Rheumatoid arthritis (RA) is a disease of the synovium that involves the small joints of hands and feet. The focus in RA-research, however, has primarily been on involvement of the hands. In this... Show moreRheumatoid arthritis (RA) is a disease of the synovium that involves the small joints of hands and feet. The focus in RA-research, however, has primarily been on involvement of the hands. In this thesis we studied involvement of the forefoot. Throughout this thesis we found that synovitis in the rheumatoid foot affects more than just the joints. In an anatomic study we revealed that the tendon-sheaths in the forefoot also possess a synovial layer. Inflammation of this, detected by MRI that is referred to as tenosynovitis, was an important aspect of RA involvement in the forefoot. In addition, intermetatarsal bursae also detected by MRI are also often inflamed due to disease-involvement. These extra-articular involvements of the synovium that are found in RA importantly contribute to joint swelling and walking disability, and are therefore clinically relevant. Therefore we believe that it is essential for the clinician to pay attention to the forefeet of patients with RA to have a complete idea of disease activity Show less
Overactive bladder syndrome (OAB) is a common lower urinary tract disorder. So far, no therapy is beneficial and applicable for all OAB patients because patients with OAB represent a very... Show moreOveractive bladder syndrome (OAB) is a common lower urinary tract disorder. So far, no therapy is beneficial and applicable for all OAB patients because patients with OAB represent a very heterogeneous group of patients. Research has mainly focused on bladder function. recently the international continence society has called for research to urethral function within OAB. The aim of this thesis is to further elucidate the role of urethral function within OAB to contribute to better targeted therapy in patients with OAB. This thesis consists of seven chapters and contains the results of an anatomical study to the presence of adrenoceptor B3 in the human female urethra, a review of the literature on this subject, the results of a functional urodynamic study to assess the best method to demonstrate urethral pressure variations and the results of clinical urodynamic study to the effect of pharmacotherapy with adrenoceptor B3-agonist in patients with OAB and urethral pressure variations and finally the results of a pilot study to the efficacy of a localized treatment with botuline toxin-A treatment for patients with urethral pressure variations. Show less