Rheumatology, a subspecialty of internal medicine, is devoted to the diagnosis and treatment of rheumatic diseases. The term originates from the Greek rheuma, meaning "that which flows as a river or stream" and the suffix -ology, meaning "the study of". Rheumatologists mainly deal with problems involving the muscles and/or joints.

Diseases

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Diseases diagnosed or managed by the rheumatologist include:

• rheumatoid arthritis
• lupus erythematosus
• Sjögren's syndrome
• scleroderma (systemic sclerosis)
• dermatomyositis
• polychondritis
• polymyositis
• polymyalgia rheumatica
• osteoarthritis
• septic arthritis
• gout, pseudogout
• spondyloarthropathies
  • ankylosing spondylitis
  • reactive arthritis (Reiter's syndrome)
  • psoriatic arthropathy
  • enteropathic spondylitis
  • reactive arthropathy
• vasculitis
  • polyarteritis nodosa
  • Henoch-Schönlein purpura
  • serum sickness
  • Wegener's granulomatosis
  • giant cell arteritis
  • temporal arteritis
  • Takayasu's arteritis
  • Behçet's syndrome
  • Kawasaki's disease (mucocutaneous lymph node syndrome)
  • Buerger's disease (thromboangiitis obliterans)

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Permanent Rheumatology Job in Laurinburg North Carolina with Scotland Memorial Hospital
NORTH CAROLINA RHEUMATOLOGY OPPORTUNITY Private practice or employed positions in family-oriented community with progressive, growing hospital. Just 35 minutes from the golf resort of Pinehurst
Permanent Rheumatology Job in AL statewide Alabama with Medical Doctor Associates, Inc.
Tremendous growth requires recruitment of BC/BE Rheumatologist to meet community needs. Excellent financial package with Sign On Bonus/Loan Repayment. Located in the beautiful Tennessee River Valley,
Permanent RHEUMATOLOGY Job in Southeast Idaho Idaho with Enterprise Medical Service
Southeast Idaho critical care access facility in need of first Rheumatologist due to patient demand. This hospital employed position will split practice 50% Rhuem/50% IM traditional patient. Call shared

Arthritis Research & Therapy - Latest Articles

Serum levels of hyaluronic acid and chondroitin sulfate as a non-invasive method to evaluate healing after cartilage repair procedures
Andreas Gomoll Fri, 03 Jul 2009 00:00:00 -0000
MRI remains the only non-invasive method to assess the quality of cartilage repair procedures, but ideally would be complemented by other modalities, particularly blood tests. Pruksakorn et al. investigated serum levels of hyaluronic acid (HA) and chondroitin sulfate (CS) for their correlation with tissue quality after cartilage repair with autologous chondrocytes versus subchondral drilling in a dog model. They reported better tissue quality in animals treated with chondrocyte implantation. Serum levels correlated with the histological score of biopsy samples: CS showed a negative (r= -0.69), and HA a positive correlation (r= +0.46). Many questions remain to be answered before serum markers can provide a reliable, non-invasive tool to assess tissue quality, but these data provide an important foundation for additional research.
Apoptotic cell-mediated suppression of streptococcal cell wall-induced arthritis is associated with alteration of macrophage function and local regulatory T cell increase: a potential cell-based therapy?
Sylvain PerruchePhilippe SaasWan Jun Chen Wed, 01 Jul 2009 00:00:00 -0000
IntroductionExperimental streptococcal cell wall (SCW)-induced arthritis is characterized by two successive phases of the disease. The acute phase occurs early and is associated with an inflammatory process and neutrophil infiltration into the synovium. The second chronic phase is related to effector T cell activation and the dysregulation of macrophage function. Creation of an immunomodulatory environment has been attributed to apoptotic cells themselves, apoptotic cell uptake by phagocytes as well as a lesser sensitivity of phagocytes capturing apoptotic bodies to activation. Therefore we evaluated the potential of apoptotic cell injection to influence the course of inflammation in SCW-induced arthritis in rats. Methods: Rat apoptotic thymocytes were injected i.p. (2.10e8) in addition to an arthritogenic dose of systemic SCW in LEW female rats. Control rats received SCW immunization and PBS. Rats were then followed for arthritis occurrence and circulating cytokine detection. At sacrifice, regulatory T cells (Treg) and macrophages were analyzed. Results: Apoptotic cell injection profoundly suppressed joint swelling and destruction typically observed during the acute and chronic phases of SCW-induced arthritis. Synovial inflammatory cell infiltration and bone destruction were also markedly suppressed. Ex vivo experiments revealed reduced levels of tumor necrosis factor (TNF) in cultures of macrophages from rats challenged with SCW in the presence of apoptotic thymocytes as well as reduced macrophage response to lipo-polysaccharide (LPS). Moreover, apoptotic cell injection induced higher Foxp3+ Tregs in the lymphoid organs, especially in the draining lymph nodes. Conclusions: Our data indicate that apoptotic cells modulate macrophage function and result in Treg generation/increase. This may be involved in inhibition of inflammation and amelioration of arthritis. This highlights and confirms previous studies showing that in vivo generation of Tregs using apoptotic cell injection may be a useful tool to prevent and treat inflammatory autoimmune responses.
Antibodies to cyclic citrullinated protein and erythrocyte sedimentation rate predict hand bone loss in patients with rheumatoid arthritis of short duration: a longitudinal study
Pernille BoyesenMari HoffSigrid OdegardGlenn HaugebergSilje SyversenPer GaarderCecilie OkkenhaugTore Kvien Wed, 01 Jul 2009 00:00:00 -0000
IntroductionRadiographic progression in rheumatoid arthritis (RA) has in several studies been shown to be predicted by serological markers widely used in daily clinical practice. The objective of this longitudinal study was to examine if these serological markers also predict hand bone mineral density (BMD) loss in patients with RA of short disease duration. Methods: 163 patients with RA of short disease duration (2.4 years) were included and followed longitudinally. Antibodies to cyclic citrullinated protein (anti-CCP), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were analysed from baseline blood-samples. Hand BMD was measured by digital X-ray radiogrammetry (DXR) based on hand and wrist radiographs obtained at baseline and 1, 2 and 5-year follow-up. Results: During the study period, DXR-BMD decreased by median (inter quartile range) 1.7% (4.1 to 0.4), 2.8% (5.3 to 0.9) and 5.6% (11.7 to 2.3) after 1, 2 and 5 years, respectively. Elevated baseline anti-CCP, RF, ESR and CRP levels were in univariate linear regression analyses consistently associated with DXR-BMD change at all time-points. Anti-CCP and ESR were independently associated with hand DXR-BMD in multivariate linear regression analyses. Elevated anti-CCP levels were consistent and independent predictors of loss in cortical hand bone during the study period, with the odds ratios (95% confidence interval) 2.2 (1.0 to 4.5), 2.6 (1.1-6.2) and 4.9 (1.4-16.7) for the 1, 2, and 5-year follow-up periods, respectively. Conclusions: Anti-CCP and ESR were found to be independent predictors of early localised BMD loss. This finding adds to the understanding of anti-CCP and ESR as important predictors of bone involvement in RA.
Broad-range PCR, cloning and sequencing of the full 16S rRNA gene for detection of bacterial DNA in synovial fluid samples of Tunisian patients with reactive and undifferentiated arthritis
Mariam SialaRadhouane GdouraHela FouratiMarkus RihlBenoit JaulhacMohamed YounesJean SibiliaSofien BakloutiNaceur BargaouiSlaheddine SellamiAbdelghani SghirAdnane Hammami Wed, 01 Jul 2009 00:00:00 -0000
IntroductionBroad-range rDNA polymerase chain reaction (PCR) provides an alternative, cultivation-independent approach for identifying bacterial DNA in reactive and other form of arthritis. The aim of this study was to use broad-range rDNA polymerase chain reaction targeting the 16S rRNA gene in patients with reactive and other forms of arthritis and to screen for the presence of DNA from any given bacterial species in synovial fluid (SF) samples. Methods: We examined the synovial fluid (SF) samples from a total of 27 patients consisting of patients with reactive arthritis (ReA) (n=5), undifferentiated arthritis (UA) (n=9), rheumatoid arthritis (n=7), and osteoarthritis (n=6) of which the latter two were used as controls. Using broad-range bacterial PCR amplifying a 1,400-base-pair fragment from the 16S rRNA gene, we identified and sequenced at least 24 clones from each synovial fluid sample. To identify the corresponding bacteria, DNA sequences were compared to the EMBL (European Molecular Biology Laboratory) database. Results: Bacterial DNA was identified in 20 of the 27 SF samples (74, 10 %). Analysis of a large number of sequences revealed the presence of DNA from more than one single bacterial species in the SF of all patients studied. The nearly complete sequences of the 1,400 bp were obtained for most of the detected species. DNA of bacterial species including Shigella sp, Escherichia sp, and other coli-form bacteria as well as opportunistic pathogens such as Stenotrophomonas maltophilia and Achromobacter xylosoxidans were shared in all arthritis patients. Among pathogens described to trigger ReA, DNA from Shigella sonnei was found in ReA and UA patients. We also detected DNA from rarely occurring human pathogens such as Aranicola sp and Pantoea ananatis. We also found DNA from bacteria so far not described in human infections such as Bacillus niacini, Paenibacillus humicus, Diaphorobacter sp and uncultured bacterium genera incertae sedis OP10. Conclusions: Broad-range PCR followed by cloning and sequencing the entire 16S rDNA, allowed the identification of the bacterial DNA environment in the SF samples of arthritic patients. We found a wide spectrum of bacteria including those known to be involved in ReA and others not previously associated with arthritis.
Increased production of soluble CTLA-4 in patients with spondylarthropathies correlates with disease activity
Eric ToussirotPhilippe SaasMarina DeschampsFabienne PouthierLucille PerrotSylvain PerrucheJacqueline ChabodPierre TiberghienDaniel Wendling Wed, 01 Jul 2009 00:00:00 -0000
IntroductionSpondylarthropathies (SpA) are characterized by abnormal immune responses including T cell activation. Cytotoxic T lymphocyte associated molecule-4 (CTLA-4) is involved in down-regulating immune responses. A soluble form of CTLA-4 (sCTLA-4), resulting from an alternative splicing, has been identified and was found increased in several autoimmune diseases. Here, we evaluated circulating levels of sCTLA-4 as a marker of immune dysregulation in SpA. Intracellular CTLA-4 and levels of CTLA-4 transcript expression in peripheral blood lymphocytes (PBL) were also studied. Methods: Sera from 165 patients with SpA were evaluated for sCTLA-4 measurements. Results were compared to those from 71 patients with rheumatoid arthritis (RA) and 88 healthy subjects. In 32 patients with SpA, 22 patients with RA and 15 healthy controls, we analyzed the intracellular CTLA-4 expression in CD4+ T cells, CD8+ T cells, activated (HLA-DR+Foxp3-) CD4+ T cells, CD4+ regulatory (CD25+Foxp3+) T cells and in CD3 negative cells by flow cytometry. Expression of the full length (coding for membrane CTLA-4) and spliced form (coding for sCTLA-4) of CTLA-4 transcripts in PBL were analyzed by quantitative real-time polymerase chain reaction (RT-PCR). Results: High levels of sCTLA-4 were found in the SpA group compared to the RA group and healthy controls (P< 0.0001). Soluble CTLA-4 serum levels strongly correlated with clinical index of disease activity BASDAI (r= 0.42, P< 0.0001) and C-reactive protein (CRP) levels (r= 0.17, P= 0.037). In contrast to RA patients, SpA patients did not exhibit changes in intracellular CTLA-4 expression in the different PBL subsets tested. Finally, the SpA group showed a preferential expression of the spliced CTLA-4 mRNA (P= 0.0014) in PBL. Conclusions: SpA patients exhibit high levels of circulating sCTLA-4 that may result from an alternative splicing of CTLA-4 transcripts. This may influence immune activation and regulation in SpA.
Pathogenesis of tendinopathies: inflammation or degeneration?
Michele AbateKarin Gravare – SilbernagelCarl SiljeholmAngelo Di IorioDaniele De AmicisVincenzo SaliniSuzanne WernerRoberto Paganelli Tue, 30 Jun 2009 00:00:00 -0000
The intrinsic mechanisms of tendinopathies are largely unknown and whether inflammation or degeneration have the prominent pathogenetic role is debated.Assuming that there is a continuum from physiology to pathology, overuse may be considered as the initial disease factor; microruptures of tendon fibers occur and several molecules are expressed: some of them promote the healing process, others, including inflammatory-cytokines can act as disease mediators. The neural ingrowth, accompanying the neovessels, explains the occurrence of pain and triggers a neurogenic mediated inflammation.It is conceivable that inflammation and degeneration are not mutually exclusive, but work together in the pathogenesis of tendinopathies.

Annals of the Rheumatic Diseases current issue

[Editorials] Methotrexate: the gold standard without standardisation
Kay, J., Westhovens, R. Fri, 12 Jun 2009 00:00:00 -0000

[Reviews] Erectile dysfunction in systemic sclerosis
Walker, U A, Tyndall, A, Ruszat, R Fri, 12 Jun 2009 00:00:00 -0000
Erectile dysfunction (ED) is observed in up to 81% of men with systemic sclerosis (SSc) and therefore should be counselled as a common complaint in this disorder. Whereas ED is frequently associated with atherosclerosis in the general population in which it is also a harbinger of cardiovascular events, ED has a different aetiology in SSc. In SSc the penile blood flow is impaired due to both myointimal proliferation of small arteries and corporal fibrosis. Data on the prevention of ED in SSc are not available. On-demand phosphodiesterase type 5 (PDE-5) inhibitors are not effective in improving erectile function, but fixed daily or alternate day regimens of long acting PDE-5 inhibitors provide a measurable, although often limited, clinical benefit. When intracavernous injections of prostaglandin E1 (alprostadil) are ineffective, the implantation of a penile prosthesis may be considered. Complex treatment options may require the involvement of urology.
[Recommendation] Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative
Visser, K, Katchamart, W, Loza, E, Martinez-Lopez, J A, Salliot, C, Trudeau, J, Bombardier, C, Carmona, L, van der Heijde, D, Bijlsma, J W J, Boumpas, D T, Canhao, H, Edwards, C J, Hamuryudan, V, Kvien, T K, Leeb, B F, Martin-Mola, E M, Mielants, H, Muller-Ladner, U, Murphy, G, Ostergaard, M, Pereira, I A, Ramos-Remus, C, Valentini, G, Zochling, J, Dougados, M Fri, 12 Jun 2009 00:00:00 -0000
Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007–8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005–7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use.
[Clinical and epidemiological research] Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: a systematic review of the literature
Visser, K, van der Heijde, D Fri, 12 Jun 2009 00:00:00 -0000
Objectives: To review systematically the available literature on the optimal dosage and route of administration of methotrexate in patients with rheumatoid arthritis (RA), as an evidence base for generating clinical practice recommendations. Methods: A systematic literature search was carried out in MEDLINE, EMBASE, Cochrane Library and American College of Rheumatology/European League Against Rheumatism meeting abstracts, searching for randomised controlled trials evaluating various dosages or routes of administration of methotrexate in RA. Articles that fulfilled predefined inclusion criteria were systematically reviewed and the quality was appraised. Effect sizes and odds ratios for clinical, radiological and toxicity outcomes were calculated and directly or indirectly compared between study groups using methotrexate in different dosages or by different routes. Results: A total of 38 publications out of 1748 identified references was included in the review. Start doses of 25 mg/week or fast escalation with 5 mg/month to 25–30 mg/week were associated with higher clinical effect sizes and more (gastrointestinal) adverse events in comparison with doses of 5–15 mg/week or slow escalation. Starting with 15 mg/week subcutaneous versus oral methotrexate was associated with higher clinical efficacy but more withdrawal due to toxicity in early RA. In longstanding RA, after failure on 15–20 mg/week orally, a switch to 15 mg/week intramuscularly with subsequent dose escalation did not result in increased efficacy. Conclusions: Starting on methotrexate 15 mg/week orally, escalating with 5 mg/month to 25–30 mg/week, or the highest tolerable dose, with a subsequent switch to subcutaneous administration in the case of an insufficient response, seems to be the optimal evidence-based dosing and routing recommendation for methotrexate in RA.
[Clinical and epidemiological research] Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research
Salliot, C, van der Heijde, D Fri, 12 Jun 2009 00:00:00 -0000
Objective: To perform a systematic literature review of the long-term safety of methotrexate (MTX) monotherapy in rheumatoid arthritis (RA). Methods: A search was performed in Medline, Cochrane and EMBASE. Adults with RA who had received MTX monotherapy for more than 2 years were studied. Results: 88 published studies were included. Over 12 years of treatment, the termination rate of MTX due to toxicity was less than for sulfasalazine, gold, d-penicillamine and higher than for hydroxychloroquine (level of evidence 2a–2b). Long-term use of MTX does not appear to be a risk factor for serious infections, including herpes zoster (2b–4), and could provide a survival benefit by reducing cardiovascular mortality (2b). The prevalence of raised liver enzymes (more than twice the upper limit of normal) is close to 13% of patients; 3.7% of patients stopped MTX permanently owing to liver toxicity (2b). Data on the risk for liver fibrosis/cirrhosis are conflicting: a meta-analysis showed an incidence of fibrosis of 2.7% after 4 years of MTX (2a). However, two other studies on sequential liver biopsies did not show evidence for developing severe damage (2b). Insufficient data are available to fully assess the risk of lymphoma and malignancies, although there is no strong evidence of increased risk (2b–4). Conclusion: This systematic literature search on MTX monotherapy with relatively low-dose use during at least 2 years shows favourable long-term safety.
[Clinical and epidemiological research] Efficacy and toxicity of methotrexate (MTX) monotherapy versus MTX combination therapy with non-biological disease-modifying antirheumatic drugs in rheumatoid arthritis: a systematic review and meta-analysis
Katchamart, W, Trudeau, J, Phumethum, V, Bombardier, C Fri, 12 Jun 2009 00:00:00 -0000
Objective: To evaluate the efficacy and toxicity of methotrexate (MTX) monotherapy compared with MTX combination with non-biological disease-modifying antirheumatic drugs (DMARDs) in adults with rheumatoid arthritis. Method: A systematic review of randomised trials comparing MTX alone and in combination with other non-biological DMARDs was carried out. Trials were identified in Medline, EMBASE, the Cochrane Library and ACR/EULAR meeting abstracts. Primary outcomes were withdrawals for adverse events or lack of efficacy. Results: A total of 19 trials (2025 patients) from 6938 citations were grouped by the type of patients randomised. Trials in DMARD naive patients showed no significant advantage of the MTX combination versus monotherapy; withdrawals for lack of efficacy or toxicity were similar in both groups (relative risk (RR) = 1.16; 95% CI 0.70 to 1.93). Trials in MTX or non-MTX DMARD inadequate responder patients also showed no difference in withdrawal rates between the MTX combo versus mono groups (RR = 0.86; 95% CI 0.49 to 1.51 and RR = 0.75; 95% CI 0.41 to 1.35), but in one study the specific combination of MTX with sulfasalazine and hydroxychloroquine showed a better efficacy/toxicity ratio than MTX alone with RR = 0.3 (95% CI 0.14 to 0.65). Adding leflunomide to MTX non-responders improved efficacy but increased the risk of gastrointestinal side effects and liver toxicity. Withdrawals for toxicity were most significant with ciclosporin and azathioprine combinations. Conclusion: In DMARD naive patients the balance of efficacy/toxicity favours MTX monotherapy. In DMARD inadequate responders the evidence is inconclusive. Trials are needed that compare currently used MTX doses and combination therapies.

Arthritis Care & Research

Clinical and immunogenetic prognostic factors for radiographic severity in ankylosing spondylitis
Michael M. Ward, Matthew R. Hendrey, James D. Malley, Thomas J. Learch, John C. Davis Jr., John D. Reveille, Michael H. Weisman Mon, 29 Jun 2009 10:54:00 -0000
To improve prognostic ability in ankylosing spondylitis (AS), we sought to identify demographic, clinical, and immunogenetic characteristics associated with radiographic severity in a large cohort of patients.Patients with AS for [ge]20 years were enrolled in a cross-sectional study (n = 398). Pelvic and spinal radiographs were scored using the Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s), and radiographic severity was measured as the BASRI-s/duration of AS. Clinical factors and HLA-B, DR, DQ, and DP alleles associated with the highest quartile of the distribution of radiographic severity were identified by first using random forests and then using multivariable logistic regression modeling. Similar procedures were used to identify factors associated with the lowest quartile of radiographic severity.Radiographic severity (being in the top quartile of BASRI-s/duration of AS) was associated with older age at onset of AS (odds ratio [OR] 1.10 per year), male sex (OR 1.90), current smoker (OR 4.72), and the presence of HLA-B*4100 (OR 11.73), DRB1*0804 (OR 12.32), DQA1*0401 (OR 5.24), DQB1*0603 (OR 3.42), and DPB1*0202 (OR 23.36), whereas the presence of DRB1*0801 was strongly negatively associated (OR 0.03). Being in the lowest quartile of BASRI-s/duration of AS was also less likely among those with an older age at onset of AS (OR 0.94 per year), men (OR 0.28), and current smokers (OR 0.29).The accuracy of the prognosis of radiographic severity in AS is improved by knowing the age at disease onset, sex, smoking history, and the presence of HLA-B*4100, DRB1*0804, DQA1*0401, DQB1*0603, DRB1*0801, and DPB1*0202 alleles.
Mail-delivered arthritis self-management tool kit: A randomized trial and longitudinal followup
Jean Goeppinger, Kate R. Lorig, Philip L. Ritter, Sonal Mutatkar, Frank Villa, Ziya Gizlice Mon, 29 Jun 2009 10:54:00 -0000
To determine the effectiveness of an intervention Tool Kit of arthritis self-management materials to be sent once through the mail, and to describe the populations reached.Spanish speakers (n = 335), non-Hispanic English-speaking African Americans (n = 156), and other non-Hispanic English speakers (n = 404) were recruited separately and randomized within each of the 3 ethnic/racial categories to immediately receive the intervention Tool Kit (n = 458) or to a 4-month wait-list control status (n = 463). At the end of 4 months, controls were sent the Tool Kit. All subjects were followed in a longitudinal study for 9 months. Self-administered measures included health status, health behavior, arthritis self-efficacy, medical care utilization, and demographic variables. Using analyses of covariance and t-tests, analyses were conducted for all participants and for Spanish- and English-language groups.At 4 months, comparing all intervention subjects with randomized wait-list controls, there were significant (P < 0.01) benefits in all outcomes except medical care utilization and self-rated health. The results were maintained at 9 months compared with baseline. On average, the Tool Kit reached persons ages 50-56 years with 12-15 years of schooling. There were few differences between English- and Spanish-language participants in either the effectiveness or reach variables.A mailed Arthritis Self-Management Tool Kit proved effective in improving health status, health behavior, and self-efficacy variables for up to 9 months. It also reached younger persons in both English- and Spanish-language groups and Spanish speakers with higher education levels than previous studies of the small-group Arthritis Self-Management Program.
Comparison of two methods of conducting the fit and strong! program
Rachel B. Seymour, Susan L. Hughes, Richard T. Campbell, Gail M. Huber, Pankaja Desai Mon, 29 Jun 2009 10:54:00 -0000
Fit and Strong! is an award winning, evidence-based, multiple-component physical activity/behavior change intervention. It is a group- and facility-based program that meets for 90 minutes 3 times per week for 8 weeks (24 sessions total). We originally tested Fit and Strong! using physical therapists (PTs) as instructors but have transitioned to using nationally certified exercise instructors (CEIs) as part of an effort to translate Fit and Strong! into community-based settings, and have tested the impact of this shift in instruction type on participant outcomes.We used a 2-group design. The first 161 participants to sequentially enroll received instruction from PTs. The next 190 sequential enrollees received instruction from CEIs. All participants were assessed at baseline, at the conclusion of the 8-week Fit and Strong! program, and at the 6-month followup.We saw no significant differences by group on outcomes at 8 weeks or 6 months. Participants in both groups improved significantly with respect to lower-extremity strength, aerobic capacity, pain, stiffness, and physical function. Significant differences favoring the PT-led classes were seen on 2 of 5 mediators, self-efficacy for exercise and barriers adherence efficacy. Participant evaluations rated both types of instruction equally highly, attendance was identical, and no untoward health events were observed or reported under either instruction mode.Outcomes under the 2 types of instruction are remarkably stable. These findings justify the use of CEIs in the future to extend the reach of the Fit and Strong! program.

Arthritis & Rheumatism

In this issue
Mon, 29 Jun 2009 10:54:00 -0000
No abstract.
Fibroblast growth factor 2: A new key player in osteoarthritis
Jelena Gavrilovic Mon, 29 Jun 2009 10:54:00 -0000
No abstract.
B lymphocyte cytokines and rheumatic autoimmune disease
Pierre Youinou, Taher E. Taher, Jacques-Olivier Pers, Rizgar A. Mageed, Yves Renaudineau Mon, 29 Jun 2009 10:54:00 -0000
No abstract.

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