12 results on '"J.M. Esdaile"'
Search Results
2. Renal Biopsy Specimens From Patients With Rheumatoid Arthritis and Apparently Normal Renal Function After Therapy With Cyclosporine
- Author
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J.M. Esdaile, David Ludwin, Iakovina Alexopoulou, and Peter Tugwell
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medicine.medical_specialty ,Chemotherapy ,Creatinine ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Urology ,Renal function ,medicine.disease ,Surgery ,Nephropathy ,Nephrotoxicity ,chemistry.chemical_compound ,chemistry ,Nephrology ,Rheumatoid arthritis ,Biopsy ,medicine ,Renal biopsy ,business - Abstract
Renal biopsies were performed in 14 patients with severe rheumatoid arthritis who had no evidence of compromised renal function after completion of treatment with low-dose cyclosporine (±5 mg/kg/d). Mean serum creatinine at the time of biopsy was 0.84 mg/dL (range, 0.59 to 1.23 mg/dL). In the 13 patients who had received 6 months of cyclosporine therapy, mild glomerular expansion was noted in two biopsy specimens, obsolescent glomeruli (range, 5% to 20%) in five, and glomerular amyloid deposits in one. Five biopsy specimens had mild and three had mild to moderate interstitial fibrosis. Moderate interstitial fibrosis with a striped pattern was attributed to cyclosporine in the 14th patient. The results of a second biopsy performed in one patient after a further 18 months of therapy were unchanged. Although the renal biopsy changes were minimal in 13 patients and pathologic features characteristic of cyclosporine nephropathy were absent from all but one biopsy, a greater frequency of adverse effects due to cyclosporine could not be excluded. In the absence of clinical data, long-term cyclosporine therapy must be administered with caution to patients with rheumatoid arthritis, who commonly have underlying renal damage, and the value of renal biopsies in predicting and preventing end-stage renal failure remains to be determined.
- Published
- 1994
3. Low-dose cyclosporin versus placebo in patients with rheumatoid arthritis
- Author
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P. Tugwell, C. Bombardier, M. Gent, K.J. Bennett, R.S. Roberts, D. Ludwin, W.G. Bensen, S. Carette, A. Chalmers, A.V. Klinkhoff, J.M. Esdaile, and G.R. Kraag
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Administration, Oral ,Arthritis ,Blood Pressure ,Cyclosporins ,Placebo ,Severity of Illness Index ,Drug Administration Schedule ,Arthritis, Rheumatoid ,Placebos ,chemistry.chemical_compound ,Activities of Daily Living ,medicine ,Humans ,Multicenter Studies as Topic ,In patient ,Randomized Controlled Trials as Topic ,Chemotherapy ,Creatinine ,business.industry ,Low dose ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Blood pressure ,chemistry ,Rheumatoid arthritis ,Drug Evaluation ,Female ,business ,Follow-Up Studies - Abstract
144 patients with severe rheumatoid arthritis from six centres were randomised to receive oral cyclosporin or placebo for 6 months. The initial daily dose of cyclosporin was 2·5 mg/kg, which was increased cautiously with monitoring of serum cyclosporin levels and creatinine; the mean stabilisation dose was 3·8 mg/kg. There were significant improvements in the cyclosporin-treated patients compared with the controls in the major outcomes of reduction of active joints (23% improvement), pain (24%), and functional status (16%); global improvement was 27%. In the cyclosporin group serum creatinine increased by a mean of 15·6 μmol/l and mean arterial blood pressure by 6·27 mm Hg; these increases were controlled in all but 2 patients by dose adjustment without withdrawal from the study.
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- 1990
4. Steroid interactions affecting metabolic activities of a T-lymphocyte line
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C.K. Osterland, J.M. Esdaile, A.J. Antakly, and E.A. St. Louis
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medicine.medical_specialty ,Hydrocortisone ,medicine.medical_treatment ,T-Lymphocytes ,Immunology ,Biology ,Pharmacology ,Dexamethasone ,Steroid ,Internal medicine ,medicine ,Tumor Cells, Cultured ,Humans ,Drug Interactions ,Androstanols ,Dose-Response Relationship, Drug ,Biological activity ,Drug interaction ,In vitro ,Steroid hormone ,Endocrinology ,Cell culture ,Steroids ,Antagonism ,Glucocorticoid ,medicine.drug - Abstract
A glucocorticoid sensitive T-lymphocyte cell line (CEM) was used to study in vitro interaction effects of steroidal compounds on their metabolic activity. Mixtures of steroidal hormones and related substances were added to the cells and assessed in short-term culture experiments by the incorporation of 3H dTr. Dose ranges were selected to include the linear portion of the dose-response curve of each of the potentially interactive substances. Evidence for synergy, additivism or antagonism was obtained for each of the various steroid combinations studied using algebraic and geometric calculations.
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- 1992
5. Hairy-cell leukaemia with polyarteritis nodosa
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K.B. Elkon, M. Seligmann, G.R.V. Hughes, J.M. Esdaile, J.P. Clauvel, Daniel Catovsky, H. Tannenbaum, and J. Dumont
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Adult ,Male ,Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,Hepatic Artery ,Biopsy ,medicine ,Humans ,Arteritis ,Fat Necrosis ,Skin ,Chemotherapy ,Leukemia, Hairy Cell ,medicine.diagnostic_test ,Polyarteritis nodosa ,business.industry ,Arthritis ,General Medicine ,Middle Aged ,medicine.disease ,Aneurysm ,Neutrophilia ,Polyarteritis Nodosa ,Blood Vessels ,Polyarthritis ,medicine.symptom ,Vasculitis ,business ,Systemic vasculitis - Abstract
In four patients a systemic vasculitis similar to polyarteritis nodosa developed within 2 years of the onset of hairy-cell leukaemia. Arteriographic studies in two patients revealed microaneurysms, and biopsy specimens in three patients revealed a vasculitis affecting medium-sized vessels. Blood neutrophilia and neutrophilic vascular infiltrate were absent. One patient had circulating immune complexes. Two patients responded to corticosteroids alone, one required cyclophosphamide as well as steroids, and one improved without chemotherapy. The association of vasculitis with hairy-cell leukaemia may provide insight into the pathogenesis of arteritis.
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- 1979
6. Lymphocyte transformation to connective tissue antigens in adult and juvenile rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, systemic lupus erythematosus, and a nonarthritic control population
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E.E. Golds, H. Strawczynski, J.M. Esdaile, I.B.M. Stephen, and A.R. Poole
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Adult ,Pathology ,medicine.medical_specialty ,Inflammatory arthritis ,Immunology ,Arthritis ,Connective tissue ,Lymphocyte Activation ,Autoantigens ,Arthritis, Rheumatoid ,Osteoarthritis ,medicine ,Humans ,Lupus Erythematosus, Systemic ,Spondylitis, Ankylosing ,Antigens ,skin and connective tissue diseases ,Child ,Immunity, Cellular ,Systemic lupus erythematosus ,Lupus erythematosus ,business.industry ,medicine.disease ,Connective tissue disease ,Arthritis, Juvenile ,medicine.anatomical_structure ,Connective Tissue ,Rheumatoid arthritis ,Collagen ,business ,Juvenile rheumatoid arthritis - Abstract
Transformation of peripheral blood lymphocytes after exposure to connective tissue antigens was measured in patients with adult (n = 35) and juvenile rheumatoid arthritis (n = 34), osteoarthritis (n = 21), ankylosing spondylitis (n = 15), and systemic lupus erythematosus (n = 26) and in control subjects (n = 36). The connective tissue antigens included homologous cartilage-type proteoglycan, cyanogen bromide-derived peptides of type I, II, and III collagens, and type I and II helical collagens. Lymphocyte transformation was not detected in the osteoarthritic and control groups, with one exception. Sensitization to at least one connective tissue antigen was detected in approximately one-third of the rheumatoid arthritic and lupus patients and in one-quarter of the juvenile rheumatoid patients. In ankylosing spondylitis, positive responses occurred to proteoglycan in 20% of patients tested but never to collagens or peptides. Sensitivity to proteoglycan was detected only in ankylosing spondylitis except for one patient with juvenile rheumatoid arthritis. In patients with systemic lupus erythematosus and both forms of rheumatoid arthritis, lymphocyte transformation was usually more frequently detected to peptides than to the helical collagens. In adult rheumatoid arthritis, type II peptides elicited an elevated number of responses (14%) as did type I (9%) and III (8%) peptides to lesser degrees. Responses to type I (4%) and II (4%) helical collagens were infrequent. Rheumatoid arthritic patients usually exhibited sensitivity to only one antigen and lymphocyte transformation was often detected when the arthritis was improving. In juvenile rheumatoid arthritis, lymphocyte transformation was detected to peptides of type I (16%), II (9%), and III (29%) collagens and to helical type I (12%) and II (8%) collagens. In systemic lupus erythematosus, sensitization was detected to peptides of type I (13%), II (20%), and III (14%) collagens and to helical type I collagen (18%) but not type II collagen. Simultaneous sensitivity to several antigens often occurred in both systemic lupus erythematosus and juvenile rheumatoid arthritis. Examination of individual patients in all three rheumatic disease groups revealed that immune sensitivity developed to collagen peptides rather than to the helical molecules, particularly in the case of type II collagen. Thus, some patients with inflammatory arthritis exhibit immune responses to connective tissue components which are, as a group, characteristic for each type of arthritis. These responses, which were not obviously associated with disease activity, may develop as a result of inflammation or trauma which destroys connective tissue and exposes molecules, in either a native or degraded state, to cells of the immune system. Expression of sensitivity to these tissue antigens may contribute to the chronicity of the inflammatory arthritides.
- Published
- 1983
7. Investigating Associations Between Access to Rheumatology Care, Treatment, Continuous Care, and Healthcare Utilization and Costs Among Older Individuals With Rheumatoid Arthritis.
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Aviña-Zubieta JA, Esdaile JM, Hazlewood GS, Faris P, Katz S, MacMullan P, Mosher D, and Widdifield J
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- Humans, Female, Aged, Male, Delivery of Health Care, Patient Acceptance of Health Care, Ontario, Rheumatology, Arthritis, Rheumatoid drug therapy
- Abstract
Objective: To examine the association between rheumatologist access, early treatment, and ongoing care of older-onset rheumatoid arthritis (RA) and healthcare utilization and costs following diagnosis., Methods: We analyzed data from a population-based inception cohort of individuals aged > 65 years with RA in Ontario, Canada, diagnosed between 2002 and 2014 with follow-up to 2019. We assessed 4 performance measures in the first 4 years following diagnosis, including access to rheumatology care, yearly follow-up, timely treatment, and ongoing treatment with a disease-modifying antirheumatic drug. We examined annual healthcare utilization, mean direct healthcare costs, and whether the performance measures were associated with costs in year 5., Results: A total of 13,293 individuals met inclusion criteria. The mean age was 73.7 (SD 5.7) years and 68% were female. Total mean direct healthcare cost per individual increased annually and was CAD $13,929 in year 5. All 4 performance measures were met for 35% of individuals. In multivariable analyses, costs for not meeting access to rheumatology care and timely treatment performance measures were 20% (95% CI 8-32) and 6% (95% CI 1-12) higher, respectively, than where those measures were met. The main driver of cost savings among individuals meeting all 4 performance measures were from lower complex continuing care, home care, and long-term care costs, as well as fewer hospitalizations and emergency visits., Conclusion: Access to rheumatologists for RA diagnosis, timely treatment, and ongoing care are associated with lower total healthcare costs at 5 years. Investments in improving access to care may be associated with long-term health system savings., (Copyright © 2023 by the Journal of Rheumatology.)
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- 2023
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8. Prevalence of Femoroacetabular Impingement Syndrome among Young and Middle-aged White Adults.
- Author
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Kopec JA, Hong Q, Wong H, Zhang CJ, Ratzlaff C, Cibere J, Li LC, Prlic H, Wilson DR, Forster BB, and Esdaile JM
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- Adult, British Columbia epidemiology, Female, Hip Joint diagnostic imaging, Humans, Male, Middle Aged, Prevalence, Radiography, Range of Motion, Articular, Young Adult, Femoracetabular Impingement diagnostic imaging, Femoracetabular Impingement epidemiology
- Abstract
Objective: The purpose of the study was to determine the prevalence of femoroacetabular impingement syndrome (FAIS) in white adults 20 to 49 years of age., Methods: Participants were white men and women aged 20-49 years, recruited through random digit dialing from the population of Metro Vancouver, British Columbia, Canada. Participants filled out a self-administered questionnaire and underwent a physical examination and radiographs of both hips. FAIS was defined as a combination of hip symptoms, physical signs of impingement, and radiological findings of cam or pincer morphology as recommended by the Warwick Agreement. All analyses were weighted to reflect the population from which the sample was drawn., Results: Data were obtained for 500 participants. In the study population, 48.9% were males and the age distribution was 32.2%, 31.4%, and 36.4% in the groups 20-29, 30-39, and 40-49 years, respectively. The physical signs of impingement correlated significantly with symptoms, but there was no significant association between either symptoms or physical examination with radiographic findings. FAIS on either side was found in 3.0% (95% CI 1.5-4.5) of the population., Conclusion: In this study, FAIS was present in 3% of whites aged 20-49 years. Further research is needed to develop consistent criteria for assessing hip symptoms, physical signs, and hip joint morphology, and to better understand the relationships between them.
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- 2020
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9. Quadriceps Weakness and Risk of Knee Cartilage Loss Seen on Magnetic Resonance Imaging in a Population-based Cohort with Knee Pain.
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Chin C, Sayre EC, Guermazi A, Nicolaou S, Esdaile JM, Kopec J, Thorne A, Singer J, Wong H, and Cibere J
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- Adult, Aged, British Columbia, Cohort Studies, Female, Humans, Male, Middle Aged, Muscle Strength, Muscle Weakness complications, Osteoarthritis, Knee etiology, Arthralgia physiopathology, Cartilage, Articular pathology, Magnetic Resonance Imaging methods, Muscle Weakness diagnostic imaging, Patellofemoral Joint pathology, Quadriceps Muscle pathology
- Abstract
Objective: To determine whether baseline quadriceps weakness predicts cartilage loss assessed on magnetic resonance imaging (MRI)., Methods: Subjects aged 40-79 with knee pain (n = 163) were recruited from a random population sample and examined for quadriceps weakness with manual isometric strength testing, using a 3-point scoring system (0 = poor resistance, 1 = moderate resistance, 2 = full resistance), which was dichotomized as normal (grade 2) versus weak (grade 0/1). MRI of the more symptomatic knee was obtained at baseline and at mean of 3.3 years. Cartilage was graded 0-4 on MRI. Exponential regression analysis was used to evaluate whether quadriceps weakness was associated with whole knee cartilage loss, and in secondary analyses with compartment-specific cartilage loss, adjusted for age, sex, body mass index, Western Ontario and McMaster Universities Osteoarthritis Arthritis Index pain score, and baseline MRI cartilage score., Results: Of 163 subjects, 54% were female, with a mean age of 57.7 years. Quadriceps weakness was seen in 11.9% of the subjects. Weakness was a predictor of whole knee cartilage loss (HR 3.48, 95% CI 1.30-9.35). Quadriceps weakness was associated with cartilage loss in the medial tibiofemoral (TF) compartment (HR 4.60, 95% CI 1.25-17.02), while no significant association was found with lateral TF (HR 1.53, 95% CI 0.24-9.78) or patellofemoral compartment (HR 2.76, 95% CI 0.46-16.44)., Conclusion: In this symptomatic, population-based cohort, quadriceps weakness predicted whole knee and medial TF cartilage loss after 3 years. To our knowledge, this is the first study to show that a simple clinical examination of quadriceps strength can predict the risk of knee cartilage loss.
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- 2019
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10. Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines.
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Schmidt TJ, Aviña-Zubieta JA, Sayre EC, Abrahamowicz M, Esdaile JM, and Lacaille D
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- Aged, Aged, 80 and over, Blood Glucose analysis, British Columbia epidemiology, Comorbidity, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Mass Screening, Middle Aged, Patient Compliance, Prevalence, Statistics, Nonparametric, Arthritis, Rheumatoid epidemiology, Cardiovascular Diseases prevention & control, Diabetes Mellitus epidemiology, Guideline Adherence
- Abstract
Objective: To evaluate compliance with diabetes screening guidelines for cardiovascular disease (CVD) prevention in rheumatoid arthritis (RA) compared to the general population., Methods: We conducted the first longitudinal study of a population-based RA cohort including all prevalent RA cases in British Columbia between 1996 and 2006 and followed until 2010, with matched general population comparators. Using administrative data, we measured compliance with general population guidelines [i.e., testing plasma glucose (PG) at least once every 3 years after age 45] after excluding individuals with previous diabetes. Followup was divided into 3-year eligibility periods. Compliance was measured as the proportion of periods with ≥ 1 PG test performed. OR (95% CI) of compliance in RA (vs general population) was calculated using generalized estimating equation models, adjusting for age and sex. Mean compliance rate per patient was also calculated and compared using the Mann-Whitney U test., Results: Analysis included 22,624 individuals with RA, contributing 48,724 three-year eligibility periods; and 22,579 people in a general population group, contributing 51,081 three-year eligibility periods. PG was measured in 72.3% (SD 37%) of the eligible time periods in the RA sample and in 70.4% (SD 38%) for the general population (OR 1.05, 95% CI 1.02-1.09, p < 0.0001). RA individuals met recommended screening guidelines in 71.4% of their eligible periods, compared to 70.6% (p < 0.001). Screening improved over time in RA relative to the general population. Family physicians ordered nearly all the PG tests., Conclusion: Compliance with general population guidelines for diabetes screening in RA was suboptimal, with little difference relative to the general population, despite a higher risk of CVD and diabetes.
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- 2018
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11. Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators.
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Barber CE, Esdaile JM, Martin LO, Faris P, Barnabe C, Guo S, Lopatina E, and Marshall DA
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- Adrenal Cortex Hormones therapeutic use, Adult, Age of Onset, Aged, Aged, 80 and over, Arthritis, Rheumatoid drug therapy, Body Mass Index, Cardiovascular Diseases etiology, Comorbidity, Dyslipidemias complications, Female, Humans, Hypertension complications, Incidence, Male, Mass Screening, Middle Aged, Obesity complications, Quality Indicators, Health Care, Risk, Smoking adverse effects, Young Adult, Arthritis, Rheumatoid epidemiology, Cardiovascular Diseases epidemiology
- Abstract
Objective: Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice., Methods: Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate., Results: There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively)., Conclusion: Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.
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- 2016
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12. Imbalance of prevalence and specialty care for osteoarthritis for first nations people in Alberta, Canada.
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Barnabe C, Hemmelgarn B, Jones CA, Peschken CA, Voaklander D, Joseph L, Bernatsky S, Esdaile JM, and Marshall DA
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- Canada epidemiology, Databases, Factual, Female, Humans, Indians, North American statistics & numerical data, Male, Osteoarthritis ethnology, Prevalence, Primary Health Care statistics & numerical data, Specialization, Health Services statistics & numerical data, Health Status Disparities, Osteoarthritis epidemiology
- Abstract
Objective: To estimate the population-based prevalence and healthcare use for osteoarthritis (OA) by First Nations (FN) and non-First Nations (non-FN) in Alberta, Canada., Methods: A cohort of adults with OA (≥ 2 physician claims in 2 yrs or 1 hospitalization with ICD-9-Clinical Modification code 715x or ICD-10-Canadian Adaptation code M15-19, 1993-2010) was defined with FN determination by premium payer status. Prevalence rates (2007/8) were estimated from the cohort and the population registered with the Alberta Health Care Insurance Plan. Rates of outpatient primary care and specialist visits (orthopedics, rheumatology, internal medicine), arthroplasty (hip and knee), and all-cause hospitalization were estimated., Results: OA prevalence in FN was twice that of the non-FN population [16.1 vs 7.8 cases/100 population, standardized rate ratio (SRR) adjusted for age and sex 2.06, 95% CI 2.00-2.12]. The SRR (adjusted for age, sex, and location of residence) for primary care visits for OA was nearly double in FN compared with non-FN (SRR 1.88, 95% CI 1.87-1.89), and internal medicine visits were increased (SRR 1.25, 95% CI 1.25-1.26). Visit rates with an orthopedic surgeon (SRR 0.49, 95% CI 0.48-0.50) or rheumatologist (SRR 0.62, 95% CI 0.62-0.63) were substantially lower in FN with OA. Hip and knee arthroplasties were performed less frequently in FN with OA (SRR 0.48, 95% CI 0.47-0.49), but all-cause hospitalization rates were higher (SRR 1.59, 95% CI 1.58-1.60)., Conclusion: We estimate a 2-fold higher prevalence of OA in the FN population with differential healthcare use. Reasons for higher use of primary care and lower use of specialty services and arthroplasty compared with the general population are not yet understood.
- Published
- 2015
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