Rational/antiemotional behaviors in interpersonal relationships and the functional prognosis of patients with rheumatoid arthritis: a Japanese multicenter, longitudinal study.

BACKGROUND: The repression of negative emotions is a personality factor that received considerable attention in the 1950-60s as being relevant to the onset and course of rheumatoid arthritis (RA). Despite subsequent, repeated criticisms of the cross-sectional nature of the earlier studies, even to date few prospective studies have been reported on this issue. This multicenter study prospectively examined if "rational and antiemotional" behavior (antiemotionality), characterized by an extreme tendency to suppress emotional behaviors and to rationalize negative experiences in conflicting interpersonal situations, is associated with the functional prognosis of patients with RA. METHODS: 532 patients with RA who regularly visited one of eight hospitals/clinics in Japan in 2000 were recruited for study. All completed a self-administered baseline questionnaire about lifestyle and psychosocial factors including antiemotionality. Two years after, 460 (mean age, 56.1 years; 54 men and 406 women) of 471 patients who continued to visit the clinics agreed to take the follow-up questionnaire. The functional status of the patients was evaluated by rheumatologists based on the ACR classification system. RESULTS: A multiple logistic regression model that included baseline demographic, disease activity/severity-related, therapeutic, and socioeconomic factors as covariates found a tendency toward higher antiemotionality to be related to poorer functional status at follow-up. This relationship was not explained by lifestyle factors. CONCLUSIONS: Antiemotionality may be a prognostic factor for the functional status of patients with RA. This finding sheds light on a seemingly forgotten issue in the care of patients with RA.

Long-term results of open elbow synovectomy for rheumatoid arthritis.

Long-term results of open synovectomy of the elbow with rheumatoid arthritis (RA) were reviewed in 15 elbows. The subjects were evaluated at two time points with average follow-up periods of 4 and 8.7 years, and the results were compared between the two follow-ups. The Mayo Clinic performance score showed significant improvement in pain, motion, and daily function from the intermediate to the long-term follow-up. Overall results were satisfactory with little time-dependent deterioration in radiological grading, confirming the long-term effectiveness of this procedure.

Giant geode at the olecranon in the rheumatoid elbow--two case reports.

A single giant geode at the olecranon in a patient with rheumatoid arthritis (RA) is relatively rare, and may cause diagnostic difficulties or cause a spontaneous pathological fracture owing to weakness of the cortical bone associated with osteoporosis. We report two cases of patients presenting with single giant geodes at the olecranon. In one case we performed an open reduction and internal fixation with bone grafting for a pathological fracture due to the geode. In the other case we performed curettage of the geode with bone grafting to prevent a pathological fracture, and a synovectomy of the elbow. We suggest that the presence of a giant geode at the olecranon may necessitate surgical intervention to prevent the occurrence of a spontaneous pathological fracture.

Comparison of the Sauvé-Kapandji procedure and the Darrach procedure for the treatment of rheumatoid wrists.

Abstract In surgical treatment of the rheumatoid wrist, the Darrach procedure combined with synovectomy has been the treatment of choice in the past. However, owing to the significant ulnar carpal shift observed after the Darrach procedure, the Sauvé-Kapandji (S-K) procedure has become increasingly popular. The purpose of this study was to compare the clinical results of the S-K and Darrach procedures. Thirty-two wrists in the S-K-procedure group and 31 wrists in Darrach-procedure group were examined. Before and after surgery, clinical evaluations of pain, swelling, range of motion, grip strength, and radiological findings were performed and the results were compared. Both procedures resulted in decreased pain and swelling, as well as improved rotatory motion of the forearm. The S-K procedure was shown to be superior to the Darrach procedure in reducing ulnar carpal migration and improving grip strength. On the other hand, the prevention of carpal bone destruction could not be completely achieved in either procedure.