Die Prognose der fruehen chronischen Polyarthritis und der undifferenzierten Arthritis mit besonderer Beruecksichtigung beruflicher Veraenderungen

Available from TIB Hannover: F94B964+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Die Prognose der fruehen chronischen Polyarthritis und ihrer beruflich-sozialen Folgen Abschlussbericht

The objectives were to examine (i) the diseases course, (ii) the occupational consequences in early rheumatoid arthritis (RA) and (iii) prognostic indicators. In a prospective multicentre study 422 patients with a disease duration #<=#12 months were followed for 2 years. At the start of the study (T1) they were classified as RA (n=305) or undifferentiated arthritis (UA), a disease related to RA. At the end of the followup 15% of the 305 RA patients, 30% of the 117 patients with UA, respectively, went into remission. At T1 indicators of an unfavourable diesease course were higher age, longer diesease duration, high pain intensity, arthritis of MCP joints, large number of swollen joints, symmetric arthritis, low functional capacity, positive rheumatoid factor, elevated ESR and erosiveness. Determination of HLA-DRB1-allels did not achive additional information regarding the prognosis. Of 141 patients with RA gainfully employed at T1 25 (18%) received work disability (WD) pensions because of RA at the end of the observation period and 13 (9%) stopped working because of RA without WD pension. After one year disease duration the probability of WD pension was 5%, after two years 17% and after three years 25%. Already after 1.5 years disease duration the risk of giving up gainful employment was higher than in the general population. Various combinations of disability variables (functional capacity, walking time) and sociodemographic parameters (income, age) defined risk profiles for WD. Parameters which can be easily determined at the onset of the disease (above all the rheumatoid factor) are very helpful for patient councelling and therapeutic decisions. Because of the marked risk of WD in early RA intensive efforts have to be initiated in good time in order to maintain gainful employment. The indicators of WD reported in this study help to identify patients with different risks of WD in order to plan the treatment and rehabilitation. (orig.)Available from TIB Hannover: F97B2072+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

The three A's in asthma - airway smooth muscle, airway remodeling & angiogenesis

Asthma affects more than 300 million people worldwide and its prevalence is still rising. Acute asthma attacks are characterized by severe symptoms such as breathlessness, wheezing, tightness of the chest, and coughing, which may lead to hospitalization or death. Besides the acute symptoms, asthma is characterized by persistent airway inflammation and airway wall remodeling. The term airway wall remodeling summarizes the structural changes in the airway wall: epithelial cell shedding, goblet cell hyperplasia, hyperplasia and hypertrophy of the airway smooth muscle (ASM) bundles, basement membrane thickening and increased vascular density. Airway wall remodeling starts early in the pathogenesis of asthma and today it is suggested that remodeling is a prerequisite for other asthma pathologies. The beneficial effect of bronchial thermoplasty in reducing asthma symptoms, together with the increased potential of ASM cells of asthmatics to produce inflammatory and angiogenic factors, indicate that the ASM cell is a major effector cell in the pathology of asthma. In the present review we discuss the ASM cell and its role in airway wall remodeling and angiogenesis