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To investigate whether illness perceptions and coping influence the relationship between back pain and health outcomes in patients suspected of having axial spondyloarthritis (SpA). In the SPondyloArthritis Caught Early cohort, regression models were computed at baseline, with back pain intensity (range 0–10) as the determinant and health‐related quality of life, the physical component summary score (PCS) and mental component summary (MCS) of the Short Form 36 (SF‐36) health survey, or work productivity loss as outcomes. Subsequently, using Leventhal's Common‐Sense Model of Self‐Regulation, illness perceptions and, thereafter, coping were added to the models. Analyses were repeated for patients diagnosed and classified as having axial SpA according to the Assessment of SpondyloArthritis international Society axial SpA criteria (ASASaxial SpA), patients only diagnosed with axial SpA (axial SpA–diagnosed only), and those with chronic back pain. A total of 424 patients (145 with ASASaxial SpA, 81 with only a diagnosis of axial SpA, and 198 with chronic back pain); 64% of the total group were female, the mean ± SDage was 30.9 ± 8.1 years, and the mean ± SDsymptom duration was 13.3 ± 7.1 months) were studied. In all patients, the strength of the associations between back pain and the PCS, back pain and the MCSscore, and back pain and loss of work productivity were decreased by adding illness perceptions to the model, but explained variance improved. Adding coping to these models did not change the results. Comparable results were observed in all subgroups. Illness perception, but not coping, is important in the relationship between back pain and HRQoL and work productivity loss in patients suspected of having axial SpA, irrespective of subgroup. This finding suggests that targeting illness perceptions could improve health outcomes in patients suspected of having axial SpA.

Outcome in asthma is determined not only by pulmonary function or other biomedical characteristics. An important determinant of asthma outcome is illness perceptions patients' subjective beliefs and emotional responses to their illness. Illness perceptions influence patients' coping and self-management behavior, and thereby outcome.

ObjectiveSternocostoclavicular hyperostosis SCCH is a rare, debilitating, chronic inflammatory disorder of the anterior chest wall due to a chronic sterile osteomyelitis of unknown origin, often associated with characteristic skin lesions of palms and soles: pustulosis palmoplantaris. SCCH goes often unrecognized for years before the diagnosis is established and treatment instituted. The objective of this study was to trace the diagnostic paths of patients with SCCH and to investigate the consequences associated with diagnostic delay.MethodsData were collected through structured interviews of 52 patients with a clinically, scintigraphically, and radiologically established diagnosis of SCCH.ResultsThe majority of patients presented with swelling andor pain in the sternocostoclavicular region andor limited movement of the shoulder girdle. Pustulosis palmoplantaris was present in ∼30 of patients. The disease went unrecognized for a median of 3.5 years. Patients were often seen by at least 3 members of the medical profession before the diagnosis was suspected and eventually established. Lack of recognition of the clinical manifestations of the disease and delay in diagnosis were associated with important physical, psychological, and socioeconomic consequences affecting quality of life.ConclusionSCCH remains an illrecognized disease despite its characteristic clinical features. A low level of awareness of the disorder leads to a delay in diagnosis, which has a significant impact on various aspects of quality of life. Awareness should be raised for this disorder, enabling timely diagnosis and initiation of treatment to prevent the irreversible physical and psychological sequelae associated with the protracted untreated state.

Objectives: To investigate impairments in Quality of Life (QoL), and their determinants, in patients with mild to moderate asthma and chronic obstructive pul-monary disease (COPD) under treatment in general practice.Methods: In a cross-sectional study, 340 adult patients with asthma and COPD completed a self-administered questionnaire containing a generic (COOP-WONCA charts) and a disease-specific (QOL-RIQ) instrument, both especially developed for measuring QoL in primary care. Symptoms, exacerbations, medication use, FEV1, and comorbidity were also measured.Results: For both COOP-WONCA charts and QOL-RIQ: two-thirds of the patients reported some impairment; about 10% of these patients reported moderate to severe impairment. For the five COOP-WONCA charts the relationships between QoL scores and clinical characteristics ranged from r2=0.24 (physical fitness) to r2=0.12 (social activities). For the total QOL-RIQ score the variance (r2=0.31) was mostly explained by disease-related characteristics, especially the degree of dyspnoea. Patients with more impairment on the COOP-WONCA charts or the QOL-RIQ are characterised as more frequently having comorbidity, a diagnosis of COPD and exacerbations, chronic cough and/or production of phlegm, and more severe dyspnoea. However, a large group of patients remain who have more impairment without having these characteristics.Discussion: The majority of these patients reported impairment of their QoL, although this impairment was only minor for both the generic COOP-WONCA charts and for the disease-specific QOL-RIQ. Most of the variation in QoL is determined by factors other than those considered relevant for treatment and follow-up. Of the known factors, dyspnoea is most related with impaired QoL. For these patients, the general practitioner should focus on minimising dyspnoea to ensure optimal QoL.

In a primary care setting, the prevalence of depression in elderly patients was studied, and the reliability and validity of the geriatric depression scale (GDS) were assessed. In 141 consecutive elderly attenders (64–90) of four general practices, we estimated the point prevalence of depression with two self-rating depression scales. The results of the two scales were compared. Fourteen patients (12%) scored above cut-off on the Zung self-rating depression scale and 14 (12%) on the GDS. In 10 patients both scales indicated depression. The psychometric quality of both scales was adequate. The results of the investigation established prevalences found in other countries. The GDS may be a useful case-finding instrument aiding the general practitioner in the identification of depression in elderly patients.