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1.  External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain 
PLoS ONE  2015;10(7):e0131963.
To validate and optimize a referral rule to identify primary care patients with chronic low back pain (CLBP) suspected for axial spondyloarthritis (axSpA).
Cross-sectional study with data from 19 Dutch primary care practices for development and 38 for validation.
Primary care patients aged 18-45 years with CLBP existing more than three months and onset of back pain started before the age of 45 years.
Main Outcome
The number of axSpA patients according to the ASAS criteria.
The referral rule (CaFaSpA referral rule) was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables; inflammatory back pain, good response to nonsteriodal anti-inflammatory drugs, family history of spondyloarthritis and a back pain duration longer than five years. This referral rule is positive when at least two variables are present. Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients from 38 practices from other areas. Performance of the referral rule was assessed by c-statistic and calibration plot. To fit the final referral rule the development and validation datasets were pooled leading to a total study population of 943 primary care participants.
The referral rule was validated in 579 patients (41% male, mean age 36 (sd7.0). The percentage of identified axSpA patients was 16% (n=95). External validation resulted in satisfactory calibration and reasonable discriminative ability (c-statistics 0.70 [95% CI, 0.64-0.75]). In the pooled dataset sensitivity and specificity of the referral rule were 75% and 58%.
The CaFaSpA referral rule for axSpA consists of four easy to use predictors for primary care physicians and has a good predictive value in this validation study. The referral rule has the potential to be a screening tool for primary care by identifying CLBP patients suspected for axSpA.
PMCID: PMC4511700  PMID: 26200904
2.  A multidisciplinary job retention vocational rehabilitation programme for patients with chronic rheumatic diseases: patients' and occupational physicians' satisfaction 
Annals of the Rheumatic Diseases  2004;63(5):562-568.
Objective: To investigate patients' and occupational physicians' satisfaction with the quality of a vocational rehabilitation programme for maintaining work ability in chronic rheumatic diseases.
Methods: The vocational rehabilitation programme was developed for patients with rheumatic diseases and consisted of systematic assessment of the problems at work and the development of individual solutions. The programme was run by a multidisciplinary team comprising a rheumatologist, a social worker, a physical and occupational therapist, and a psychologist. Satisfaction ratings were measured using a multidimensional questionnaire involving a rating scale (0–10) and a structured telephone interview.
Results: 59 of the 65 patients who participated in the programme (91%) completed the questionnaire. Patients were most satisfied with the interpersonal approach and professional knowledge, and least satisfied with the waiting time for the final report and the practical application of the given advice. Mean satisfaction score was 7.3 (SD 1.0). Twenty eight of the occupational physicians involved were interviewed. They were satisfied with the programme overall; 21 (75%) stated that their role in the vocational rehabilitation process could be defined more clearly, and they would appreciate more contact with the team members, preferably in the early phases.
Conclusions: Patients' and occupational physicians' satisfaction with a multidisciplinary vocational rehabilitation programme was good. Areas for improvement mainly concerned the speed of the process and the communication between team members and occupational physicians.
PMCID: PMC1754975  PMID: 15082488
3.  Communication between Dutch rheumatologists and occupational physicians in the occupational rehabilitation of patients with rheumatic diseases 
Objective: To assess the quality and quantity of communication and cooperation between Dutch rheumatologists and occupational physicians.
Methods: A postal survey among 187 Dutch rheumatologists.
Results: 153/187 rheumatologists (82%) returned the questionnaire. They considered reducing pain and fatigue to be their major responsibility in the process of occupational rehabilitation, followed by improving work participation (68/153 (44%)) and quality of work (55/153 (36%)). Although 112/153 (73%) of the rheumatologists judged the communication and cooperation with occupational physicians as reasonable to good, 119/153 (78%) of them were willing to improve the collaboration. Perceived bottlenecks mentioned were a lack of clarity about the occupational physician's position and activities, and the absence of practice guidelines. The most important prerequisites for improvement were found to be guarantees about the occupational physician's professional independence and more clarity about the competence of the occupational physicians and how they used the information provided.
Conclusion: Dutch rheumatologists are willing to improve cooperation and communication with occupational physicians. The perceived lack of clarity about their mutual tasks appears to be a major obstacle. Thus the development of a joint education programme and a guideline for occupational rehabilitation in rheumatic diseases may be appropriate first steps towards improvement.
PMCID: PMC1753888  PMID: 11779762
4.  Influence of HLA-class II incompatibility between mother and fetus on the development and course of rheumatoid arthritis of the mother 
Annals of the Rheumatic Diseases  1998;57(5):286-290.
OBJECTIVE—To assess the relation between the course of rheumatoid arthritis (RA) during pregnancy or the onset of RA postpartum and DRB1, DQA1, and DQB1 incompatibilities between mother and child.
METHODS—In 45 pregnancies of 33 RA patients the course of RA was related to the number of class II incompatibilities. Furthermore class II incompatibilities in 16 pregnancies followed by RA onset were compared with those in 87 control pregnancies.
RESULTS—The risk of a favourable compared with an unfavourable course was 0.95, 2.67, and 2.38 in case of DRB1, DQA1, and DQB1 incompatibility respectively. DQA1 and DQB1 incompatibilities were seen more often in the 10 pregnancies followed by RA onset within three months than in control pregnancies (OR 8.02, 95% CI 0.97, 66.06 and OR 8.79 95% CI 1.07, 72.46 respectively).
CONCLUSIONS—DQA1 and DQB1 incompatibility between mother and child seems to have a favourable effect on the course of RA and may postpone the risk of RA onset during pregnancy.

 Keywords: pregnancy; rheumatoid arthritis; HLA; incompatibility
PMCID: PMC1752598  PMID: 9741312

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