No abstract

Background: Markers of collagen type I (CTX-1) and type II (CTX-II) degradation, reflecting bone and cartilage breakdown, appear to predict long term radiographic progression in chronic persistent arthritis. Objective: To analyse longitudinally whether changes in arthritis severity are linked to immediate changes in the level of CTX-I and CTX-II degradation. Methods: CTX-I and CTX-II were measured in urine samples from 105 patients with early rheumatoid arthritis who had participated in the COBRA trial at baseline and at 3, 6, 9, and 12 months after the start of treatment. The course of the biomarkers over time was compared with the course of ESR, swollen and tender joint counts, and 28 joint disease activity score (DAS28), measured at the same time points, with adjustment for rheumatoid factor, treatment, and baseline radiographic damage, by generalised estimating equations (GEE) with first order autoregression. Results: GEE showed that CTX-I was longitudinally associated with DAS28, but not with ESR, swollen joint count, or tender joint count. CTX-II, however, was longitudinally associated with ESR, swollen joint count and DAS28, but not with tender joint count. The longitudinal association implies that an increase in the extent of arthritis is immediately followed by an increase in collagen type II degradation, and to a lesser extent collagen type I degradation. Conclusions: Cartilage degradation as measured by CTX-II and to a lesser extent bone degradation as measured by CTX-I closely follows indices of arthritis. Clinically perceptible arthritis is responsible for immediate damage, which will become visible on plain x rays only much later.

A fter introduction of reimbursement of the cost of infliximab for the treatment of patients with active rheumatoid arthritis (RA), 1 several hospitals had insufficient capacity at their hospital's day care centre to administer the drug. Therefore, we explored the possibility of administering infliximab in an extramural setting supervised by a rheumatology specialist nurse (RSN).A vacant room in a nursing home 5 km from the hospital was prepared as the infusion facility. Two nurses and the nursing home physician were given details of the clinical aspects of RA, with emphasis on treatment with infliximab. The hospital infliximab protocol, including the screening before each infusion, the preparation and administration of infliximab, and the safety procedure, was adapted. A form to guarantee communication between the hospital and the extramural setting was developed. Arrangements with the hospital pharmacy were made to assure punctual delivery of the exact number of infliximab vials to the extramural setting on the day of the infusion. The infusions were organised and supervised by the RSN once a week.At the start of the project, all patients with RA attending the day care centre for infliximab infusions completed a questionnaire and an interview was carried out. Information was obtained on demographic and disease characteristics, previous problems related to the infusion treatment, the EQ-5D, 2 and satisfaction with infliximab administration. Satisfaction with treatment was measured on a visual analogue scale (0-100; higher values better satisfaction) and by a self composed questionnaire comprising 33 items (four point Likert scale) over seven domains covering information, accessibility, professionalism, courtesy of personnel, recreation possibilities, accommodation, and continuity of care. At the new infusion centre, all administrative and clinical events connected with the administration of infliximab were recorded prospectively. After 6 months, the patients again completed the EQ-5D and satisfaction questions.After a pilot with eight patients, all 57 remaining patients with RA who had received at least four infusions in the hospital completed the screening questionnaire in September and October 2002. Forty (70%) patients were female, with a mean (SD) age of 54 (14.8) years, mean disease duration 12.3 (10.3) years, mean duration of infliximab administration 13.1 (6.8) months. Four patients were not considered eligible by the rheumatologist owing to events during one of the previous infusions or comorbidity, 13 refused extramural treatment for personal reasons, and nine had stopped the infusions before continuing extramurally because of the inefficacy of infliximab. Overall, the patients not participating were older (56 (17.3)) than the other patients (51 (12.7)). Of those who refused to change to the extramural setting, the schedule of a weekday infusion was unsuitable (54%) or they were resistant to change for non-obvious reasons (46%). Those with personal reasons for resistance were older (58 (18.5)) than thos...

A patient with seropositive rheumatoid arthritis and recurrent oedema of the forearm was shown to have a leak from a multilobulated olecranon bursa. Bursal swelling is well known in rheumatoid arthritis and is particularly common at the elbow,1 where it is usually of little clinical consequence unless infection supervenes. To our knowledge rupture of an olecranon bursa has not been previously reported. Case report A 76-year-old man with recurrent asthmaticobronchitis, bronchiectasis, and seropositive, erosive rheumatoid arthritis of 6 years' duration was reasonably well controlled on salbutamol, indomethacin, .....l..

Hematopoietic stem cell transplantation (HSCT) care is highly complex. This chapter focuses on the aspects of supportive care required following HSCT.Assessment tools are key component of nursing practice and are necessary for planning and providing patient-centered care. HSCT care must be planned, implemented, and evaluated and is underpinned by collaboration with the entire multidisciplinary healthcare team.With supportive care following HSCT, we ultimately aim to improve the quality of life of our patients in the posttransplant period.Supportive care extends beyond symptom management and includes social, psychological, and spiritual care. The needs of the patient are multifactorial and can be complex, considering multiple issues at the same time and involving multiple disciplines.Throughout supportive nursing care, our clinical competence is critical and is complemented by experience, knowledge, and awareness.