Prevalence and risk factors for joint pain among men and women in the West of Scotland Twenty-07 study

Objective: To examine the association between three modifiable risk factors (obesity, smoking, and alcohol consumption) and reported joint pain. Methods: Cross sectional data were collected on 858 people aged 58 years living in the West of Scotland and on the same individuals four years later, aged 62 years. Results: There was a positive relation between obesity and reported pain in the hips, knees, ankles, and feet. The strongest relation was with knee pain (odds ratio = 2.42 (95% confidence interval, 1.65 to 3.56)). There were no strong consistent associations between smoking habits and pain in any joint after adjusting for sex, alcohol consumption, body mass index, social class, and occupational exposures. Similarly, alcohol was not consistently related to pain in any joint in the fully adjusted models. Conclusions: Obesity had consistent and readily explained associations with lower limb joint pain. The data suggest that smoking behaviour and alcohol consumption are not consistently associated with joint pain across the body

Inhibitor regulation of tissue kallikrein activity in the synovial fluid of patients with rheumatoid athritis

Tissue kallikrein (TK) and 1-antitrypsin (AT)/TK complexes can be detected in SF from patients with RA if components of the fluids which interfere with the detection of TK are removed. 2-Macroglobulin (2-M) in SF was demonstrated to contain trapped proteases which were still active in amidase assays. Removal of 2-M from RA SF reduced their amidase activity. However, at least some of the remaining activity was due to TK because it was soya bean trypsin inhibitor resistant and trasylol sensitive and was partly removed by affinity chromatography on anti-TK sepharose. Removal of RF from the fluids reduced the values obtained for TK levels by ELISA. Addition of SF to human urinary kallikrein (HUK) considerably reduced the levels of TK detected suggesting the presence of a TK ELISA inhibitor in the fluids. Removal of components of >300 kDa from SF markedly reduced the TK ELISA inhibitory activity and increased the values for both the TK and l-AT/TK levels in fluids as measured by ELISA. It is considered this novel inhibitor does not bind to the active site of TK but rather binds to the site reactive with anti-TK antibodies

Doctors' understanding of individualisation of drug treatments: a qualitative interview study

addresses: University of Exeter Medical School, Institute of Health Services Research, Exeter, UK.notes: PMCID: PMC3657639To explore doctors' understanding of individualisation of drug treatments, and identify the methods used to achieve individualisation

Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time

This is the final version. Available from BMJ Publishing Group via the DOI in this record.OBJECTIVE: Investigators within many disciplines are using measures of well-being, but it is not always clear what they are measuring, or which instruments may best meet their objectives. The aims of this review were to: systematically identify well-being instruments, explore the variety of well-being dimensions within instruments and describe how the production of instruments has developed over time. DESIGN: Systematic searches, thematic analysis and narrative synthesis were undertaken. DATA SOURCES: MEDLINE, EMBASE, EconLit, PsycINFO, Cochrane Library and CINAHL from 1993 to 2014 complemented by web searches and expert consultations through 2015. ELIGIBILITY CRITERIA: Instruments were selected for review if they were designed for adults (≥18 years old), generic (ie, non-disease or context specific) and available in an English version. RESULTS: A total of 99 measures of well-being were included, and 196 dimensions of well-being were identified within them. Dimensions clustered around 6 key thematic domains: mental well-being, social well-being, physical well-being, spiritual well-being, activities and functioning, and personal circumstances. Authors were rarely explicit about how existing theories had influenced the design of their tools; however, the 2 most referenced theories were Diener's model of subjective well-being and the WHO definition of health. The period between 1990 and 1999 produced the greatest number of newly developed well-being instruments (n=27). An illustration of the dimensions identified and the instruments that measure them is provided within a thematic framework of well-being. CONCLUSIONS: This review provides researchers with an organised toolkit of instruments, dimensions and an accompanying glossary. The striking variability between instruments supports the need to pay close attention to what is being assessed under the umbrella of 'well-being' measurement.This research was supported by a University of Exeter Medical School PhD Studentship

All cause and disease specific mortality in patients with knee or hip osteoarthritis: Population based cohort study

Copyright © 2011 by the BMJ Publishing Group Ltd. This articles was first published in: BMJ, 2011, Vol. 342, Issue 7798, pp. 638 - 638To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip

Individualisation of drug treatments for patients with long-term conditions: a review of concepts.

Journal ArticleOBJECTIVES: Patients and policy makers advocate that drug treatments should be individualised. However, the term is used in a variety of ways. We set out to identify the range of related terminology and concepts in the general field of individualisation, map out the relationships between these concepts and explore how patients' perspectives are considered. DESIGN: We consulted members of an established patient and public involvement group about their experience of medicine taking for long-term conditions and their ideas about individualisation. We then conducted a scoping review of the literature to explore how terms surrounding individualisation of drug treatment are used and defined in the literature, and to explore the extent to which patients' perspectives are represented, with a view to informing future recommendations as to how individualisation can be operationalised. METHODS: We identified relevant literature using a range of search strategies. Two researchers independently extracted definitions of terms using a template. Inductive and deductive methods were used to explore the data. RESULTS: Definitions were categorised according to the following themes: medical management; pharmacogenetics, the patient's perspective; interactions between the healthcare provider and patient and management of long-term conditions. CONCLUSIONS: Within the literature reviewed, the involvement of patients in the ongoing management of drug treatment was largely absent. We propose the use of a new term 'mutually agreed tailoring' (MAT). This describes the ongoing pharmacological management of conditions that incorporates patients' specific needs, experiences and existing strategies for using their medications, and the professionals' clinical judgement. This usually includes patients monitoring their symptoms and, with the support of the professional, making appropriate product, dose or timing adjustments as necessary. Our previous work suggests that many patients and doctors are successfully practising MAT, so we suggest that a formal description may facilitate wider utilisation of strategies that will improve patient outcomes.NIHR - CLAHR

MOBILE and the provision of total joint replacement

Modern joint replacements have been available for 45 years, but we still do not have clear indications for these interventions, and we do not know how to optimize the outcome for patients who agree to have them done. The MOBILE programme has been investigating these issues in relation to primary total hip and knee joint replacements, using mixed methods research

The Bristol ‘OA500 study’: progression and impact of the disease after 8 years

AbstractObjective To study the natural history of peripheral joint osteoarthritis (OA) and assess its impact over eight years in a prospective study of 500 patients.Methods 500 consecutive patients with peripheral joint OA were recruited from a hospital-based rheumatology clinic. All were invited for review 3 and 8 years after entry. Joint sites involved, pain severity, change in index joints, global change in the condition, use of medication, surgery and walking aids were all recorded at each visit, and after eight years disability was assessed by the health assessment questionnaire (HAQ) and anxiety and depression by the Hospital anxiety and depression scale (HAD).Results At eight-year review, 349 patients were seen: 90% of those remaining alive. Outcome was heterogeneous. Sixty patients (17.2%) reported worsening in all three subjective parameters (pain, index joint and global change) compared with 22 (6.3%) who improved in all three parameters. Using this definition of worsening or improvement, strong baseline predictors of clinical outcome did not emerge. For further description, the group was split according to the index joint sites involved at entry to the study, there being 111 with knee OA alone, 87 with hand and knee OA, 72 with hand disease alone, and 29 with hip disease alone. Forty-four percent of those with lone hand disease at entry had acquired significant knee or hip OA 8 years later. The mean HAQ and HAD scores at 8 years were high, especially in those with knee disease, indicating significant disability as a result of the disease. Those with knee or knee and hand disease had the worst outcome in all parameters recorded. The data showed a general decrease in use of NSAIDs over the eight years, but an increase in utilization of analgesics, surgery (especially for hip disease) and walking aids.Conclusions Patients with peripheral joint OA of sufficient severity to lead to hospital referral have a heterogeneous, but generally bad outcome over 8 years, the disease resulting in high levels of physical disability, anxiety and depression, with a high level of utilization of healthcare resources, including joint replacement, drugs and walking aids. The results were consistent with previous suggestions that peripheral joint OA in older people is characterized by the slow acquisition of new joint sites. Progression and outcome may depend on a complex set of psychosocial factors, as well as biological ones