Re: RESEARCH - Level of radiographic damage and progression are determinants of physical function: TEMPO

[Guest guest]

Hi ,

I read the article but I could not understand what it was really

saying- too technical. Between the damage and progression and the

longitudinal analysis...I got lost. Can you help explain this?

Thank you,

Stella

>

> Published Online First: 18 January 2008. doi:10.1136/ard.2007.081331

> --------------------------------------------------------------------

------------

> EXTENDED REPORTS

>

>

> Level of radiographic damage and radiographic progression are

> determinants of physical function: a longitudinal analysis of the

> TEMPO trial

>

>

> D van der Heijde 1, R Landewé 2, R van Vollenhoven 3, S Fatenejad

4, L

> Klareskog 3

> 1 Leiden University Medical Centre, Leiden, The Netherlands

> 2 University Hospital, Maastricht, The Netherlands

> 3 Karolinska University Hospital, Stockholm, Sweden

> 4 Wyeth Research, Collegeville, Pennsylvania, USA

>

>

> Background: Many studies have examined the relationship between

> long-term radiographic damage and physical function. However, it is

> not known if short-term radiographic progression is also associated

> with physical function.

>

> Aim: To investigate the longitudinal relationship between physical

> function and both the level of radiographic damage and the

> radiographic progression rate in patients with early or advanced

> active rheumatoid arthritis.

>

> Methods: The database for the 2-year Trial of Etanercept and

> Methotrexate with Radiographic Patient Outcomes (TEMPO) was used for

> this study. Physical function was measured by the Health Assessment

> Questionnaire (HAQ) score at baseline, 6 months and 1 and 2 years.

> Radiographs of the hands and feet, taken at the same time points,

were

> scored by the van der Heijde-modified Total Sharp Score (TSS). The

HAQ

> score was modelled using generalised mixed linear modelling by TSS

or

> progression in TSS (interval 0–1 year and 1–2 years) adjusted for

age,

> sex, treatment and disease activity.

>

> Results: After adjustment for age, sex and disease activity, both

TSS

> and the change in TSS (progression rate) were significant

determinants

> of the HAQ score. When radiographic progression was divided into

four

> categories (negative, zero, minor and greater progression), results

> showed that HAQ scores tended to be higher with a higher rate of

> progression. Patients with negative progression scores had lower HAQ

> scores than patients with positive progression scores.

>

> Conclusions: Patients with greater radiographic damage, and those

with

> recent radiographic progression, have a higher degree of disability.

>

>

> *************************************************

>

> Read the entire article here:

>

> http://ard.bmj.com/cgi/content/full/67/9/1267

>

>

> --

>

> Not an MD

>

[Guest guest]

Stella,

A longitudinal analysis simply means that the researchers were

measuring the same things for the same study participants at certain

intervals over a period of time (in this study, a total of two years)

and trying to understand the significance of the results.

To measure joint damage, they used a commonly employed method - the

Sharp score. Using the Sharp score enables the researchers to grade

erosions and joint space narrowing in a standard way.

To measure progression, they examined how the Sharp score changed over

the course of the study. These data would give them an idea of how

much worse and how fast the patients' damage was occurring.

They used the Health Assessment Questionnaire (HAQ) to measure disability.

In the end, the researchers found a relationship between the severity

of joint damage and short-term progression with more disability.

Not an MD

On Mon, Sep 22, 2008 at 9:10 AM, smf1mom <smf1mom@...> wrote:

> Hi ,

>

> I read the article but I could not understand what it was really

> saying- too technical. Between the damage and progression and the

> longitudinal analysis...I got lost. Can you help explain this?

>

> Thank you,

> Stella

[Guest guest]

,

Thank you for the explanation, noow I understand. How does that

translate to us as far as what our doctors can do to see the

progression of our deterioration and disability.

Stella

> > Hi ,

> >

> > I read the article but I could not understand what it was really

> > saying- too technical. Between the damage and progression and the

> > longitudinal analysis...I got lost. Can you help explain this?

> >

> > Thank you,

> > Stella

>

[Guest guest]

Stella,

First of all, rheumatologists should give all new RA patients a

baseline set of tests, including x-rays (or MRIs) of their hands and

feet.

Rheumatologists can use the Health Assessment Questionnaire (HAQ) or

Disease Activity Score (DAS) or some other measure to gauge how you

are doing during the course of treatment.

If you aren't doing well according to the HAQ, DAS, or other scale

your rheumatologist uses, your rheumatologist will probably order more

imaging and/or add to or change your DMARD.

You can see the HAQ here:

http://aramis.stanford.edu/HAQ.html

Here's the DAS:

http://www.das-score.nl/www.das-score.nl/

Not an MD

On Mon, Sep 22, 2008 at 6:08 PM, smf1mom <smf1mom@...> wrote:

> ,

> Thank you for the explanation, noow I understand. How does that

> translate to us as far as what our doctors can do to see the

> progression of our deterioration and disability.

>

> Stella

[Guest guest]

and Group,

Does anyone's rheumy follow your progress with meds by using this HAQ

questionare in this study from ? My doc asks me how i feel about

pain and joints. Anything else I say he doesn't hear. He doesn't ask

how I am functioning and what I can and cannot do. And when I told

him that the fatigue holds me back more than anything else, he

shrugged his shoulder and said that nothing much can be done about

fatigue and continued on about RA. Never inquired about anything more

indepth. How do your docs follow your progress. What do they ask you

and what do they base their decisions on? I'm full of questions

after my hospitalization for muscle weakness, most likely due to

Plaquanil.

Wishing you all no pain but a lot of energy.

Hugs,

Stella

> > ,

> > Thank you for the explanation, noow I understand. How does that

> > translate to us as far as what our doctors can do to see the

> > progression of our deterioration and disability.

> >

> > Stella

>

[Guest guest]

Stella,

My rheummy ask the same as yours. I was told a while back at two

years they will x-ray again to see what changes are seen on the x-

rays.

I have always been the one to bring up my limitations with my job.

It has included climbing, pulling, lifting, carrying heavy

equipment, standing and walking. I have been blessed to have a

manager that has let me work repair. Most of the time I don't get

the physical stress to my body that I got when working the

installation end.

I hope you get more feedback. This is really interesting.

Shirley

> > > ,

> > > Thank you for the explanation, noow I understand. How does that

> > > translate to us as far as what our doctors can do to see the

> > > progression of our deterioration and disability.

> > >

> > > Stella

> >

>

[Guest guest]

Stella and group;

Hi Stella nice to meet you. Sorry your doctor don't seem to have

the right questions for you. THere is something to do about fatique

I heard others say that they are on meds for it.

My doctor asks me what level Of pain I am in from 1 to 10. ANd she

goes on from there. Maybe its time to look for a new RA, or is that

your primary doctor. My RA base her dicisions on my blood tests. I

do hope you feel much better.

gentle hugs

Clora

> and Group,

> Does anyone's rheumy follow your progress with meds by using this

HAQ

> questionare in this study from ? My doc asks me how i feel

about

> pain and joints. Anything else I say he doesn't hear. He doesn't

ask

> how I am functioning and what I can and cannot do. And when I told

> him that the fatigue holds me back more than anything else, he

> shrugged his shoulder and said that nothing much can be done about