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Author Plant, M.J.; Jones, P.W.; Saklatvala, J.; Ollier, W.E.; Dawes, P.T. url  openurl
  Title Patterns of radiological progression in early rheumatoid arthritis: results of an 8 year prospective study Type Journal Article
  Year 1998 Publication (up) Abbreviated Journal J Rheumatol.  
  Volume 25 Issue 3 Pages 417-426  
  Keywords Adolescent; Adult; Aged; Aged,80 and over; analysis; Arthritis; Arthritis,Rheumatoid; Biological Markers; C-Reactive Protein; Disease Progression; England; Female; Follow-Up Studies; Hand; HLA-DR Antigens; Humans; immunology; Joints; Male; methods; Middle Aged; Patients; Prospective Studies; radiography; Research Support; Rheumatoid Factor; Severity of Illness Index  
  Abstract OBJECTIVE: To describe the course of radiological progression in a cohort of 126 patients presenting with early nonerosive rheumatoid arthritis (RA). METHODS: Criteria for recruitment to the study were fulfillment of the 1958 American Rheumatism Association criteria, absence of erosive disease at presentation and duration of symptoms less than 3 years. Radiographs of hands and feet at 0, 1, 2, 5, and 8 years were available on 114 patients and were scored by Sharp's method for erosion (ERO) and joint space narrowing (JSN). Eighty-six patients were typed for the RA susceptibility shared HLA-DR epitope. RESULTS: The feet showed greatest initial radiological progression, but tended to reach an earlier and lower plateau. ERO progressed more rapidly than JSN in the first 2 years, but in parallel thereafter. The relative proportion of ERO:JSN varied, 1:1 for the wrists, 4:1 for the proximal interphalangeal joints. Thirty-eight percent of joints were eroded at 2 years, 63% at 8 years. Four patterns of radiological progression were identified: flat or nonerosive disease in 29 patients, linear in 51, lag in 13, and plateau in 19 (irregular in 2). Changes in the rate of radiological progression were reflected by the time-integrated C-reactive protein over the same period. Rheumatoid factor titer was higher in the progressive groups compared to the flat group (p = 0.01). The RA susceptibility shared HLA-DR epitope was more frequent in the linear compared to the flat group (p = 0.03). CONCLUSION: A large proportion of joints become eroded in the first 2 years of early RA. The subsequent course of radiological progression is highly variable and cannot be easily explained by any single model  
  Address Staffordshire Rheumatology Centre, The Haywood Hospital, Stoke-on-Trent, England  
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  Notes DA – 19980506 IS – 0315-162X (Print) LA – eng PT – Journal Article PT – Research Support, Non-U.S. Gov't RN – 0 (Biological Markers) RN – 0 (HLA-DR Antigens) RN – 9009-79-4 (Rheumatoid Factor) SB – IM Approved no  
  Call Number 9 Serial 887  
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Author Prashker, M.J.; Meenan, R.F. url  openurl
  Title The total costs of drug therapy for rheumatoid arthritis. A model based on costs of drug, monitoring, and toxicity Type Journal Article
  Year 1995 Publication (up) Abbreviated Journal Arthritis Rheum.  
  Volume 38 Issue 3 Pages 318-325  
  Keywords adverse effects; Antirheumatic Agents; Arthritis; Arthritis,Rheumatoid; Azathioprine; Boston; Decision Trees; Diagnosis-Related Groups; Drug Costs; Drug Monitoring; drug therapy; economics; Gold; Health Care Costs; Hospitals,University; Humans; Hydroxychloroquine; Massachusetts; methods; Methotrexate; Models,Economic; New Hampshire; Patients; Penicillamine; Research Support; Sensitivity and Specificity; statistics & numerical data; therapeutic use; therapy; utilization  
  Abstract OBJECTIVE. We created a model to estimate the total medication costs of treating patients with rheumatoid arthritis with 6 second-line agents for the first 6 months of treatment. METHODS. Drug costs were obtained from a survey of pharmacies; monitoring costs were calculated from utilization information obtained in a survey of rheumatologists; toxicity costs were obtained using decision trees to represent the evaluation and treatment of potential toxicities. Monitoring and toxicity costs were estimated using costs from the Boston University Medical Center or, for hospitalizations, using appropriate diagnosis-related group categories. The sum of the 3 components determined the total medication costs. RESULTS. The least expensive medication was penicillamine, at $10.62/week, and the most expensive was injectable gold, at $30.89/week. In terms of monitoring costs, methotrexate had the highest costs associated with necessary laboratory tests and office visits. Hydroxychloroquine had the lowest monitoring costs for office visits, and oral gold had the lowest for laboratory costs. Hematologic toxicities were the largest component of toxicity costs for all 6 medications, and renal toxicities were costly for patients taking oral gold, penicillamine, and injectable gold. Total medication costs revealed oral gold as the least expensive medication and injectable gold as the most expensive. The combination of monitoring and toxicity costs accounted for more than 60% of the total costs for all medications except injectable gold. In all cases, the cost of treating toxicities was the smallest of the 3 components. CONCLUSION. When calculating the costs of drug therapy, it is important to consider not only the price of the drug, but also the costs of monitoring and treating the toxicities that might occur. Failure to do so will result in underestimating the true costs of treatment with these medications  
  Address Boston Veterans Affairs Medical Center, MA 02130  
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  Notes DA – 19950406 IS – 0004-3591 (Print) LA – eng PT – Journal Article PT – Research Support, U.S. Gov't, Non-P.H.S PT – Research Support, U.S. Gov't, P.H.S RN – 0 (Antirheumatic Agents) RN – 118-42-3 (Hydroxychloroquine) RN – 446-86-6 (Azathioprine) RN – 52-67-5 (Penicillamine) RN – 59-05-2 (Methotrexate) RN – 7440-57-5 (Gold) SB – AIM SB – IM Approved no  
  Call Number 50 Serial 888  
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Author Pugner, K.M.; Scott, D.I.; Holmes, J.W.; Hieke, K. url  openurl
  Title The costs of rheumatoid arthritis: an international long-term view Type Journal Article
  Year 2000 Publication (up) Abbreviated Journal Semin.Arthritis Rheum.  
  Volume 29 Issue 5 Pages 305-320  
  Keywords analysis; Arthritis; Arthritis,Rheumatoid; Costs and Cost Analysis; Developed Countries; diagnosis; economics; Health; Health Care Costs; Health Status; Humans; Medline; methods; Patients; Questionnaires; Research Support; Work; World Health  
  Abstract OBJECTIVES: To review the literature on the measurable direct and indirect costs of rheumatoid arthritis (RA) in industrialized countries from a societal perspective and to develop a template for international use. METHODS: A literature search using MEDLINE and other sources identified 153 relevant published articles, press releases, and so forth on the costs of RA and rheumatism from the major Organization for Economic Cooperation and Development (OECD) countries in English and other languages. Sixty-eight publications provide some economic data for analysis and are included in the bibliography. Twelve publications provide sufficiently detailed and robust information for inclusion in country overview tables. The concept of varied costs at different disease stages measured by years since diagnosis and Health Assessment Questionnaire (HAQ) scores is used to guide rational decisions in the allocation of scarce health care resources. RESULTS: Direct costs increase overproportionately during the course of the disease. The most important driver of direct costs is hospitalization, especially in moderate and severe RA. Costs of medication represent a comparatively small proportion of direct costs. Indirect costs caused by work disability can be substantially higher than direct costs, particularly in working-age patients. The total costs of RA to society, and the different cost components such as direct and indirect costs, are broadly comparable in industrialized countries by their order of magnitude. Major confounding factors for international comparison are different study methodologies and patient samples. CONCLUSIONS: The cost template developed in this article can be used to estimate the likely costs of RA to society for industrialized countries. It probably will underestimate indirect costs because of their incomplete coverage in the studies examined. A long-term perspective is needed for chronic diseases such as RA to assess the future effects of early interventions. Treatment in the early stages of RA that effectively reduces long-term disability has the potential to save substantial costs to society  
  Address Economists Advisory Group Ltd, London, United Kingdom. KlausP@eag.co.uk  
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  Notes DA – 20000622 IS – 0049-0172 (Print) LA – eng PT – Journal Article PT – Research Support, Non-U.S. Gov't PT – Review SB – IM Approved no  
  Call Number 48 Serial 889  
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Author Raftery, J. url  openurl
  Title NICE: faster access to modern treatments? Analysis of guidance on health technologies Type Journal Article
  Year 2001 Publication (up) Abbreviated Journal Bmj  
  Volume 323 Issue 7324 Pages 1300-1303  
  Keywords analysis; Cost-Benefit Analysis; Decision Making; England; Government Agencies; Health; Health Services; Health Services Accessibility; Humans; organization & administration; Practice Guidelines; Quality-Adjusted Life Years; Technology Assessment,Biomedical; Wales  
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  Address Health Services Management Centre, School of Public Policy, University of Birmingham, Birmingham B15 2RT. J.P.Raftery@bham.ac.uk  
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  Notes DA – 20011203 IS – 0959-8138 (Print) LA – eng PT – Journal Article PT – Review SB – AIM SB – IM Approved no  
  Call Number 77 Serial 890  
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Author Raikou, M.; McGuire, A. url  openurl
  Title The economics of screening and treatment in type 2 diabetes mellitus Type Journal Article
  Year 2003 Publication (up) Abbreviated Journal Pharmacoeconomics  
  Volume 21 Issue 8 Pages 543-564  
  Keywords analysis; complications; Coronary Disease; Diabetes Mellitus; Diabetes Mellitus,Type 2; Diabetic Foot; Diabetic Nephropathies; Diabetic Retinopathy; economics; etiology; Health; Health Care Costs; Humans; Mass Screening; Patients; Randomized Controlled Trials; Research Support; statistics & numerical data; therapy; trends  
  Abstract A systematic review of the literature was conducted to identify articles on the economics of type 2 diabetes mellitus. Articles were classified into two main categories: cost/burden-of-illness studies of type 2 diabetes and economic evaluations of type 2 diabetes interventions. This systematic review was supplemented by an overview of the findings relating to economic evaluations of associated diabetic complications. A number of conclusions emerge from this review, the most important of which is that intensive treatment of patients with type 2 diabetes appears to be relatively cost effective compared with more conservative strategies. This finding reflects the cost offsets that arise from the range and degree of complications attributable to diabetes. Primary prevention of type 2 diabetes also appears to be cost effective, particularly in high-risk groups. The evidence on screening for type 2 diabetes is less conclusive and further economic analysis is required  
  Address LSE Health and Social Care, London School of Economics and Political Science, Cowdray House, Houghton Street, London WC2A 2AE, UK. m.raikou@lse.ac.uk  
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  Notes DA – 20030519 IS – 1170-7690 (Print) LA – eng PT – Journal Article PT – Research Support, Non-U.S. Gov't PT – Review SB – T Approved no  
  Call Number 39 Serial 891  
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Author Riemsma, R.P.; Rasker, J.J.; Taal, E.; Griep, E.N.; Wouters, J.M.; Wiegman, O. url  openurl
  Title Fatigue in rheumatoid arthritis: the role of self-efficacy and problematic social support Type Journal Article
  Year 1998 Publication (up) Abbreviated Journal Br J Rheumatol.  
  Volume 37 Issue 10 Pages 1042-1046  
  Keywords Aged; analysis; Arthritis; Arthritis,Rheumatoid; blood; Blood Sedimentation; complications; Fatigue; Female; Health; Health Status; Hemoglobins; Humans; Male; Middle Aged; Netherlands; Outpatients; Pain; Patients; psychology; Questionnaires; Research Support; Rheumatoid Factor; Self Care; Severity of Illness Index; Social Support  
  Abstract OBJECTIVE: To examine the relationship of fatigue in people with rheumatoid arthritis (RA) with self-efficacy, positive and problematic aspects of social support, and demographic and disease-related variables. METHOD: Out-patients with at least 5 yr RA were studied. Fatigue was measured with a visual analogue scale. Other variables included were: positive social support [Social Support List-Interactions (SSL12-I)] and problematic social support; self-efficacy towards coping with RA and towards mobilizing support; health status (Dutch-AIMS2); and laboratory tests: erythrocyte sedimentation rate (ESR), haemoglobin (Hb) and rheumatoid factor (RF); and disease duration. RESULTS: A total of 229 out-patients were included. Fatigue correlated with all scales of the Dutch-AIMS2: with pain, physical function and affect (P < 0.001). There was no significant correlation with social support, but there was a highly significant correlation of fatigue with problematic social support (P < 0.001). Both forms of self-efficacy correlated strongly with fatigue: patients with high self-efficacy expectations towards coping with RA, and towards mobilizing the social network (P < 0.001), had less fatigue. In the regression analysis to explain the variation in fatigue, only pain, self-efficacy expectations towards coping with RA, and towards asking for help and problematic social support remained significant. CONCLUSIONS: Fatigue can to a large extent (37%) be explained by pain, self-efficacy towards coping with RA, and towards asking for help and problematic social support. It is known that self-efficacy can be enhanced by self-management courses and it may thus be possible to improve fatigue  
  Address Department of Psychology, University of Twente, Enschede, The Netherlands  
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  Notes DA – 19981203 IS – 0263-7103 (Print) LA – eng PT – Journal Article PT – Multicenter Study PT – Research Support, Non-U.S. Gov't RN – 0 (Hemoglobins) RN – 9009-79-4 (Rheumatoid Factor) SB – AIM SB – IM Approved no  
  Call Number 20 Serial 892  
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Author Saklatvala, J. url  openurl
  Title Tumour necrosis factor alpha stimulates resorption and inhibits synthesis of proteoglycan in cartilage Type Journal Article
  Year 1986 Publication (up) Abbreviated Journal Nature  
  Volume 322 Issue 6079 Pages 547-549  
  Keywords Animals; Arthritis; Cartilage; Cattle; Chromatography,Gel; Culture Techniques; Cytokines; drug effects; genetics; Glycoproteins; Inflammation; Interleukin-1; metabolism; pharmacology; Proteoglycans; Recombinant Proteins; Research Support; Swine; Time Factors; Tumor Necrosis Factor-alpha  
  Abstract During inflammatory reactions, activated leukocytes are thought to produce a variety of small proteins (cytokines) that influence the behaviour of other cells (including other leukocytes). Of these substances, which include the interleukins, interferons and tumour necrosis factors (TNFs), interleukin-1 (IL-1) has been considered potentially a most important inflammatory mediator because of its wide range of effects. In vivo it is pyrogenic and promotes the acute phase response; in vitro it activates lymphocytes and stimulates resorption of cartilage and bone. Cartilage resorption is a major feature of inflammatory diseases such as rheumatoid arthritis, and IL-1 is the only cytokine hitherto known to promote it. TNFs are characterized by their effects on tumours and cytotoxicity to transformed cells, but share some actions with IL-1. I report here that recombinant human TNF alpha stimulates resorption and inhibits synthesis of proteoglycan in explants of cartilage. Its action is similar to and additive with IL-1, and it is a second macrophage-derived cytokine whose production in rheumatoid arthritis, or inflammation generally, could contribute to tissue destruction  
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  Notes DA – 19860917 IS – 0028-0836 (Print) LA – eng PT – Journal Article PT – Research Support, Non-U.S. Gov't RN – 0 (Glycoproteins) RN – 0 (Proteoglycans) RN – 0 (Recombinant Proteins) RN – 0 (Tumor Necrosis Factor-alpha) SB – IM Approved no  
  Call Number 12 Serial 893  
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Author Saxne, T.; Palladino, M.A., Jr.; Heinegard, D.; Talal, N.; Wollheim, F.A. url  openurl
  Title Detection of tumor necrosis factor alpha but not tumor necrosis factor beta in rheumatoid arthritis synovial fluid and serum Type Journal Article
  Year 1988 Publication (up) Abbreviated Journal Arthritis Rheum  
  Volume 31 Issue 8 Pages 1041-1045  
  Keywords Adult; analysis; Arthritis; Arthritis,Rheumatoid; Female; Humans; Interferon Type II; Male; metabolism; Patients; Sweden; Synovial Fluid; Tumor Necrosis Factor-alpha  
  Abstract Synovial fluids from 6 of 12 patients with rheumatoid arthritis (RA) and from 3 of 11 patients with reactive arthritis contained measurable levels of tumor necrosis factor alpha (TNF alpha). Seven of 12 sera from RA patients contained TNF alpha, while only 1 of those from reactive arthritis patients was positive. Gamma-interferon was detected in the synovial fluids and sera of only the RA patients. Tumor necrosis factor beta was not detected in any sera or synovial fluids. RA patients with detectable TNF alpha had higher erythrocyte sedimentation rates and synovial fluid leukocyte counts  
  Address Department of Rheumatology, University of Lund, Sweden  
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  Notes DA – 19880913 IS – 0004-3591 (Print) LA – eng PT – Comparative Study PT – Journal Article RN – 0 (Tumor Necrosis Factor-alpha) RN – 82115-62-6 (Interferon Type II) SB – AIM SB – IM Approved no  
  Call Number 85 Serial 894  
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Author Scott, D.L.; Pugner, K.; Kaarela, K.; Doyle, D.V.; Woolf, A.; Holmes, J.; Hieke, K. url  openurl
  Title The links between joint damage and disability in rheumatoid arthritis Type Journal Article
  Year 2000 Publication (up) Abbreviated Journal Rheumatology (Oxford)  
  Volume 39 Issue 2 Pages 122-132  
  Keywords Arthritis; Arthritis,Rheumatoid; Disability Evaluation; Health; Humans; Joints; Medline; methods; Pain Measurement; pathology; Patients; physiopathology; Time Factors  
  Abstract OBJECTIVE: The characteristic joint damage and disability of rheumatoid arthritis (RA) increase slowly over 10-20 yr. Although it is generally believed that persisting inflammatory synovitis causes joint damage and subsequent disability, the strength of their relationship has not been systematically evaluated. This review describes their progression and interrelationship in treated RA. METHODS: MEDLINE and Current Contents databases were searched for the combined terms of rheumatoid arthritis AND X-rays, Health Assessment Questionnaire, slow-acting anti-rheumatic drugs and all identifiable synonyms. This search identified 1303 articles and from these we evaluated in detail 23 reports on the progression of joint damage, 12 reports on the progression of disability and 25 reports dealing with their interrelationship. Additional information was obtained from four data sets comprising 725 RA patients studied cross-sectionally and 33-126 cases followed prospectively for 1-5 yr. X-ray damage was primarily assessed by Larsen and Sharp indices, and disability by the Health Assessment Questionnaire (HAQ). RESULTS: Joint damage and disability both increase throughout the duration of RA. Although disability (HAQ score) is correlated with disease duration (correlation coefficients between 0.27 and 0.30), the link between X-ray damage and disability is stronger (correlation coefficients between 0.30 and 0.70). In the earliest phases of RA, X-ray damage and HAQ scores are not related. By 5-8 yr, there are significant correlations with correlation coefficients between 0.30 and 0.50. In late RA (>8 yr), most studies show highly significant correlations between 0.30 and 0.70. CONCLUSIONS: Joint damage progresses constantly over the first 20 yr of RA. It accounts for approximately 25% of disability in established RA. The link between damage and disability is strongest in late (>8 yr) RA. However, avoiding or reducing joint damage in both early and established/late RA is likely to maintain function  
  Address Clinical and Academic Rheumatology, Kings College Hospital (Dulwich), London, Economists Advisory Group Ltd, 105 Victoria Street, London, UK  
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  Notes DA – 20000419 IS – 1462-0324 (Print) LA – eng PT – Journal Article PT – Review SB – AIM SB – IM Approved no  
  Call Number 10 Serial 898  
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Author Scott, D.L. url  openurl
  Title Prognostic factors in early rheumatoid arthritis Type Journal Article
  Year 2000 Publication (up) Abbreviated Journal Rheumatology.(Oxford)  
  Volume 39 Suppl 1 Issue Pages 24-29  
  Keywords Aged; analysis; Antibodies; Arthritis; Arthritis,Rheumatoid; Biological Markers; C-Reactive Protein; Disability Evaluation; Disabled Persons; Humans; Immunoglobulin A; Longitudinal Studies; Middle Aged; pathology; physiopathology; Prognosis; radiography; Rheumatoid Factor; Severity of Illness Index; Synovitis; therapy  
  Abstract The current paradigm for rheumatoid arthritis suggests that persistent synovitis leads to erosive joint damage, progression of which results in functional disability. Studies of X-ray progression followed for 1-9 yr have shown that 40-83% of subsequent progression can be predicted by a combination of prognostic factors such as joint involvement, high levels of C-reactive protein and rheumatoid factor (RF) positivity. There are similar findings for predictors of functional disability in studies followed for 2-15 yr. The most consistent prognostic feature is RF positivity, which is equally important in predicting joint damage and functional disability. Immunoglobulin A RF and the co-presence of RF with anti-keratin or anti-filaggrin antibodies may increase levels of prediction. Added value of genetic predictors over that of RF remains inconclusive. Therefore, therapeutic management should be individualized. Cases with active disease and seropositive RF tests merit aggressive therapy; conversely, cases with little synovitis and seronegative tests require conservative management  
  Address GKT School of Medicine, London, UK  
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  Notes DA – 20001003 IS – 1462-0324 (Print) LA – eng PT – Journal Article PT – Review RN – 0 (Biological Markers) RN – 0 (Immunoglobulin A) RN – 9007-41-4 (C-Reactive Protein) RN – 9009-79-4 (Rheumatoid Factor) SB – AIM SB – IM Approved no  
  Call Number 136 Serial 899  
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