The presented data seem to exclude measuring free plasma DNA as an inexpensive, simple and quick tool to assess disease activity in patients with SLE. Further studies on a larger patient population would be needed to confirm our results.
Patients with rheumatoid arthritis (RA) have an increased risk of urolithiasis which is further negatively impacted by a reduced bone density. Interstitial cystitis also tends to occur more often in patients with rheumatic diseases. The high incidence of bacterial urogenital infections is influenced by the use of immunomodulating drugs. Many RA patients have to undergo numerous tests until a diagnosis is reached and are then treated as outpatients on a tightly controlled schedule. Despite a closely controlled rheumatological follow-up, urological screening and determination of a baseline prostate-specific antigen (PSA) value (in men over 45 years old) should not be neglected. In patients with an increased risk of renal and bladder neoplasms or when such a diagnosis is known, the benefit of long-term use of high doses of non-steroidal anti-inflammatory drugs (NSAID, aspirin type) should be carefully weighed up with a risk profile and after specialist urological assessment. Patients who suffer from sexual dysfunction due to physical limitations and prolonged medical therapy should undergo urological and gynecological assessment to exclude contributing causes. The use of aphrodisiacs and erection-enhancing drugs (e.g. PDE5 inhibitors, local injection with prostaglandins and vacuum therapy) require prior approval by a medical specialist and also cardiovascular stability. Acute urinary retention is more common in chronic inflammatory musculoskeletal diseases.
BackgroundA survey was conducted to evaluate whether a steady improvement in the quality of life of Rheumatoid Arthritis (RA) patients as frequently reported in clinical studies, does actually occur. The focus of this study laid on the personal perception of RA patients. How do patients who have been treated along accepted guidelines see the state of their health and their joint pain at different points in time?MethodsRA patients were asked to complete a questionnaire and return it to an opinion research centre. The questionnaire, which was developed by the authors, was divided into the areas: demography, symptom description and medical care, as well as the illness in a personal context. Three telephone interviews followed in monthly intervals when the patients´ feelings about their illness, their every-day coping mechanisms and their social lives were rated. Intra-subject correlation and the level of agreement among patients when assessed at three different points within a two month period, was determined.Results127 patients replied to the questionnaire. RA exerts a significant impact on a patient’s daily life. Average ratings of current state of health and joint pain (answered on a 5-part scale extending from 1 (very good) to 5 (very bad)) range between 2.6 and 2.9 all three times. However, intra-subject correlation between the different assessment times, is in general quite modest. Concerning the question: “How is your join pain today?” only 14 of 127 participants express identical ratings all three times , while in one third of the participants, a difference of two digits on the 5-part scale, at least twice had to be noticed. Intra-class correlation coefficients between answers at different points are often much smaller than 0.5. Results were similar in all subgroups analysed (men vs. women; patients receiving biologics vs. those not receiving biologics; disease duration ≤3 years vs. 4 to 10 years vs. ≥11 years).ConclusionOn an individual level personal assessments of health, well-being and joint pain are nevertheless unsteady even within the timeframe of two months. This is why, even now, RA patients still cannot plan their lives as non-affected people can.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0567-5) contains supplementary material, which is available to authorized users.
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