Loneliness among women with rheumatoid arthritis:A cross-cultural study in the Netherlands and Egypt

The objective of this study was to explain loneliness as experienced by women with rheumatoid arthritis (RA) in a cross-cultural context. We studied 36 Egyptian female RA patients and 140 female Dutch RA patients.. Self-report data were collected about loneliness, physical and psychological health status, social support and social network, needs for help, attitudes and feelings of guilt. Loneliness was significantly higher among Egyptian (44.2 ± 32.3) than Dutch (12.9 ± 18.9) female RA patients (F = 54.3, p < 0.001). In Egypt, 36% of the variance of loneliness could be explained by worse affect (anxiety and depression; β = 0.51), fewer children (β = 0.31), and higher negative social support for the patients (β = 0.28) in multiple regression analysis. In the Netherlands, 35% of feeling lonely could be explained by worse affect scores (β = 0.52), less positive social support for the patients (β = 0.24), and a higher degree of disability (β = 0.21). Age of the patients and disease duration only explained 4% and 3% of the loneliness of RA patients in Egypt and the Netherlands, respectively. Female Egyptian RA patients experienced more loneliness than Dutch patients. Affect is the most important and constant variable in explaining loneliness in both countries. The role of the family in perceived loneliness is greater in Egypt than the Netherlands. Low social support received by patients is important in explaining loneliness in the Netherlands but not in Egypt

Mast Cell-Derived Histamine Mediates Cystitis Pain

Background: Mast cells trigger inflammation that is associated with local pain, but the mechanisms mediating pain are unclear. Interstitial cystitis (IC) is a bladder disease that causes debilitating pelvic pain of unknown origin and without consistent inflammation, but IC symptoms correlate with elevated bladder lamina propria mast cell counts. We hypothesized that mast cells mediate pelvic pain directly and examined pain behavior using a murine model that recapitulates key aspects of IC. Methods and Findings: Infection of mice with pseudorabies virus (PRV) induces a neurogenic cystitis associated with lamina propria mast cell accumulation dependent upon tumor necrosis factor alpha (TNF), TNF-mediated bladder barrier dysfunction, and pelvic pain behavior, but the molecular basis for pelvic pain is unknown. In this study, both PRV-induced pelvic pain and bladder pathophysiology were abrogated in mast cell-deficient mice but were restored by reconstitution with wild type bone marrow. Pelvic pain developed normally in TNF- and TNF receptor-deficient mice, while bladder pathophysiology was abrogated. Conversely, genetic or pharmacologic disruption of histamine receptor H1R or H2R attenuated pelvic pain without altering pathophysiology. Conclusions: These data demonstrate that mast cells promote cystitis pain and bladder pathophysiology through the separable actions of histamine and TNF, respectively. Therefore, pain is independent of pathology and inflammation, an

The burden of informal caregivers for people with rheumatoid arthritis in Egypt and the Netherlands

Objectives:\ud To study the burden as experienced by informal caregivers for people with Rheumatoid Arthritis (RA) in Egypt and the Netherlands and to determine which factors are related to this burden.\ud \ud Methods:\ud A total of 99 Dutch and 30 Egyptian females with RA and their caregivers participated in the study. Data were collected by means of questionnaires including the amount of help provided, mental health and subjective burden as experienced by the caregiver, patient demographic and health status, social support, self-efficacy expectations and caregiver characteristics. Differences between Egypt and the Netherlands were analysed with ANCOVA, controlled for age and disease duration. Variables related to subjective burden and mental health were analyzed by multiple regression.\ud \ud Results:\ud The objective burden as measured in the hours spent on helping the patients was less in Egypt (24 hours) compared to the Netherlands (35 hours). But the number of ADL tasks performed by the caregiver was higher in Egypt (4.3 vs 2.4). Subjective burden of the Egyptian caregivers was higher (32.4 vs 14.2) and their mental health was worse (61.5 vs 78.6) than those of the Dutch caregivers.\ud In Egypt 34% of the subjective burden of caregivers could be explained by negative attitude towards help (β = −0.47), worse affect (β = 0.31), and the fact that the caregivers felt that the patients were heavily dependent upon them (β = 0.26). Whereas, in the Netherlands 27% could be explained by negative attitude towards help (β = −0.45), the fact that the caregivers felt that the patients were heavily dependant upon them (β = 0.30), and higher patient income (β = 0.27). Poor mental health among Egyptian caregivers could for 33% be explained by higher level of education (β = −0.47), and more pain (β = −0.47) of patients. Among the Dutch caregivers 45% could be explained by positive attitude towards help (β = −0.53), less negative social support for patients (β = −0.34), high self efficacy of caregivers for giving help (β = 0.27), and good physical health of the caregivers (β = 0.19).\ud \ud Conclusion:\ud Egyptian caregivers for RA patients have higher subjective burden than the Dutch and worse mental health. In both countries negative attitude towards help and high caregiver estimation of dependency of their care-receivers were consistent variables for predicting subjective burden. In Egypt patient variables are the most important variables in predicting poor mental health of the caregivers whereas in the Netherlands caregiver variables are

Screening for amyloid in subcutaneous fat tissue of Egyptian patients with rheumatoid arthritis: clinical and laboratory characteristics

Objective: To screen for amyloid and to assess associated clinical and laboratory characteristics in Egyptian patients with rheumatoid arthritis (RA). Methods: Abdominal subcutaneous fat aspirates were consecutively collected from 112 patients (103 women, nine men) having RA for five years or more. To detect amyloid, fat smears were stained with Congo red and the concentration of amyloid A protein in fat tissue was measured. Clinical, radiological, and laboratory characteristics of the patients were assessed. Results: Amyloid was detected in eight (7%) of the fat smears stained with Congo red. Compared with the Congo red stain, the sensitivity for detecting amyloid by measurement of amyloid A protein in fat tissue was 75% and the specificity was 100%. The amount of amyloid found was small for both methods. The median disease duration of the eight amyloid patients was significantly longer (17 years) than that of the non-amyloid patients (10 years). Bronchopulmonary disease and constipation were more common, whereas proteinuria and chronic renal insufficiency were not. The number of swollen joints and the number of red blood cells were significantly lower in the amyloid group. Conclusions: Quantification of amyloid A protein and staining with Congo red are strongly concordant methods of screening for amyloid in fat tissue. The prevalence of amyloid in Egyptian patients with RA is 7%. Proteinuria is not a discriminating feature, whereas long disease duration, constipation, bronchopulmonary symptoms, and a moderate to low number of red blood cells may help to identify the arthritic patients with amyloid

Standardized multidisciplinary evaluation yields significant previously undiagnosed morbidity in adult women with Turner syndrome

Contains fulltext : 96365.pdf (publisher's version ) (Open Access)CONTEXT: Besides short stature and gonadal dysgenesis, Turner syndrome (TS) is associated with various abnormalities. Adults with TS have a reduced life expectancy, mainly related to structural abnormalities of the heart and aorta, and an increased risk of atherosclerosis. OBJECTIVE: Our objective was to investigate the yield of an initial standardized multidisciplinary screening in adult TS patients. DESIGN AND SETTING: This was an observational study at a multidisciplinary care unit for adult women with TS. PARTICIPANTS: Participants were adult women with TS (n = 150). Mean age was 31.0 +/- 10.4 yr, with 47% karyotype 45,X. INTERVENTIONS: All women were consulted by an endocrinologist, a gynecologist, a cardiologist, an otorhinolaryngologist, and when indicated, a psychologist. The screening included magnetic resonance imaging of the heart and aorta, echocardiography, electrocardiogram, dual-energy x-ray absorptiometry, renal ultrasound, audiogram, and laboratory investigations according to international expert recommendations. MAIN OUTCOME MEASURES: New diagnoses and prevalence of TS-associated morbidity were evaluated. RESULTS: Thirty percent of patients currently lacked medical follow-up, and 15% lacked estrogen replacement therapy in the recent last years. The following disorders were newly diagnosed: bicuspid aortic valve (n = 13), coarctation of the aorta (n = 9), elongation of the transverse aortic arch (n = 27), dilation of the aorta (n = 34), osteoporosis (n = 8), osteopenia (n = 56), renal abnormalities (n = 7), subclinical hypothyroidism (n = 33), celiac disease (n = 3), glucose intolerance (n = 12), dyslipidemia (n = 52), hypertension (n = 39), and hearing loss warranting a hearing aid (n = 8). Psychological consultation was needed in 23 cases. CONCLUSIONS: Standardized multidisciplinary evaluation of adult women with TS as advocated by expert opinion is effective and identifies significant morbidity. Girls with TS benefit from a careful transition to ongoing adult medical care