied. Whether improved compliance leads to better health status could not be determined. Compliance with RA treatments are generally low. Systematic study of the effect of patient education on treatment and health is warranted. Self-efficacy enhancing techniques in patient education may improve compliance.
Seminars in Arthritis and Rheumatism 03/1997; 26(4):702-10. · 4.97 Impact Factor
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ABSTRACT: A nationwide survey among all 118 Dutch rheumatologists (response rate 85%) yielded 42 patients with Lyme arthritis. The arthritis was nonpersistent in all these patients. A tick bite was reported by 23 of these 42 patients (55%). Erythema migrans was recalled by 19 patients (45%). Cardiac manifestations occurred in 4 patients (9%) and neurologic symptoms in 14 patients (33%). By immunoabsorbent assay or immunofluorescence technique 37 patients (88%) had positive IgG antibodies to Borrelia burgdorferi. The distribution of HLA-DR alleles of 28 of these patients was not different from the healthy population. The response to antibiotic treatment was considered good in 34 patients (81%). The clinical features of the Dutch patients with Lyme arthritis closely resemble the description of the disease reported from the United States.
The Journal of Rheumatology 01/1992; 18(12):1819-22. · 3.69 Impact Factor
