A randomized clinical trial was performed to evaluate a psychological treatment intervention and a social support program, compared with a control program in which no adjunct treatment was rendered, and their effects upon pain behavior, affect, and disease activity of 53 patients with rheumatoid arthritis. The psychological intervention produced significant reductions in patients' pain behavior and disease activity at posttreatment. Significant reductions were also observed in trait anxiety at posttreatment and 6-month followup. Relaxation training may have been the most important component of the psychological intervention. The social support program produced a significant reduction in trait anxiety only at posttreatment. This is the first well-controlled study to demonstrate reduced pain behavior, disease activity, and trait anxiety following psychological treatment. Several recent reports have described the effects of various psychological interventions upon the ~~
Rats injected with bleomycin over a 58-week period developed weight loss, alopecia, hyperpigmentation, skin thickening and skin tautness when compared with saline-injected control animals. The only significant abnormality in laboratory blood tests was an increased sedimentation rate in the bleomycin-treated rats compared with controls. Histological examination of dorsal skin showed atrophied sebaceous glands and increased collagen fibres, with diameters ranging from 37.5 to 75 nm as compared with 72.5 to 100 nm in control animals. Chronic bleomycin exposure produces clinical, histological and ultrastructural skin changes similar to those found in human progressive systemic sclerosis (scleroderma).
This study examined the extent to which the psychological variables of depression, anxiety, and helplessness predicted the pain behavior and functional status of 64 rheumatoid arthritis (RA) patients beyond what could be predicted on the basis of demographic and medical status variables. Pain behavior was evaluated using a standardized observation method, and functional status was assessed using a modified Health Assessment Questionnaire (MHAQ) and rheumatologists' ratings. Regression analyses revealed that a modified rheumatoid activity index and/or disease duration were significant predictors of levels of guarding, rigidity, and total pain behavior. The psychological variables examined did not predict independently RA pain behavior. The rheumatoid activity index explained a significant proportion of the variance in functional status ratings and MHAQ daily function scores. Age, disease duration and depression also were independent predictors of functional status ratings. Thus, depression had a significant relationship with physician ratings of functional status but not with patient self-reports of disability. Psychological factors not examined in this study that might influence RA pain behavior and self-reports of functional status are discussed.
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