Rheumatoid Arthritis: Cardiel MH

Soriano ER, Galarza-Maldonado C, Cardiel MH, Pons-Estel BA, Massardo L, Caballero-Uribe CV, Achurra-Castillo AF, Barile-Fabris LA, Chávez-Corrales J, Díaz-Coto JF, Esteva-Spinetti MH, Guibert-Toledano M, Palazuelos FI, Keiserman MW, Lomonte AV, Mota LM, Pineda Villaseñor C, Alarcón GS, Anonymous00427. · Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires y Fundación Dr Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina. · Rheumatology (Oxford). · Pubmed #18463144 links to  free full text

This publication has no abstract.

Mody GM, Cardiel MH. · Department of Rheumatology, Nelson R Mandela School of Medicine, University of Kwa Zulu-Natal, Congella, Durban 4013, South Africa. · Best Pract Res Clin Rheumatol. · Pubmed #18783741 No free full text.

Abstract: Rheumatoid arthritis (RA) is a systemic autoimmune disease which is characterized by chronic inflammation of the joints. Patients experience chronic pain and suffering, and increasing disability; without treatment, life expectancy is reduced. It is imperative to identify patients early so that control of inflammation can prevent joint destruction and disability. Although great advances have been made in the developed nations, early diagnosis remains a great challenge for developing countries during the Bone and Joint Decade (2000-2010) and beyond. Developing countries face important and competitive social, economic, health- and poverty-related issues, and this frequently results in chronic diseases such as RA being forgotten in health priorities when urgent health needs are considered in an environment with poor education and scarce resources. Epidemiological studies in developing countries show a lower but still important prevalence in different regions when compared to that in Caucasians. It seems that the severity of RA varies among different ethnic groups, and probably starts at a younger age in developing countries. Practising rheumatologists in these regions need to take into account several important problems that include suboptimal undergraduate education, inadequate diagnosis, late referrals, lack of human and technical resources, poor access to rheumatologists, and some deficiencies in drug availability. Infections are very important in RA, and special care is needed in developing countries as some endemic infections include tuberculosis, human immunodeficiency virus (HIV), hepatitis B, and hepatitis C. These infections should be carefully taken into account when medications are prescribed and monitored. This chapter presents published information covering the main challenges faced in these environments, and suggests strategies to overcome these important problems in RA management.

Massardo L, Suárez-Almazor ME, Cardiel MH, Nava A, Levy RA, Laurindo I, Soriano ER, Acevedo-Vázquez E, Millán A, Pineda-Villaseñor C, Galarza-Maldonado C, Caballero-Uribe CV, Espinosa-Morales R, Pons-Estel BA. · Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. · J Clin Rheumatol. · Pubmed #19502907 No free full text.

Abstract: OBJECTIVE: A consensus meeting of representatives of 18 Latin-American and Caribbean countries gathered in Reñaca, Chile, for 2 days to identify problems and provide recommendations for the care of patients with rheumatoid arthritis (RA) in Latin America, a region where poverty and other health priorities make the efforts to provide effective and high quality care difficult. This report includes recommendations for health professionals, patients, and health authorities in Latin America, with an emphasis on education and therapeutic issues. METHODS: Fifty-one rheumatologists (list available only online on the JCR website) from 18 Latin-American and Caribbean countries with a special interest in RA participated in the consensus meeting. Participants were experts identified and appointed by the National Societies of Rheumatology affiliated with the Pan-American League of Associations for Rheumatology (PANLAR) and by the Grupo Latino Americano De Estudio de Artritis Reumatoide (GLADAR)-an independent group of Latin American rheumatologist researchers were also invited to the meeting. Eight topics were identified as priorities: patient, community and allied health professional education, health policy and decision making, programs for early detection and appropriate treatment of RA, role of classic disease modifying antirheumatic drugs (DMARDs), role of biologic therapy, and drug safety surveillance. To reach consensus, a survey with questions relevant to the topic of interest was sent to all participants before the meeting. During a 2 day meeting, the answers of the survey were reviewed and discussed by each group, with final recommendations on action items. RESULTS: The specific topic of the survey was answered by 86% of the participants and 68% of them answered the entire survey. It was agreed that RA and rheumatic diseases which are currently not but should be public health priorities in Latin America, because of their prevalence and impact on quality of life. CONCLUSIONS: Strategic areas identified as priorities for our region included: early diagnosis and access to care by multidisciplinary teams, creation of databases to identify infections with the use of biologic agents in RA which are relevant to Latin America, and overall efforts to improve the care of RA patients in accordance with international standards. Implementation of educational programs aimed to improve self-management for patients with RA was also considered crucial.

Reyes-Llerena GA, Guibert-Toledano M, Penedo-Coello A, Pérez-Rodríguez A, Baez-Dueñas RM, Charnicharo-Vidal R, Cardiel MH. · Reumatologo e Internista, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), Ciudad Habana, Cuba. · J Clin Rheumatol. · Pubmed #19265344 No free full text.

Abstract: OBJECTIVE: To estimate the prevalence, burden of illness, and help-seeking behavior of patients with musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis, gout, and bone fractures not related to trauma among the adult population in a urban community in Havana City. METHODS: Home survey of adults validated against physical examination. Forty-eight trained family doctors and 3 rheumatologists supervised the interviews and confirmed diagnoses. Family doctors applied a validated Community Oriented Program for the Control of Rheumatic Diseases core questionnaire. A diagnosis using American College of Rheumatology criteria was established. Analysis was based on descriptive statistics and point prevalence estimates with 95% confidence intervals (CIs) of most common diseases and associated disability rate. RESULTS: One thousand two hundred thirty-eight men and 1917 women were included. Prevalence of musculoskeletal pain was estimated in 43.9% (95% CI: 42.2-45.7). The knees were the most affected area (11.7%; 95% CI: 10.6-12) followed by low back pain (11.6%; 95% CI: 10.5-12.8). Point prevalence and 95% CI were as follows: osteoarthritis, 20.4% (95% CI: 19-21.8); gout, 0.38% (95% CI: 0.2-0.6); fibromyalgia, 0.22% (95% CI: 0.09-0.4); systemic lupus erythematosus, 0.06% (95% CI: 0.01-0.25); spondyloarthropathies, 0.19% (95% CI: 0.07-0.4); and rheumatoid arthritis,1.24% (95% CI: 0.8-1.7). Bone fractures not related to trauma were found in 1.14%, hip fracture being the most common (30.5%). Most patients were seen by the general practitioner (65.4%) and 6.2% described some disability. CONCLUSIONS: Musculoskeletal pain is highly prevalent in Cuba. Prevalence estimates are similar to those described in other surveys except for rheumatoid arthritis that seems more prevalent in Cuba and fibromyalgia less prevalent.

Cardiel MH, Anonymous00194, Anonymous00195. · Unidad de Investigación Clínica, Hospital General Dr Miguel Silva, Morelia, Mich, México. · Rheumatology (Oxford). · Pubmed #16709584 links to  free full text

Abstract: BACKGROUND: Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that involves synovial joints, resulting in severe dysfunction or burden for individual patients, families and society. Latin American Rheumatology Associations have acknowledged its relevance and recognized multiple limitations for its diagnosis and treatment in Latin America and the Caribbean. This document underscores issues regarding the impact and relevance of this disease in these countries. OBJECTIVES: To develop a consensus document that may unify and guide the pharmacological management of RA in Latin America and the Caribbean. METHODS: An Executive Committee appointed by the Epidemiology, Rheumatoid Arthritis and Radiology Committees of Pan-American League of Association for Rheumatology (PANLAR), held a meeting at Lisbon in May 2003. The goal was to establish a task force for the development of a Latin American consensus on the management of RA. Efforts focused on the problems encountered in the region regarding the availability of appropriate treatment for RA and the development of treatment guidelines for clinical practice. A secondary objective was the diffusion of the consensus conclusions and recommendations in participating countries. RESULTS: Six major issues were identified for discussion by six working groups. All Latin American Rheumatology Associations registered in PANLAR were invited to participate in the consensus. PANLAR members were well-represented in each group. Coordinators identified essential literature to be reviewed, analysed, and electronically discussed before the consensus meeting. CONCLUSIONS: The consensus' results and recommendations of this effort to delineate RA management in Latin America are contained in this article, which has been reviewed by participant societies and authors during 2004/2005 and endorsed by PANLAR.

Alarcón-Segovia D, Alarcón-Riquelme ME, Cardiel MH, Caeiro F, Massardo L, Villa AR, Pons-Estel BA, Anonymous00344. · University of Uppsala, Uppsala, Sweden. · Arthritis Rheum. · Pubmed #15818688 links to  free full text

Abstract: OBJECTIVE: To determine whether there is familial aggregation of systemic lupus erythematosus (SLE) and/or other autoimmune diseases in SLE patients and to identify clinical differences between patients with and those without familial autoimmunity. METHODS: We interviewed members of the Grupo Latinoamericano de Estudio del Lupus Eritematoso (GLADEL) inception cohort of 1,214 SLE patients to ascertain whether they had relatives with SLE and/or other autoimmune diseases. Identified relatives were studied. Familial aggregation was tested using reported highest and intermediate population prevalence data for SLE, rheumatoid arthritis (RA), or all autoimmune diseases, and studies were performed to identify the genetic model applicable for SLE. RESULTS: We identified 116 first-, second-, or third-degree relatives with SLE, 79 with RA, 23 with autoimmune thyroiditis, 3 with scleroderma, 1 with polymyositis, and 16 with other autoimmune diseases, related to 166 of the 1,177 SLE patients in the GLADEL cohort who agreed to participate. Forty-two SLE patients had 2 or more relatives with an autoimmune disease. We found a lambda(sibling) of 5.8 and 29.0 for SLE and of 3.2-5.3 for RA, when comparing with their reported high or intermediate population prevalence, respectively. We also found familial aggregation for autoimmune disease in general (lambda(sibling) = 1.5) and determined that for SLE, a polygenic additive genetic model, rather than a multiplicative one, is applicable. CONCLUSION: In SLE there is familial aggregation of SLE, RA, and autoimmune disease in general. A polygenic additive model applies for SLE. American Indian-white Mestizo SLE patients and those with higher socioeconomic level were more likely to have familial autoimmunity.

Rodríguez-Carreón AA, Zúñiga J, Hernández-Pacheco G, Rodríguez-Pérez JM, Pérez-Hernández N, Montes de Oca JV, Cardiel MH, Granados J, Vargas-Alarcón G. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico. · J Autoimmun. · Pubmed #15725578 No free full text.

Abstract: The aim of this study was to determine the frequency and potential relevance of the promoter polymorphisms of the tumor necrosis factor-alpha (TNF-alpha) in the severity of rheumatoid arthritis (RA) in Mexicans. HLA-DR and polymorphisms at positions -238 and -308 of TNF-alpha gene were determined in 137 Mexican RA patients (44 with severe and 93 with non-severe RA) as well as in 169 healthy controls (99 were typed for HLA-DR). We observed an increased frequency of HLA-DR4 in severe RA compared to healthy controls (pC=0.02, OR=2.33). TNF polymorphism analysis showed a significant increased frequency of TNF -238 GG genotype in the whole group of RA patients when compared to healthy controls (pC=0.007, OR=4.71). When the analyses were carried out separately in severe and non-severe RA patients, the increased frequency of -238 GG genotype only was observed in patients with non-severe forms of the disease. Analysis of -308 polymorphism showed increased frequency of -308 T2 (A) allele in severe RA when compared to non-severe disease (pC=0.011, OR=3.29) and to healthy controls (pC=0.002, OR=3.97). The data demonstrate that -308 T2 (A) allele is associated with susceptibility to develop severe RA in Mexicans. This association could be independent from HLA-DR alleles and might be used as a prognostic marker for severe RA.

Weder-Cisneros ND, Téllez-Zenteno JF, Cardiel MH, Guibert-Toledano M, Cabiedes J, Velásquez-Paz AL, García-Ramos G, Cantú C. · Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Immunology and Rheumatology, INCMNSZ. · Cephalalgia. · Pubmed #15566417 No free full text.

Abstract: Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-beta2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache (P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and beta2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and beta2GP-I antibodies.

Ruiz-Morales JA, Vargas-Alarcón G, Flores-Villanueva PO, Villarreal-Garza C, Hernández-Pacheco G, Yamamoto-Furusho JK, Rodríguez-Pérez JM, Pérez-Hernández N, Rull M, Cardiel MH, Granados J. · Department of Immunology and Rheumatology (J.A.R.-M., C.V.-G., J.K.Y.-F., M.R., M.H.C., J.G.), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico. · Hum Immunol. · Pubmed #15041166 No free full text.

Abstract: The risk to develop rheumatoid arthritis (RA) has been associated with the presence of HLA-DRB1 alleles encoding the "shared epitope" (SE). Additionally, HLA-DRB1 alleles encoding an aspartic acid at position 70 (D70+ ) have been associated with protection against the development of RA. In this study we tested the association between either SE or D70+ and rheumatoid arthritis in Mexican Mestizos. We included 84 unrelated Mexican Mestizos patients with RA and 99 unrelated healthy controls. The HLA-typing was performed by PCR-SSO and PCR-SSP. We used the chi-squared test to detect differences in proportions of individuals carrying at least one SE or D70+ between patients and controls. We found that the proportion of individuals carrying at least one HLA-DRB1 allele encoding the SE was significantly increased in RA cases as compared to controls (p(c) = 0.0004, OR = 4.1, 95% CI = 2.2-7.7). The most frequently occurring allele was HLA-DRB1*0404 (0.161 vs 0.045). Moreover, we observed a significantly increased proportion of HLA-DRB1 SE+ cases with RF titers above the median (p = 0.005). Conversely, the proportion of individuals carrying at least one HLA-DRB1 allele encoding the D70+ was significantly decreased (p(c) = 0.004, OR = 0.4, 95% CI 0.2-0.7) among RA patients compared with controls. In conclusion, the SE is associated with RA in Mexican Mestizos as well as with the highest titers of RF.

Araiza-Casillas R, Cárdenas F, Morales Y, Cardiel MH. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Mexico DF, Mexico. · Lupus. · Pubmed #14995005 No free full text.

Abstract: Antimalarials are very useful drugs in the treatment of various rheumatic diseases. One of their main side effects is ocular toxicity, specifically retinopathy. Our objective was to identify risk factors associated with chloroquine retinopathy. A single, trained evaluator reviewed patient records with rheumatic diseases. They were taking chloroquine and identified by the ophthalmology department as having retinopathy during their routine eye evaluation. These cases were classified according to clinical evaluation, visual fields and fluorangiographic study. Up to four controls were selected for each case, matched by age, gender, diagnosis and similar time on chloroquine. In all, 34 variables were studied, among these: weight, age, disease duration, keratopathy, total cumulative dose (TCD), mean daily dose (MDD), lean body weight adjusted daily dose (LBWDD) and laboratory tests. Descriptive and inferential statistics comparing cases and controls in all patients and subgroup analysis were carried out. Significance was set at the 0.05 level. Odds ratio and 95% confidence intervals were calculated. Sixteen cases of chloroquine retinopathy were identified, eight patients with rheumatoid arthritis (RA), seven with systemic lupus erythematosus (SLE) and one with dermatomyositis. All were female. Mean age was 47.3 +/- 12.2 years; weight 59.5 +/- 10.7 kg; disease duration 12.8 +/- 6.0 years; time on chloroquine 54.1 +/- 27.8 (min-max: 30-197) months. There was a significant difference in the following variables in all patients: MDD 212.3 +/- 52.6 versus 170 +/- 51.3, p = 0.009; and LBWDD 5 +/- 1 versus 4.2 +/- 1.5, p = 0.03, for cases and controls, respectively. In subgroup analysis the MDD remained significantly different (235.5 +/- 45.8 versus 169.7 +/- 46.1, p = 0.004) only in RA, whereas LBWDD was different both in SLE and RA. Keratopathy increased the risk for retinopathy: OR, 95% CI: 5, 1.4-17.6, p = 0.01. In conclusion, in accordance with previous studies, the MDD, LBWDD and keratopathy were risk factors associated with chloroquine retinopathy. Periodic ophthalmologic evaluations are mandatory.

Zúñiga JA, Villarreal-Garza C, Flores E, Barquera R, Pérez-Hernández N, Montes de Oca JV, Cardiel MH, Vargas-Alarcón G, Granados J. · Molecular Biology and Immunogenetics Laboratory, Infectious Diseases Unit, Instituto Nacional de Enfermedades Respiratorias, Calzada Tlalpan 4502, Tlalpan 14080, Mexico, D.F. · Clin Exp Rheumatol. · Pubmed #12846056 No free full text.

Abstract: OBJECTIVE: The aim of this study was to analyze the frequencies of the CCR5 delta 32 deletion and HLA class II alleles in Mexican Amerindian populations and its relevance in the development and severity of RA. METHODS: We studied 212 Mexican Mestizo subjects (40 patients with refractory RA, 102 patients with non-refractory RA and 70 healthy individuals). At the same time, to evaluate the ethnicity of the CCR5 delta 32 deletion we also studied 192 individuals from three Mexican Amerindian populations (70 Mayo (Capomo) individuals, 61 Teenek individuals, and 61 Mazatecan Indians). The delta 32 deletion in the CCR5 structural gene and HLA-DRB1 were determined by a PCR-SSP and a PCR-SSO procedure, respectively. RESULTS: In the non-refractory RA group the CCR5 delta 32 gene frequency was 0.019 and the following genotype frequencies were observed: CCR5/CCR5 = 98.0%, CCR5/CCR5 delta 32 = 1.9% and CCR5 delta 32/CCR5 delta = 1.0%. In the refractory RA group the CCR5 delta 32 gene frequency was 0.025 and the genotype distribution was similar to that in the non-refractory RA group. The deletion was not detected in the Mexican Mestizo healthy group, or among the Teenek and Mayo Amerindians, all being individuals homozygous for the wild type allele. In the Mazatecan group the deletion frequency was 1.6% (g.f. = 0.016). We observed a significant increase in the frequency of the DRB1*07 allele in severe RA patients in relation to the non-severe RA group (p = 0.02, OR = 5.65, 95% CI = 0.95-43.05). CONCLUSION: Our results suggest that the CCR5 delta 32 deletion is not common in Mexican Amerindian populations and this study does not support an important role of CCR5 delta 32 in the pathogenesis of RA or a severe form of the disease in Mexicans.

Cardiel MH, Rojas-Serrano J. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Clin Exp Rheumatol. · Pubmed #12412191 No free full text.

Abstract: OBJECTIVE: To estimate the prevalence, burden of illness and help seeking behavior of musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis and gout among adult population in a suburban community in Mexico city. METHODS: Home survey of adults in a balanced and stratified sample validated against physical exam. Three trained interviewers applied a validated COPCORD core questionnaire. Subjects with pain (in the last seven days or ever) > or = 4 (0-10) and no trauma; or with current or past disability were evaluated preferably the same day by a trained clinician in a structured interview. A diagnosis using ACR criteria when available, recommendation or referral was provided as required. Analysis was based on descriptive statistics of participant characteristics, pain site and distribution, patterns of help seeking behavior. Point prevalence with 95% confidence intervals of most common diseases and associated disability rate. RESULTS: 1169 men and 1331 women were included. Pain in the last 7 days not associated with trauma was reported in 419 (17%) participants. The most common sites of involvement were knee (12.3%); low back (6.3%); ankles (6%) and shoulders (5.3%). The mean/SD pain score was 4.8/2.5. Thirteen percent of the total sample had some treatment. The general practitioner treated 72% of those; 75% perceived good efficacy with medications. Point prevalence estimates and 95% CI were: disability: 1.4% (0.0-1.9); osteoarthritis: 2.3% (1.7-2.9); fibromyalgia: 1.4 (1.0-2.0); low back pain: 6.3% (5.4-7.3); rheumatoid arthritis: 0.3% (0.1-0.6) and gout 0.4% (0.1-0.7). CONCLUSION: Pain in the last 7 days due to musculoskeletal disorders is 17% in this community. Medications were commonly prescribed. Point prevalence estimates of most common diagnoses was similar to other community surveys using COPCORD methodology but very different help seeking behavior.

Sánchez-Guerrero J, Aguirre-García E, Pérez-Dosal MR, Kraus A, Cardiel MH, Soto-Rojas AE. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14000 México, D.F. Mexico. · Rheumatology (Oxford). · Pubmed #11961167 links to  free full text

Abstract: OBJECTIVE: To develop a screening test for xerostomia. METHODS: A cross-sectional study was conducted among 152 healthy subjects aged <20-60 yr, 30 patients with primary Sjögren's syndrome and 60 patients with other connective tissue diseases, sampled randomly. A validated screening questionnaire for sicca syndrome and the Schirmer-1 and wafer tests were carried out in all subjects. In addition, non-stimulated whole salivary flow was measured in a random sample of 113 participants. The main outcome was the time of dissolution of the wafer. RESULTS: Time of dissolution of the wafer was 2.8+/-2.1 min in the healthy group, 3.3+/-1.5 min in the connective tissue diseases group, and 9.2+/-3.9 min in the primary Sjögren's syndrome group (P<0.001). The correlation coefficient between the wafer test and non-stimulated whole salivary flow was -0.60 [95% confidence interval (CI) -0.47, -0.71]. A cut-off value of 4 min ('wafer 4') showed sensitivity of 92.9%, specificity of 71.7%, a positive predictive value of 31.7%, a negative predictive value of 98.6%, accuracy of 74.3%, an ROC (receiver operating curve) value of 82.3 and a likelihood ratio of 3.3 (95% CI 2.3, 4.6) for xerostomia. The proportion of patients with wafer 4 was 8% in the healthy group, 23% in the connective tissue diseases group and 93% in the primary Sjögren's syndrome group (P<0.001). Wafer 4 was a significant predictor of xerostomia after controlling for age, gender, temperature and relative humidity. CONCLUSION: The wafer test is valid and reliable for identifying subjects with xerostomia.

Escalante A, Cardiel MH, del Rincón I, Suárez-Mendoza AA. · Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio 78284, USA. · Arthritis Care Res. · Pubmed #11081004 No free full text.

Abstract: OBJECTIVE: To show evidence of the cross-cultural equivalence between the original English version of a 5-item scale for measuring helplessness and a translated Spanish version. METHODS: English and Spanish versions of the 5 items that constitute the helplessness factor of the Rheumatology Attitudes Index were tested in 3 separate groups of patients: 1) 20 bilingual rheumatology patients; 2) 100 consecutive English- and 50 consecutive Spanish-speaking monolingual rheumatology patients; and 3) 192 English- and 44 Spanish-speaking patients with rheumatoid arthritis who were consecutively enrolled in a cohort to study disease outcomes. English-Spanish concordance among bilingual subjects was measured using intraclass correlation coefficients (ICC). Internal consistency was measured by Cronbach's coefficient alpha. Associations between the helplessness scale and variables measured simultaneously in English- and Spanish-speaking patients were measured by correlation analysis. RESULTS: Agreement between the English and Spanish versions of the helplessness scale among bilingual subjects was excellent (ICC = 0.87), and internal consistency among monolingual subjects was acceptable (coefficient alpha = 0.73 in English and 0.87 in Spanish). The correlation between helplessness and most other measured variables was of similar size and direction in English as in Spanish (10-point pain scale r = -0.53 and -0.52; modified Health Assessment Questionnaire physical disability r = -0.45 and -0.43; self-assessed joint count r = 0.36 and 0.36; Medical Outcomes Study Short Form 36 [SF-36] physical function r = 0.37 and 0.39; SF-36 mental health r = 0.27 and 0.35; Center for Epidemiological Studies Depression scale r = -0.37 and -0.33, respectively). CONCLUSION: The evidence shown supports the cross-cultural equivalence between the original 5-item helplessness scale developed in English and our translated Spanish version.