Major advances have been made in the treatment of rheumatoid arthritis, a potentially chronic disabling disease which poses a large burden on both patients and society. By early start of disease... Show moreMajor advances have been made in the treatment of rheumatoid arthritis, a potentially chronic disabling disease which poses a large burden on both patients and society. By early start of disease-modifying antirheumatic drugs, including methotrexate as a prominent drug, the use of combination therapies including prednisone or biologicals, and tight control of disease activity, many patients are able to reach a state of clinical remission and some can even taper and stop antirheumatic therapy. Challenges lie in correctly identifying the earliest manifestations of the disease, starting the right treatment sufficiently early, tailored to the individual patient, and setting the optimal treatment goal at which to steer therapy adjustments. This thesis has made a start towards tackling several of these challenges and discusses further necessary steps that may lead to a fundamental change in the outlook of patients with rheumatoid arthritis. Show less
Rheumatoid arthritis (RA) is a complex chronic disease, which, despite the advanced pharmacological treatment, requires care provided by health professionals other than the rheumatologist in many... Show moreRheumatoid arthritis (RA) is a complex chronic disease, which, despite the advanced pharmacological treatment, requires care provided by health professionals other than the rheumatologist in many patients during the course of their disease. Physical therapy is an important part of the non-pharmacological treatment of patients with RA. However, due to the changes in the medical treatment of patients with RA the role of physical therapists and patient has changed as well. The aims of the present thesis were to describe the currently available RA guideline including recommendations concerning the physical therapy management, to develop a RA guideline specific for physical therapists, and make an inventory of the currently provided physical therapy management in patients with RA. Moreover, this thesis includes a synthesis of the evidence regarding the effectiveness and safety of supervised and home-based exercise programs in patients with RA and the maintenance of physical activity after two one-year internet-based physical activity interventions in RA patients. In addition, the role of motivation and health care providers__ practice regarding the level of physical activity of patients with RA was evaluated. Show less
RA is a chronic and progressive autoimmune disease affecting approximately 1% of the population worldwide, and has a large risk for causing disability of patients and consequently high costs in... Show moreRA is a chronic and progressive autoimmune disease affecting approximately 1% of the population worldwide, and has a large risk for causing disability of patients and consequently high costs in health care if left un- or improperly treated. To prevent this, patients with RA need to be identified as early as possible and treated adequately to prevent worse outcome. Early recognition, together with prediction of the disease outcome at the individual patient level would allow to achieve personalized medicine. The main scope of this thesis was to identify and evaluate the quality of risk factors for their usefulness in predicting disease course and outcome of RA. To this end, characteristics and disease outcome of RA patients included in the Leiden EAC were studied. Show less
In medical decision making decisions are made by using cost-utility analyses. Utilities, in cost-utility analyses, are benefits in health estimated by comparing preferences for health states to... Show moreIn medical decision making decisions are made by using cost-utility analyses. Utilities, in cost-utility analyses, are benefits in health estimated by comparing preferences for health states to perfect health and death. Whose__ utilities are used, those given by patients__ or by members of the general public, does matter. Previous research has shown that utilities given by patients are higher compared to those given by members of the public. The main objective of this thesis was to examine mechanisms that have been suggested to explain this gap between health state utilities. Most mechanisms suggested to influence this gap were only marginally explanatory except for focusing illusion and adaption. The public has the tendency to focus on the negative aspects of a health state. On the other hand patients adapt to their illness and take this adaptation into account. Due to focusing illusion of members of the public utilities will become lower whereas adaptation will lead to higher utilities. Whose utilities should be used in decision making depends on whose utilities are most valid. Utilities shaped by focusing illusion are biased however it is a matter of discussion if adaptation leads to invalid utilities. Show less
