Martin D. Lidsky

Abstract Methods of scoring osseous defects and joint space narrowing in the hands and wrists of patients with definite or classical rheumatoid arthritis were devised. The usefulness of the scores was tested in a group of 90 patients who had one or more sets of X‐ray films of the hands and wrists 36 months or more after onset of illness. Correlations were found between the extent of radiographic abnormalities or the rate of progression of radiographic changes and the age at onset, hand and wrist deformities, preceding physical signs of inflammation in the joints of the hands and wrists, hand function as measured by fist formation, the early appearance of subcutaneous nodules, and the titer of anti‐IgG. Among black patients the extent of elevation of γ‐globulins was associated with roentgenographic changes. The correlations between the scores of radiologic abnormalities and the clinical and laboratory manifestations of rheumatoid arthritis establish the value of the described methods of assessing the roentgenographic changes and indicate the usefulness of these methods in evaluating the effect of therapy in this disease.

Numerous methods for reading abnormalities of rheumatoid arthritis in hand and wrist radiographs have been proposed over the past several decades. There are many differences among these methods, one of the more striking of which is the variation in the number of joints that are scored. In this study, we tested the number of joints that need to be read in order to represent abnormalities accurately and reproducibly, using the scores of multiple observers. Thirteen rheumatologists and radiologists each read a set of 41 hand and wrist films from patients with rheumatoid arthritis. Ten of 13 readers scored 27 joints in each hand and wrist; the other 3 readers scored fewer areas. Fourteen combinations of joints were selected based on the frequency of involvement and the technical adequacy of routine films in assessing a given area. After testing these 14 different combinations, 1 scheme, which included 17 areas read for erosions and 18 areas read for joint space narrowing, was tested further. The correlation coefficients for 10 intraobserver scores derived from this modified scheme compared with the original scores were between 0.981 and 0.997. Seventy-one of 78 interobserver comparisons were better using the new scheme than using the original scheme. These data indicate that the simplified scheme, using a combination of 17 joints to score erosions and 18 to score joint space narrowing, more accurately reflects the extent of abnormalities perceived by a panel of experts than does the original scheme. This abbreviated number of joints shortens the amount of time required to read a set of films and simplifies the scoring of films, since a number of areas that are difficult to read are eliminated from radiographic assessment.

Gastroduodenal intolerance is one of the major factors limiting the use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAID) in patients with arthritic conditions. We evaluated the endoscopic appearance of the gastroduodenal mucosa in 65 patients (63 men and two women) taking regular daily doses of NSAIDs over a long period for osteoarthritis or rheumatoid arthritis. Eight different drugs (indomethacin, ibuprofen, naproxen, sulindac, piroxicam, aspirin, salsalate, and tolmetin) had been taken continuously for at least 6 wk. Seven patients took two different NSAIDs. No other drug known to damage the mucosa was used. Twenty-one patients (32%) had an endoscopically completely normal stomach and duodenum, and 44 (68%) had evidence of injury (mucosal hemorrhage 44.6%, erosions 53.8%, both mucosal hemorrhage and erosions 34%). Ten patients had ulcers detected (seven gastric, two pyloric channel, one duodenal bulb) for a point prevalence of 15.4%. Ulcers were found in patients taking naproxen, indomethacin, tolmetin, sulindac, and ibuprofen, either alone, or in combination with aspirin. Dyspeptic symptoms were present in 19% of those with completely normal endoscopy and in only 9% of those with abnormal endoscopic findings. Only three of the 10 patients with ulcer had dyspeptic symptoms. There was no significant difference between drugs in tendency to cause gastroduodenal injury. We confirm that fairly severe gastroduodenal injury occurs in asymptomatic patients with rheumatoid and osteoarthritis, and that symptoms do not predict the presence of damage.

<P>Abstract copyright UK Data Service and data collection copyright owner.</P> The <i>General Household Survey</i> (GHS), ran from 1971-2011 (the UKDS holds data from 1972-2011). It was a continuous annual national survey of people living in private households, conducted by the Office for National Statistics (ONS). The main aim of the survey was to collect data on a range of core topics, covering household, family and individual information. This information was used by government departments and other organisations for planning, policy and monitoring purposes, and to present a picture of households, families and people in Great Britain. In 2008, the GHS became a module of the <a href="https://beta.ukdataservice.ac.uk/datacatalogue/series/series?id=2000024">Integrated Household Survey</a> (IHS). In recognition, the survey was renamed the <a href="https://beta.ukdataservice.ac.uk/datacatalogue/series/series?id=200019">General Lifestyle Survey</a> (GLF). The GLF closed in January 2012. The 2011 GLF is therefore the last in the series. A limited number of questions previously run on the GLF were subsequently included in the <a href="http://discover.ukdataservice.ac.uk/series/?sn=2000043" title="Opinions and Lifestyle Survey">Opinions and Lifestyle Survey</a> (OPN). <br> <br> <i>Secure Access GHS/GLF</i><br> The UKDS holds standard access End User Licence (EUL) data for 1972-2006. A Secure Access version is available, covering the years 2000-2011 - see SN 6716 <i>General Lifestyle Survey, 2000-2011: Secure Access</i>.<br> <br> <i>History</i><br> The GHS was conducted annually until 2011, except for breaks in 1997-1998 when the survey was reviewed, and 1999-2000 when the survey was redeveloped.&nbsp; Further information may be found in the ONS document <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/personalandhouseholdfinances/incomeandwealth/compendium/generallifestylesurvey/2013-03-07/40yearsofdatacollection/pdf">An overview of 40 years of data (General Lifestyle Survey Overview - a report on the&nbsp;2011 General Lifestyle Survey)</a>&nbsp;(PDF). Details of changes each year may be found in the individual study documentation.<br> <br> <i>EU-SILC</i><br> In 2005, the European Union (EU) made a legal obligation (EU-SILC) for member states to collect additional statistics on income and living conditions. In addition, the EU-SILC data cover poverty and social exclusion. These statistics are used to help plan and monitor European social policy by comparing poverty indicators and changes over time across the EU. The EU-SILC requirement was integrated into the GHS/GLF in 2005. After the closure of the GLF, EU-SILC was collected via the <a href="http://discover.ukdataservice.ac.uk/series/?sn=200017" title="Family Resources Survey">Family Resources Survey</a> (FRS) until the UK left the EU in 2020. <i>Reformatted GHS data 1973-1982 - Surrey SPSS Files</i><br> SPSS files were created by the University of Surrey for all GHS years from 1973 to 1982 inclusive. The early files were restructured and the case changed from the household to the individual with all of the household information duplicated for each individual. The Surrey SPSS files contain all the original variables as well as some extra derived variables (a few variables were omitted from the data files for 1973-76). In 1973 only, the section on leisure was not included in the Surrey SPSS files. This has subsequently been made available, however, and is now held in a separate study, <i>General Household Survey, 1973: Leisure Questions</i> (SN 3982). Records for the original GHS 1973-1982 ASCII files have been removed from the UK Data Archive catalogue, but the data are still preserved and available upon request.&nbsp;