Dissertations / Theses on the topic 'Rheumatology and arthritis'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 44 dissertations / theses for your research on the topic 'Rheumatology and arthritis.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
Newbold, David Anthony. "An evaluation of the rheumatology nurse practitioner." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263598.
Full textHewlett, Sarah. "Values, disability and personal impact in rheumatoid arthritis." Thesis, University of Bristol, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310640.
Full textWang, Hui. "Modulation by transforming growth factor-#beta#1 and insulin-like growth factor-1 of cartilage collagen breakdown induced by pro-inflammatory cytokines." Thesis, University of Newcastle Upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327213.
Full textArican, Mustafa. "Bone and cartilage metabolism in canine arthropathies." Thesis, University of Liverpool, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283505.
Full textCresswell, Lynne. "Statistical modelling in rheumatology : applications to Psoriatic Arthritis and Systemic Lupus Erythematosus." Thesis, University of Cambridge, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.608755.
Full textSteel, Kathryn Jean Audrey. "Characterisation of a susceptibility locus for inflammatory arthritis." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/characterisation-of-a-susceptibility-locus-for-inflammatory-arthritis(0265f2ef-14ef-4d2a-979d-69a06b860324).html.
Full textÅngström, Lars. "Aerobic capacity in rheumatoid arthritis : aspects of associations with cardiovascular risk factors and disease activity." Licentiate thesis, Umeå universitet, Reumatologi, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-164592.
Full textBakgrund: Reumatoid artrit (RA, ledgångsreumatism) är en kronisk inflammatorisk sjukdom som i första hand angriper leder, men kan även påverka inre organ. Typiska symptom är ledsvullnad, smärta, morgonstelhet och nedsatt funktion i lederna. Patienter med RA har visat sig ha en ökad risk att insjukna i och avlida i hjärt- och kärlsjukdom. I den allmänna befolkningen har låg syreupptagningsförmåga (kondition) visat sig vara en av de starkaste riskfaktorerna för att insjukna i eller att avlida i hjärt- och kärlsjukdom. Tidigare studier har visat att patienter med RA kan ha låg kondition vilket kan utgöra en riskfaktor för hjärt- och kärlsjukdom även vid RA. Syfte: Syftet med denna avhandling var att beskriva sambanden mellan kondition och riskfaktorer för hjärt- och kärlsjukdom och sjukdomsaktivitet. Ett annat syfte var att studera hur intensiv cykelträning påverkar kondition, traditionella riskfaktorer och sjukdomsaktivitet hos patienter med RA. Metod: Studie I är en tvärsnittsstudie, bestånde av 67 patienter med tidig RA, som hade en medelålder på 53 år. De undersöktes avseende; kondition, riskfaktorer för hjärt- och kärlsjukdom och sjukdomsaktivitet för att analysera samband mellan dessa. Studie II är en träningsstudie, bestående av 13 patienter med RA, med en medianålder på 57 år. Kondition, riskfaktorer för hjärt- och kärlsjukdom och sjukdomsaktivitet analyserades för att se förändringar efter tio veckors intensiv cykelträning samt vid en uppföljning efter 25 veckor. Resultat: I studie I visade den studerade gruppen ett konditionsmedelvärde på 31.6 mL. Sambandsanalyser visade att högre kondition var relaterad till lägre grad av riskfaktorer för hjärt- och kärlsjukdom, samt lägre 10 års risk för hjärt- och kärlsjukdom och sjukdomsaktivitet. I studie II fann vi att tio veckors intensiv cykelträning kan vara en användbar metod för att förbättra kondition, blodtryck och antalet ömma leder. Ingen ökad sjukdomsaktivitet noterades. Slutsatser: Dessa studier bidrar med kunskap om samband mellan kondition och riskfaktorer för hjärt- och kärlsjukdom samt sjukdomsaktiviteten hos patienter med RA. De visar också att intensiv cykelträning kan vara en effektiv metod att förbättra kondition och blodtryck hos patienter med RA.
Kelly, Stephen Gerard. "Ultrasound imaging of synovitis : relationship to pathobiology and response to therapy." Thesis, Queen Mary, University of London, 2014. http://qmro.qmul.ac.uk/xmlui/handle/123456789/9010.
Full textRathbun, Alan M. "Depression in Rheumatoid Arthritis and an Estimation of the Bi-directional Association of Depression and Disease Burden: A Dissertation." eScholarship@UMMS, 2014. http://escholarship.umassmed.edu/gsbs_diss/699.
Full textHumphreys, Jennifer. "Validation of the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis with special emphasis on the role of autoantibodies." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/validation-of-the-2010-american-college-of-rheumatology-european-league-against-rheumatism-classification-criteria-for-rheumatoid-arthritis-with-special-emphasis-on-the-role-of-autoantibodies(189200f1-4daa-4c99-8019-9b600c03ee0c).html.
Full textAljaberi, Najla. "The use of S100 proteins testing in juvenile idiopathic arthritis and autoinflammatory diseases in a pediatric clinical setting: a retrospective analysis." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1584000950963649.
Full textGates, Donald L. "Effects of Resistance Training on Insulin Sensitivity and Markers of Inflammation in Rheumatoid Arthritis Patients Treated with Remicade." Diss., The University of Arizona, 2009. http://hdl.handle.net/10150/195856.
Full textCorsiero, Elisa. "Characterization of peripheral and lesional single B cell autoreactivity in patients with Sjögren's syndrome and rheumatoid arthritis." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/26968.
Full textBjörk, Mathilda. "Aspects of Disability in Rheumatoid Arthritis : a five-year follow-up in the Swedish TIRA project." Doctoral thesis, Linköpings universitet, Rehabiliteringsmedicin, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-11956.
Full textEriksson, Catharina. "Immunological mechanisms in systemic autoimmunity : autoantibodies and chemokines in systemic lupus erythematosus and during treatment with TNF inhibitors in rheumatoid arthritis." Doctoral thesis, Umeå universitet, Klinisk immunologi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-42954.
Full textHatch, Lashley, and Daniel C. Malone. "Statistical Information Included in Labeling for Disease-Modifying Anti-Rheumatic Drugs for Rheumatoid Arthritis." The University of Arizona, 2012. http://hdl.handle.net/10150/614497.
Full textSpecific Aims: To evaluate the presence of statistical information from clinical studies in official product labeling specific for disease-modifying anti-rheumatic drugs (DMARDs) used in the treatment of rheumatoid arthritis. Methods: Data were abstracted from official product labeling DMARDs with FDA approval for treatment of rheumatoid arthritis. Each document was examined for the presence of statement regarding a priori type 1 error rate, p-values, and measures of variance. Medications were classified as either biologic or non-biologic. Main Results: A total of 14 DMARDs, 7 biologics (50%) and 7 non-biologics (50%), were found to be FDA approved for the treatment of rheumatoid arthritis. Primary outcomes consisted of American College of Rheumatology (ACR) response rates, radiographic changes, and health assessment questionnaire score (HAQ). Any measure of variance and the presence of a p-value were both found in six (43%) of the drug labels. Inclusion of p-values was found to be significantly greater in biologics compared to non-biologics for both ACR and radiographic results. Inclusion of variance was found to be significantly greater in biologics compared to non-biologics for radiographic changes only. No package inserts contained statements regarding the a priori type I error rate. Conclusions: Measures of variance are not frequently included in product labeling for either biologic or non-biologic DMARDs. However, inclusion of variance and p-values for ACR response rates and radiographic changes were more likely to be reported for biologics therapies as compared to non-biologics. A statement regarding Type 1 error rates were absent from labels regardless of outcome assessed.
Baum, Rebecca A. "Cytosolic and Endosomal DNA-Sensing Pathways Differentially Regulate Inflammatory Arthritis, Autoantibody Production, and Bone Remodeling: A Dissertation." eScholarship@UMMS, 2016. http://escholarship.umassmed.edu/gsbs_diss/828.
Full textHallert, Eva. "Disease activity, function and costs in early rheumatoid arthritis." Doctoral thesis, Linköpings universitet, Reumatologi, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-8242.
Full textHamann, Philip. "An investigation into the predictors and frequency of sustained remission in patients with rheumatoid arthritis undergoing treatment with anti-tumour necrosis factor therapy using the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis." Thesis, University of Bath, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.760961.
Full textKastbom, Alf. "Autoantibodies and genetic variation in rheumatoid arthritis : aspects on susceptibility and disease course." Doctoral thesis, Linköping : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-8618.
Full textDahlström, Örjan. "Focus on Chronic Disease through Different Lenses of Expertise : Towards Implementation of Patient-Focused Decision Support Preventing Disability: The Example of Early Rheumatoid Arthritis." Doctoral thesis, Linköpings universitet, Institutionen för beteendevetenskap och lärande, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-18112.
Full textIntroduktion: Reumatoid artrit (RA) är en kronisk inflammatorisk sjukdom. Dagens behandlingsstrategi bygger på tidiga multiprofessionella insatser för att reducera sjukdomsaktivitet och minska risken för framtida funktionshinder. Idag finns stora datamängder tillgängliga gällande medicinering och utfall vid RA. Dessa data erbjuder möjligheter att generera ny kunskap som kan användas för att forma beslutsstöd. Syfte: Att undersöka hur olika kliniska manifestationer vid tidig RA samvarierar med funktionshinder och sjukdomsaktivitet, att pröva metoder att ställa prognos vid tidig RA, och att analysera en kontext för beslutsfattande inom vård av kroniskt sjuka. Metod: Multivariat statistik och matematisk modellering, samt observationsstudier och fokusgruppsintervjuer. Resultat: Beslutsstöd: Ett beslutsträd utformades för att bestämma vilka patienter som har dålig prognos (måttlig eller hög DAS-28) ett år efter diagnos. Beslutsträdet hade 25 % sensitivitet, 90 % specificitet och ett positivt prediktivt värde på 76 %. Vid införande av beslutsstöd på en reumatologisk klinik befanns det nödvändigt att hänsyn tas till incitamentsstrukturer, arbetsflöde och samarbetsformer. Informella kommunikationsstrukturer kan också ha stort inflytande på klinisk praxis. Prognos: En betydande del av variansen i sjukdomsaktivitet ett år efter diagnos kan förklaras av sjukdomsprogression första tre månaderna efter diagnos. Att formalisera olika experters erfarenheter före standardiserade ”data mining” metoder är en lovande ansats när man letar efter mönster i (kliniska) databaser. Funktionshinder och sjukdomsaktivitet: Kvinnor rapporterar mer trötthet än män vid tidig RA, men skillnaden är inte konsistent över tid. Trötthet vid tidig RA är nära relaterat till sjukdomsaktivitet, smärta och aktivitets begränsningar, men också till mental hälsa och sömnstörningar. Slutsats: Ett beslutsträd har utformats för att predicera patienter med dålig prognos inom tidig RA. Studier av fler mått på sjukdoms- och funktionshindersprogression behövs vid konstruktion av prediktionsregler för god eller dålig prognos framledes. Att använda sig av kunskap från olika experter – olika experters glasögon – vid sökandet efter mönster i stora datamängder för att generera ny kunskap är en lovande metodik. Implementering av beslutsstöd bör göras under övervägande av incitamentsstrukturer, arbetsflöde och samarbetsformer.
Chenna, Narendra Sudeep. "Systemic and local regulation of experimental arthritis by IFN-α, dendritic cells and uridine." Doctoral thesis, Linköpings universitet, Avdelningen för neuro- och inflammationsvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-136238.
Full textLidén, Maria. "Gut Mucosal Reactivity to Gluten and Cow´s Milk Protein in Rheumatic Diseases." Doctoral thesis, Uppsala universitet, Institutionen för medicinska vetenskaper, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-110297.
Full textBentley, Mary Jane. "Development and Evaluation of Disease Activity Measures in Rheumatoid Arthritis Using Multi-Level Mixed Modeling and Other Statistical Methodologies: A Dissertation." eScholarship@UMMS, 2010. https://escholarship.umassmed.edu/gsbs_diss/461.
Full textRuiz-Esquide, Torino Virginia. "Artritis reumatoide y tabaco. Efecto del tabaco sobre la actividad, discapacidad y daño radiológico en la artritis reumatoide y su relación con los marcadores serológicos de la enfermedad." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/96412.
Full textMatzelle, Melissa M. "Inflammation Inhibits Osteoblast-Mediated Bone Formation in Rheumatoid Arthritis and Regulates the Wnt and BMP Signaling Pathways: A Dissertation." eScholarship@UMMS, 2012. https://escholarship.umassmed.edu/gsbs_diss/596.
Full textJohansson, Martin. "Systemic lupus erythematosus and rheumatoid arthritis analyses of candidate genes involved in immune functions, for susceptibility and severity /." Doctoral thesis, Umeå : Umeå university, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-30388.
Full textBarthel, Christian [Verfasser], and Henning [Akademischer Betreuer] Zeidler. "Expression von Neurotrophinen und ihren Rezeptoren bei Rheumatoider Arthritis und Spondyloarthritis / Christian Barthel. Abteilung für Rheumatologie im Zentrum Innere Medizin der Medizinischen Hochschule Hannover. Betreuer: Henning Zeidler." Hannover : Bibliothek der Medizinischen Hochschule Hannover, 2012. http://d-nb.info/1023140268/34.
Full textSchlieker, Ricarda [Verfasser], Gernot [Gutachter] Keyßer, Jörn [Gutachter] Kekow, and Christoph [Gutachter] Baerwald. "Verankerung und Akzeptanz der Klassifikationskriterien der Spondyloarthritiden, der rheumatoiden Arthritis und des Systemischen Lupus Erythematodes im klinischen Alltag deutscher Rheumatologen / Ricarda Schlieker ; Gutachter: Gernot Keyßer, Jörn Kekow, Christoph Baerwald." Halle (Saale) : Universitäts- und Landesbibliothek Sachsen-Anhalt, 2020. http://d-nb.info/1210729288/34.
Full textMüller, Annekathrin [Verfasser], W. [Akademischer Betreuer] Mau, K. S. [Akademischer Betreuer] Delank, and F. [Akademischer Betreuer] Beyer. "Rehabilitative und ambulante physikalisch-medizinische Versorgung von Patienten mit rheumatoider Arthritis oder ankylosierender Spondylitis aus der Sicht von Betroffenen und Rheumatologen / Annekathrin Müller. Betreuer: W. Mau ; K.-S. Delank ; F. Beyer." Halle, Saale : Universitäts- und Landesbibliothek Sachsen-Anhalt, 2012. http://d-nb.info/1025302095/34.
Full textHuscher, Dörte [Verfasser]. "Versorgungsepidemiologie der rheumatoiden Arthritis in der vergangenen Dekade – Prognose, neue Behandlungsziele und aktuelle Kostenentwicklungen : eine Analyse von Daten der Kerndokumentation der Regionalen Kooperativen Rheumazentren in der Deutschen Gesellschaft für Rheumatologie / Dörte Huscher." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2015. http://d-nb.info/1075757525/34.
Full textLee, Anita Tin Yun. "Applications of real time musculoskeletal ultrasonography in rheumatology practice." 2008. http://hdl.handle.net/2440/56822.
Full text"In early arthritis, it is important to make a diagnosis before structural damage has occurred, with early disease modifying therapy effective in improving long term outcomes. The first part of this thesis addresses the deficiency in our current knowledge of standardisation and reproducibility of ultrasound (US) findings. Chapter 2 describes a standardised protocol developed for assessing the metacarphphalangeal (MCP) joints and novel measurements of synovial inflammation. Chapter 3 compares early arthritis subjects to a control group, and showed significantly more US synovitis and abnormally increased measurements, with extensor tenosynovitis (ET) and power Doppler (PD_ positivity highly specific to the early arthritis group. Chapter 4 validates HRUS findings in a subset of subjects using MRI as the reference standard..Chapter 5 presents longitudinal data which suggests that clnical swelling and PD positivity at the MCP joints were the most sensitive to change as a reseult of disease-modifying therapy. Chapter 6 validates an US assessment tooldevelopedbadsed on “sentinel joints” whilst factors that may hemp to differentiate subjects with polyarthralgias from those with early RA are identified in chapter 7. The results of this study suggest that early RA needs to be redefined in the light of our US findings. The prognostic value of early US abnormalities will contlinue to be investigated." -- from Abstract.
http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1317258
Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2008
Lee, Anita Tin Yun. "Applications of real time musculoskeletal ultrasonography in rheumatology practice." Thesis, 2007. http://hdl.handle.net/2440/56822.
Full textThesis (Ph.D.) -- University of Adelaide, School of Medicine, 2008
Sherry, Grace Carolyn. "Mia Alessandra : life with Juvenile Idiopathic Arthritis." 2013. http://hdl.handle.net/2152/22645.
Full texttext
Delaurier, Ashley. "Wait Times to Rheumatology and Rehabilitation Services for Persons with Arthritis in Quebec." Thèse, 2011. http://hdl.handle.net/1866/7028.
Full textArthritis is a leading cause of pain and disability in Canada. Persons with rheumatoid arthritis (RA) should be seen by a rheumatologist within three months of symptom onset to begin appropriate medical treatment and improve health outcomes. Early physical therapy (PT) and occupational therapy (OT) are beneficial for both osteoarthritis (OA) and RA and may prevent disability. The objectives of the study are to describe wait times from referral by primary care provider to rheumatology and rehabilitation consultation in the public system of Quebec and to explore associated factors. We conducted a cross-sectional study in the province of Quebec, Canada whereby we requested appointments from all rheumatology practices and public rehabilitation departments using case scenarios that were created by a group of experts. Three scenarios were developed for the rheumatology referrals: Presumed RA; Possible RA; and Presumed OA and two scenarios for the rehabilitation referrals: diagnosed RA and diagnosed OA. Wait times were evaluated as the time between the initial request and the appointment date provided. The statistical analysis consisted primarily of descriptive statistics as well as inferential statistics (bivariate comparisons and logistic regression). Seventy-one rheumatology practices were contacted. For all scenarios combined, 34% were given an appointment with a rheumatologist within three months of referral, 32% waited longer than three months and 34% were refused services. The odds of getting an appointment with a rheumatologist within three months was 13 times greater for the Presumed RA scenario versus the Presumed OA scenario (OR=13; 95% Cl[1.70;99.38]). However, 59% of the Presumed RA cases did not receive an appointment within three months. One hundred rehabilitation departments were also contacted. For both scenarios combined, 13% were given an appointment within 6 months, 13% within 6 to 12 months, 24% waited longer than 12 months and 22% were refused services. The remaining 28% were told that they would require an evaluation appointment based on functional assessment prior to being given an appointment. There was no difference with regards to diagnosis, RA versus OA, for the rehabilitation consultation. RA is prioritized over OA when obtaining an appointment to a rheumatologist in Quebec. However, the majority of persons with RA are still not receiving rheumatology or publicly accessible PT or OT intervention in a timely manner. Better methods for triage and increased resource allocation are needed.
Luca, Nadia J. "Reliability and Responsiveness of the Standardized Universal Pain Evaluations for Rheumatology Providers for Children and Youth (SUPER-KIDZ)." Thesis, 2013. http://hdl.handle.net/1807/43113.
Full textSeca, Susana Marisa Ferraz. "Effects of acupuncture on the pain and function of the hands of selected patients with rheumatoid arthritis." Doctoral thesis, 2020. http://hdl.handle.net/10316/90621.
Full textRheumatoid arthritis (RA) is the most common chronic inflammatory autoimmune arthritis characterized by persistent synovitis and destructive and symmetrical polyarthritis of the small and large joints. The development of the disease is associated with an increased risk of organ failure, persistent pain, progressive disability and reduced quality of life (QoL) as well as high social-economic impact on the individuals and on the health care system. Although the course of RA has greatly improved in the last years, there is no cure and the drugs used to reduce inflammation and to slow down the progression of joint damage carry some notable side effects, ranging from an irritated stomach, to liver damage or an increased susceptibility to serious infections. Women who wish to become pregnant and/or breastfeed often need to modify their medications to optimise the health of their baby. Given the fact of the expanding awareness of unwanted side effects of pharmaceutical treatment, there has been an increased utilization of acupuncture which has been reported as a kind of safe management. Evidence suggests that acupuncture interventions may have a positive effect on pain relief, physical function and QoL in RA patients. However, due to the heterogeneity and methodologic limitations of the randomized clinical trials, ineffective allocation of acupoints, lack of double blinding and quantification of its effects, evidence is not strong enough to produce a good practice guideline. Acupuncture has its roots in the most significant component of complementary and alternative medicine, Chinese Medicine (CM). RA patients may be divided into different CM syndromes wich different biomarkers, molecular signatures and, as such, with different reactions to certain treatments. That is why acupuncture treatments should be designed with acupoints corresponding to the CM syndrome differentiation. We aimed to assess acupuncture effects on RA based on clear allocation criteria of acupoints, objective and valid assessment of effects and, for the first time, with randomized, double-blinded controls. Several methodologies, applying the CONSORT guidelines, were used to strengthen the evidence base on acupuncture treatment and to understand its specific effects. First, in order to clearly quantify the effects of acupuncture for relieving pain and reducing inflammatory effects associated to RA, we tested a newly pressure algometry device designed to assess the pressure tolerated by RA patients with hand pain and the effects on this of acupuncture. The pressure algometry device proved to be suitable to quantify the differences between the hand pressure tolerate before and after the acupuncture treatments. After that, 190 RA patients with stable symptoms and stable conventional treatment, diagnosed by the criteria of the American College of Rheumatology, were stratified into two groups: “hand pain worsened by handgrip” or “hand pain worsened by thumb resistance”. After analysing these patients we found different features between RA patients with handgrip pain, and these differences were compatible with different CM syndromes. 79.5% of the 190 participants showed worsening hand pain by handgrip. The CM diagnosis of these patients’ group was obtained through inspection, auscultation, interrogation and palpation. CM diagnosis of RA patients with “hand pain worsened by handgrip” showed that they all had concomitant presence of imbalances and intermingled symptoms and clinical findings of the invasion of the pathogen agent algor/“cold”, namely: cold hands (62.9%), tearing and localized pain with gradual onset (82.9%), worse pain upon cold exposure (82.9%), pain relief by applying warmth to the affected area (62.9%), tongue exhibiting a hyaline (85.7%) and white coating (52.4%). In the last phase, 105 RA patients with the CM functional diagnosis of a “pivotal syndrome” or Turning point syndrome (TPS) were randomly assigned to a verum acupuncture, a control acupuncture or a waiting list group (each group n = 35). In the verum and control group the exact same number, depth and stimulation of needles was used as described previously in a double-blind assay. The double-blind experiment showed that RA patients with a TPS, that were treated with verum acupuncture significantly improved in: self-reported pain (Z = -5.099, p < 0.001), pressure algometry (Z = -5.086, p < 0.001); hand grip strength (Z = -5.086, p < 0.001) and arm strength (Z = -5.086, p < 0.001), health assessement questionnaire (p < 0.001, Z = -4.895) and 7/8 QoL survey domains. The number of swollen joints (Z = -2.862, p = 0.004) and tender joints (Z = -3.986, p < 0.001) significantly decreased in the verum acupuncture group. Patients treated with false acupuncture showed no significant changes. The waiting list group showed an overall worsening. The erythrocyte sedimentation rate and the c-reactive-protein rate remained unchanged. This first double-blind controlled study on acupuncture in RA objectively assessed specific effects supporting its integration in rheumatology and in the health care systems. The combination of disease diagnosis in biomedicine and integrative approaches such as CM diagnosis, identification of joint non-related symptoms and pathogenic external factors such as algor/“cold” can help to identify different functional diagnoses of RA and improve treatment strategies. By integrating the CM diagnosis as an inclusion criterion, there is homogenization of biomedical parameters and classification of CM diagnosis. Furthermore, it provides clear evidence about the importance of synergy that must exist between the diagnosis in CM and the respective selection of acupoints and it is essential for clinical practice because it might allocate interventions more adequately to the patient complaints.
A artrite reumatóide (AR) é a forma mais comum de artrite crónica inflamatória e auto-imune caracterizada por persistente sinovite, destruição e poliartrite simétrica das pequenas e grandes articulações. O desenvolvimento da doença está associado ao aumento do risco de falência orgânica, à dor persistente, incapacidade progressiva, redução da qualidade de vida (QV), e um alto impacto socioeconómico nos indivíduos e nos sistemas de saúde. Embora o curso da AR tenha melhorado muito nos últimos anos, não existe cura e os tratamentos farmacêuticos utilizados para reduzir a inflamação e retardar a progressão da doença provocam efeitos secundários notáveis, desde lesões ao nível do tracto gastrointestinal até danos hepáticos ou o aumento da susceptibilidade a infecções graves. As mulheres que desejam engravidar e/ ou amamentar muitas vezes necessitam de modificar a terapêutica utilizada para optimizar a saúde do recém-nascido. Dado o facto da crescente consciencialização dos efeitos colaterais indesejados da medicação utilizada, tem havido um aumento na procura dos tratamentos de acupunctura, que tem sido classificada como uma técnica segura. Evidências sugerem que as intervenções de acupunctura podem ter um efeito positivo no alívio da dor, função física e QV em pacientes com AR. No entanto, devido à heterogeneidade e limitações metodológicas dos ensaios clínicos randomizados, nomeadamente a alocação eficaz dos pontos de acupunctura, a falta de dupla ocultação e a quantificação dos seus efeitos, as evidências não são fortes o suficiente para produzir uma directriz de boas práticas. A acupunctura tem origem na componente mais significativa da medicina complementar e alternativa, a medicina chinesa (MC). Os doentes com AR podem ser divididos em diferentes síndromes segundo a MC, correspondentes a diferentes biomarcadores e mecanismos moleculares e, como tal, com diferentes reacções a determinado tratamento. Portanto, os tratamentos de acupunctura devem ser planeados com acupontos unânimes de acordo com as diferentes síndromes. O nosso objectivo foi avaliar os efeitos da acupunctura na AR com base em critérios claros de alocação dos pontos de acupunctura, avaliações objectivas e válidas dos efeitos e seguindo, pela primeira vez, um ensaio clinico randomizado e duplo-cego. Diversas metodologias, aplicando as recomendações CONSORT, foram utilizadas para fortalecer a evidência dos tratamentos de acupunctura e para entender os seus efeitos específicos. Primeiro, a fim de quantificar os efeitos da acupunctura no alívio da dor e inflamacção associadas à AR, testamos um novo algómetro projectado para avaliar a pressão tolerada pela dor na mão em pacientes com AR e os efeitos dos tratamentos de acupunctura. O algómetro de pressão demonstrou-se adequado para quantificar as diferenças entre a pressão da mão tolerada antes e após os tratamentos de acupunctura. Depois disso, 190 pacientes com AR, com sintomas e tratamento farmacológico convencional estáveis, diagnosticados pelos critérios do Colégio Americano de Reumatologia, foram estratificados em dois grupos: “pior dor ao apertar a mão” ou “pior dor provocada pela resistência do polegar”. Ao analisar estes pacientes encontrámos diferentes características entre os pacientes com AR com “pior dor ao apertar a mão” ou “pior dor provocada pela resistência do polegar”, e essas diferenças foram compatíveis com diferentes síndromes da MC. 79,5% dos 190 participantes apresentaram “pior dor ao apertar a mão”. Foi realizado o diagnóstico médico chinês deste grupo de pacientes por meio da inspeção, auscultação, interrogatório e palpação. Diagnóstico chines dos pacientes com “pior dor ao apertar a mão” revelou que todos eles apresentavam presença concomitante e intercalada de desequilíbrios diferenciados, sintomas e sinais clínicos da invasão do agente patogénico algor/“frio”, nomeadamente: mãos frias (62,9%), dor localizada, gradual e acompanhada da sensação de rasgar (82,9%), dor pior ao frio (82,9%), alívio da dor pela aplicação de calor na área afetada (62,9%), língua com hialina (85,7%) e cobertura branca (52,4%). Na última fase, 105 pacientes, com AR e com o diagnóstico funcional segundo a MC de uma “síndrome pivot” ou “ponto de viragem”, foram aleatoriamente destribuídos nos grupos acupunctura verdadeira, acupunctura falsa e lista de espera (cada grupo n = 35), aplicando exactamente o mesmo número, profundidade e estimulação de agulhas de acordo com a metodologia de dupla ocultação já descrita em trabalhos anteriores realizados pelos elementos deste grupo de investigação. O ensaio duplo-cego demostrou que os pacientes com AR com uma “síndrome pivot” e tratados com acupunctura verdadeira melhoraram significativamente: a dor auto-relatada (Z = -5,099, p < 0,001), a algometria de pressão (Z = -5,086, p <0,001), a força de preensão manual (Z = -5,086, p < 0,001) e a força do braço (Z = -5,086, p <0,001), a capacidade funcional (p = 0,000, Z = -4,895) e 7/8 dos domínios de pesquisa da QV. O número de articulações inchadas (Z = -2,862, p = 0,004) e dolorosas (Z = -3,986, p = 0,000) diminuiu significativamente. Os pacientes tratados com acupuntura falsa não apresentaram alterações significativas, e os pacientes do grupo “lista de espera” pioraram de uma forma geral os parâmetros avaliados. A taxa de sedimentação e a dosagem da proteína C reactiva não se alteraram significativamente em qualquer um dos grupos avaliados. Este é o primeiro ensaio clínico randomizado e duplo-cego que avalia os efeitos da acupuntura na AR e objetivamente avaliou os seus efeitos específicos, apoiando a sua integração na reumatologia e nos serviços de saúde. A combinação do diagnóstico biomédico com uma abordagem integrativa como o diagnóstico da MC, a identificação dos sinais e sintomas relevantes e não relacionados com as articulações e a avaliação dos factores externos patogénicos como é o caso do algor/“frio” podem ajudar a identificar diferentes diagnósticos funcionais da AR e a melhorar as estratégias de tratamento. A integração do diagnóstico da MC como um critério de inclusão, permitiu homogeneizar os parâmetros biomédicos e a respectiva relação com os parâmetros de classificação e diagnóstico segundo a MC, enfatizando a evidência clara e a importância da sinergia que deve existir entre o diagnóstico em MC e a respectiva seleção de acupontos como aspecto essencial para a investigação e para a prática clínica, pois permite alocar as intervenções de uma forma mais adequada às queixas individuais.
KAAS, Jiří. "Míra obtíží při vykonávání běžných denních činností u pacientů s revmatoidní artritidou." Master's thesis, 2013. http://www.nusl.cz/ntk/nusl-156327.
Full textPinsonneault, Linda. "Évaluation d’un programme de triage des références en rhumatologie pour la prise en charge rapide de la polyarthrite rhumatoïde." Thèse, 2012. http://hdl.handle.net/1866/10056.
Full textBackground : In patients with early rheumatoid arthritis (ERA), use of disease-modifying anti-rheumatic drugs substantially improves patient outcomes. Patients treated by rheumatologists are more likely to receive these treatments and to have better disease outcomes. However, delays from symptoms onset to first rheumatologist visit often exceed the guideline recommendations of 3 months. Waiting time to see a rheumatologist after a referral is made, is generally long in Quebec and contributes to those delays. Objectives : We evaluated the ability of a nurse-led triage and rapid access program to identify patients with ERA and reduce their waiting time, in order to improve process of care. Methods : A nurse assessed all new referrals received between 2009 and 2010, in a suburban Montreal rheumatology clinic. Priority level was assigned based on the written content of the referral, a telephone interview with the patient and, if needed, an partial joint examination. Patients with ERA, including undifferentiated inflammatory arthritis, and other acute rheumatologic conditions were prioritized and given an appointment as early as possible. The main outcome measures were validity (sensibility and specificity) of the priority level for patients with ERA and delay from referral to first visit with rheumatologist. Results : Of 701 newly referred patients, 65 had a final diagnosis of ERA. The triage correctly identified 85.9% of patients with ERA and 87.2% of patients with other high priority conditions. The median delay between referral date and first visit was 22 days for patients with ERA and 115 days for all others. Discussion and implications : This nurse led triage and rapid access program correctly identified most patients with ERA and resulted in rapid consultation for these patients. Since this is a labor intensive program, feasibility issues need to be resolved before implementing this type of triage in a resource constrained healthcare system.
Jäger, Jatina. "Klinische Querschnittstudie zur möglichen Assoziation rheumatoider Arthritis und parodontaler Gesundheit - Ein Vergleich zwischen Patienten mit rheumatoider Arthritis und allgemein Gesunden." Doctoral thesis, 2015. http://hdl.handle.net/11858/00-1735-0000-0022-5E4C-7.
Full textRinke, Kathinka. "Analyse prognostischer Faktoren für die TNFα Antagonisten-Therapie bei Rheumatoider Arthritis." Doctoral thesis, 2011. http://hdl.handle.net/11858/00-1735-0000-0006-B1F7-3.
Full textJohannleweling, Jens. "Einfluss von Interleukin 17 auf chondrogene Vorläuferzellen in der rheumatoiden Arthritis." Doctoral thesis, 2014. http://hdl.handle.net/11858/00-1735-0000-0022-5E12-7.
Full textGebauer, Katrin. "Retrospektive Analyse des Therapieverlaufs und kardiovaskulären Risikoprofils bei Patienten mit Rheumatoider Arthritis unter immunsuppressiver Therapie." Doctoral thesis, 2018. http://hdl.handle.net/11858/00-1735-0000-002E-E3F9-E.
Full textStreich, Jan-Hendrik. "Rheumatoide Arthritis: Proteomische Analyse von Serum und synovialen Fibroblasten zur Detektion von Biomarkern." Doctoral thesis, 2009. http://hdl.handle.net/11858/00-1735-0000-0006-AD60-1.
Full text