Control perceptions in patients with rheumatoid arthritis: the impact of the medical consultation.
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OBJECTIVE: To identify factors that patients perceive as influencing control in living with the symptoms of rheumatoid arthritis (RA). METHOD: A sample of 40 patients with RA were recruited randomly from an out-patient population. The participants of the sample were interviewed in depth by one researcher to identify perceptions of control. They also completed two self-administered questionnaires, the Health Assessment Questionnaire and the Rheumatology Attitude Index. RESULTS: Four major categories were identified that positively influenced perceptions of control in patients living with the consequences of RA. These included: (i) the reduction of physical symptoms; (ii) social support matching perceived need; (iii) the provision of information; and (iv) the medical consultation. Components of the consultation included patient involvement, provision of information, feedback and reassurance, empathy and access to an expert. CONCLUSION: The categories identified can be influenced by health-care professionals in the management of the patient, and if the medical consultation is utilized to its full potential it can play a major role in enabling patients with RA to manage the daily symptoms of their condition. (+info)
Younger age of onset of gout in Taiwan.
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OBJECTIVE: To study the clinical features of gout in the community and in medical centres, and to describe the recent changes in gout in Chinese patients. METHODS: We analysed retrospectively the clinical features of 1079 Chinese gout patients seen by a rheumatologist between 1993 and 2000. These included 558 patients from a private clinic and 521 patients from a medical centre. The data were compared with those in previous reports of large Caucasian and non-Caucasian series. RESULTS: The mean age of onset was 41.6 yr and the mean disease duration before first visit was 4.2 yr. For medical centre patients, the mean age of onset was 43.0 yr and mean disease duration before the first visit was 4.8 yr. For private clinic patients, the mean age of onset was 40.2 yr and mean disease duration before the first visit was 3.6 yr. Young patients with gout, with onset before age 30, constituted 23.3 and 26.7% of the medical centre and private clinic patients respectively. Female patients constituted 10.6 and 5.6% respectively, the family history was positive in 27.1 and 28.7%, and urolithiasis occurred in 11.5 and 10.9%. Tophi were found in 21.1% of medical centre and 12.7% of private clinic patients. The mean time from first gouty attack to visible tophi was 6.6 yr in those who developed tophi. CONCLUSIONS: The age at onset of gout was much earlier than in previous reports. Twenty-five per cent of patients had their first gouty attack before age 30. The first attack frequently occurred between the third and fifth decades (68.2%) rather than between the fourth and sixth decades, as reported in previous papers. The incidence of gout in females had increased (8.0% of the patients were female) and the incidence of tophi was high (16.8%). Besides, our patients had more frequent gouty attacks and the interval from the first attack to visible tophi was shorter than in previous reports of the disease in Caucasians. (+info)
Joint consultation of general practitioner and rheumatologist: does it matter?
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OBJECTIVE: To assess the effects of joint consultation on referral behaviour of general practitioners (GPs) in a prospective cohort study. METHODS: All patients with rheumatological complaints that 17 participating GPs, from the area of the University Hospital Maastricht, wanted to refer during a two year inclusion period (n=166) were eligible for inclusion. These patients were either referred to the outpatient clinic, or presented at a joint consultation held every six weeks at the practice of the GP, where groups of three GPs presented their patients to a visiting, consulting rheumatologist. The number of patients referred by each GP a year at the end of the trial, comparing participating and non-participating GPs, was the main outcome measure. RESULTS: During two years of inclusion, the 17 participating GPs presented 166 patients. The number of patients referred by each GP a year decreased for the participating GPs by 62% at the end of the whole study. By contrast, non-participating GPs maintained the same rate of referral. The range of diagnoses remained proportionally the same throughout the study, with the exception of fibromyalgia. The referral rate of this diagnosis decreased significantly (p=0.001). CONCLUSIONS: Joint consultation seems to be a good strategy in influencing the referral behaviour of GPs in the area of rheumatology. The decrease in referral is substantial and can subsequently lead to a reduction of waiting lists. (+info)
Use of the Trust in Physician Scale in patients with rheumatic disease: psychometric properties and correlates of trust in the rheumatologist.
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OBJECTIVES: To assess the psychometric properties of the Trust in Physician Scale and to identify variables associated with patients' trust in their rheumatologist. METHODS: Analyses of self reported data from 713 patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia. Study variables included the Trust in Physician Scale, a decision-making question, a medical skepticism measure, and demographic and health-related measures. Internal consistency and construct validity were assessed using correlational analyses and factor analysis. A regression analysis was conducted to identify factors associated with trust in the rheumatologist. RESULTS: Internal consistency of the scale was high (Cronbach's alpha = 0.87). Scale items also loaded on a single factor. Construct validity was supported by inverse correlations between higher trust scores and both skepticism and independent decision making. Decreased trust was associated with older age, minority status, higher education, diagnosis of fibromyalgia or osteoarthritis, and poorer health. CONCLUSION: The Trust in Physician Scale is appropriate for patients with rheumatic disease. Several patient characteristics appear to be associated with lower trust in the rheumatologist. (+info)
The assessment of rheumatoid arthritis and the acceptability of self-report questionnaires in clinical practice.
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OBJECTIVE: To assess the acceptability of self-report questionnaires (SRQ) in clinical practice and to understand the value that rheumatologists give to various assessment methods in rheumatoid arthritis. METHODS: Rheumatologists who completed a training course in the use of SRQ in clinical trials and clinical practice used the SRQ in their practices. Six months later 221 rheumatologists completed a survey regarding their experiences in assessing rheumatoid arthritis and in the use of SRQ. RESULTS: Prior to the start of the program, 18% of rheumatologists used self-report questionnaires, 6 months later, 48% were using SRQ in their practices. Rheumatologists who did not use questionnaires placed less value on all assessment methods, and particularly on questionnaire assessments of function and pain. They also were more likely to report that questionnaires were difficult to use, not accepted by staff, were too long, and that they had limited staff. Rheumatologists who used the questionnaires reported none of these difficulties and were satisfied with the benefits provide by SRQ. When assessment measures were ranked, rheumatologist ranked ACR 20, radiography, and erythrocyte sedimentation rate/c-reactive protein as the least important in both clinical trials and in clinical practice, and they rated swollen and tender joint counts followed by SRQ as the most useful assessment tools. CONCLUSION: SRQ are well received by rheumatologists, and following a training program almost 50% continued to use SRQ in their practices. Those who used questionnaires were generally more positive about assessments and had little difficulty in the technical aspects of administration, scoring, and interpretation. (+info)
Computer-assisted learning in undergraduate and postgraduate rheumatology education.
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Computers and the Internet form a large part of our professional and personal lives. There are advantages and disadvantages to computer-assisted learning which will be discussed. An Internet and Medline search was performed to assess the educational content of rheumatology websites and also their effect on learning in the undergraduate and postgraduate setting. (+info)
The value of masters educational programmes for specialist registrars in rheumatology.
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The training of junior doctors has undergone major changes in recent years. There is now more structure, with defined assessment time points leading to a Certificate of Specialist Training. This certificate provides documentation indicating that the trainee has undergone a satisfactory period of training and that they are sufficiently competent to practise as a specialist, unsupervised. The changes have led to re-examination of the role of, and educational provision for, research training as well as clinical training. In this article we review these issues and argue that the development of masters educational programmes may help to address several concerns. (+info)
Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis.
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OBJECTIVE: To evaluate the interobserver agreement of ultrasonographic assessment of finger and toe joints in patients with rheumatoid arthritis (RA) by 2 investigators with different medical backgrounds. METHODS: Ultrasonography and clinical examination were performed on 150 small joints of 30 patients with active RA. A General Electric LOGIQ 500 ultrasound unit with a 7-13-MHz linear array transducer was used. In each patient, 5 preselected small joints (second and third metacarpophalangeal, second proximal interphalangeal, first and second metatarsophalangeal) were examined independently on the same day by 2 ultrasound investigators (an experienced musculoskeletal radiologist and a rheumatologist with limited ultrasound training). Joint effusion, synovial thickening, bone erosions, and power Doppler signal were evaluated in accordance with an introduced 4-grade semiquantitative scoring system, on which the investigators had reached consensus prior to the study. RESULTS: Exact agreement between the 2 observers was seen in 91% of the examinations with regard to bone erosions, in 86% with regard to synovitis, in 79% with regard to joint effusions, and in 87% with regard to power Doppler signal assessments. Corresponding intraclass correlation coefficient values were 0.78, 0.81, 0.61, and 0.72, respectively, while unweighted kappa values were 0.68, 0.63, 0.48, and 0.55, respectively. Ultrasonography showed signs of inflammation in 94 joints, while clinical assessment revealed tenderness and/or swelling in 64 joints. CONCLUSION: An experienced radiologist and a rheumatologist with limited ultrasound training achieved high interobserver agreement rates for the identification of synovitis and bone erosions, using an introduced semiquantitative scoring system for ultrasonography of finger and toe joints in RA. Signs of inflammation were more frequently detected with ultrasound than with clinical examination. Ultrasonography may improve the assessment of RA patients by radiologists and rheumatologists. (+info)