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Biomedical subjects

A Calin

Publications and source records attributed to A Calin.

At least 109 records · Page 6Linked to original sources
PubMed1989

A double-blind placebo-controlled study of auranofin in patients with psoriatic arthritis.

Two hundred thirty-eight patients with psoriatic arthritis were entered into a 6-month, multicenter, double-blind trial comparing auranofin and placebo. Polyarthritis (greater than 5 tender joints) was present in 90% of the patients, and 94% were seronegative. Auranofin treatment was statistically superior to placebo treatment, according to physician's global assessment and functional scores. A trend in favor of auranofin treatment was seen for each of the other disease parameters studied. Psoriasis worsened in 6 auranofin-treated patients and in 3 placebo-treated patients. The incidence and nature of other side effects were similar to those observed in similar trials of patients with rheumatoid arthritis. Our observations suggest that the use of auranofin in the treatment of psoriatic arthritis is safe, although its therapeutic advantage over treatment with nonsteroidal antiinflammatory drugs alone is modest.

Administration, Oral↗
PubMed1989

Destructive arthritis, rheumatoid factor, and HLA-DR4. Susceptibility versus severity, a case-control study.

In response to the continuing debate as to whether seronegative rheumatoid arthritis (RA) and seropositive RA are part of the same disease spectrum or are distinct disorders, we evaluated 720 patients with definite and classic RA, of whom 53 subjects had definite persistently seronegative destructive disease. For all but 1 seronegative RA patient, a seropositive RA case control was identified and matched for age, disease duration, degree of destruction on hand radiographs, and disease-modifying drug therapy. DR typing was undertaken on these 105 patients, together with scoring of hand radiographs. The frequency of DR4 was 69% in seropositive RA patients and 60% in seronegative RA patients (P = 0.22), versus 36% in 318 healthy controls (P = 0.008 and P = 0.007 versus seropositive and seronegative RA, respectively). Patients were matched and rematched with different controls in a series of subanalyses in order to make comparisons of hand radiograph scores. We found that HLA-DR4 was associated with destructive RA in both seropositive and seronegative RA patients. In general, DR4+ patients had more severe disease by radiologic criteria than did DR4- patients. Thus, HLA-DR4 may be an additive factor to the serologic status and may be more closely related to disease severity than to disease susceptibility.

Arthritis, Rheumatoid↗
PubMed1989

Retrospective analysis of 376 irradiated patients with ankylosing spondylitis and nonirradiated controls.

Controlled, prospective studies of deep X-ray therapy (DXT) in ankylosing spondylitis (AS) are lacking. We studied a self-help group of 1702 consecutive individuals with AS. Of these, most of whom were men, 376 (22%) had undergone DXT. An attempt was made to select a control for each. Because of the difference in ages at onset, 100 treatment recipients were matched with 100 controls (mean ages 44.5 years and 44.7 years, respectively). The mean Ankylosing Spondylitis Assessment Questionnaire disability score (range 0-8) was worse for the DXT group (5.5 vs 4.8 for controls: p less than 0.0001) and most components of the Arthritis Impact Measurement Scales showed a poorer outcome for those irradiated. Thus, 22% of nationwide AS sufferers had irradiation. This group could also have had more severe disease at the outset. At review, somewhat fewer of the irradiated group were taking NSAID. Although irradiation may have favorably affected the course of these patients our data do not support the use of irradiation except in exceptional cases.

Activities of Daily Living↗
PubMed1989

Clinical aspects of the effect of NSAID on cartilage.

Tons of nonsteroidal antiinflammatory drugs (NSAID) are used every year around the world. Their use is increasing and some patients have taken these drugs for at least 2 decades. Do NSAID damage the cartilage and cause rather than prevent further joint damage? The concept of "analgesic hip" or "indomethacin hip" cannot be substantiated. (Individuals who develop progressive joint damage may do so regardless of therapy rather than because of it.) Some NSAID have no effect on normal canine cartilage glycosaminoglycan synthesis while others suppress or stimulate the synthesis. Moreover, it seems that NSAID have no effect on proteoglycan catabolism. We know, however, that intraarticular steroids have only minimal effect on cartilage. If anything, they decrease the synovial fluid proteoglycans, perhaps by decreasing the synthesis of proteoglycans or by inhibiting degradation of cartilage. We do not know whether NSAID induce, mediate or perpetuate cartilage damage. And the effect on fibrillation, proteoglycan loss of osteophyte size is unknown. NSAID are good cyclooxygenase inhibitors; they may well affect monocyte/immune function but their anabolic or catabolic effect on cartilage remains unclear. We cannot talk meaningfully about chondroprotection or chondrotoxicity of NSAID. Intuitively, it seems reasonable to assume that antiinflammatory agents decrease inflammation and the mediators that are known to destroy cartilage. It is probable that cartilage benefits rather than suffers from current NSAID.

Animals↗
PubMed1989

The outcome of 138 total hip replacements and 12 revisions in ankylosing spondylitis: high success rate after a mean followup of 7.5 years.

The outcome of total hip replacement (THR) in ankylosing spondylitis (AS) is unclear. Concern has often been voiced by both surgeons and physicians regarding potential reankylosis, mechanical failure and poor function. We present an independent review of the patients' perception of outcome in 150 total hip replacements (138 primary + 12 revisions) in 87 subjects with AS. The mean followup was 7.5 years (1-34 years). Twelve were followed for greater than 15 years and 33 for greater than 10 years. Bilateral replacements were performed in 51 of the 87 patients (59%), 33 (65%) of whom had bilateral surgery within a 12-month period. Failures were early and rare. Twelve of 138 (9%) were revised (8 patients, mean of 3.6 years postoperatively) and 3 of the 12 were rerevisions. Twelve total hip replacements followed for 15 years or more resulted in only 2 failures (same patient: reankylosis) while 3 failed out of 33 followed for 10 years or more. Overall, for the 138 total hip replacements in situ (including the revisions), the patients considered outcome to be good or very good in 86%, while 89% had no (63%) or mild (26%) pain. Mobility was good or very good in 44%. On a scale of 1-5 (very poor to very good) patients followed for up to 5 years scored 4.7, as did those followed for greater than 15 years. Sixty-nine percent of the male recipients under age 60 are at work. Reankylosis occurred in only 1 patient (4 hips). In general the first and second hips replaced had an equally good outcome. The long-term outcome of total hip replacement in AS is very good. The few failures occurred early, and patients were as satisfied with the outcome more than 15 years postoperatively as they were within the first 5 years.

Evaluation Studies as Topic↗
PubMed1988

Therapeutic intervention in rheumatoid arthritis: a case-controlled comparison of seronegative and seropositive disease.

The records of 684 patients with rheumatoid arthritis (RA) attending a referral centre were evaluated. All available patients (62 cases) with definite seronegative disease were matched, where possible, for sex, age and year of onset with seropositive controls (54 cases). Seronegative females were just as likely as those who were seropositive to require treatment with disease-modifying antirheumatic drugs, whereas seronegative males were significantly less likely to do so than seropositive controls. There were no major differences in outcome or drug toxicity. Orthopaedic surgery was equally common in the two groups, with a similar spectrum of procedures, but there was a trend towards more frequent upper limb large joint arthroplasty in the seronegative group, and this was particularly evident when elbow prostheses were considered. Seronegative rheumatoid disease (at least in females) may be as severe as seropositive disease in a referral-centre population and should be treated with similar vigour.

Arthritis, Rheumatoid↗
PubMed1988

The natural history of juvenile-onset ankylosing spondylitis: a 24-year retrospective case-control study.

UNLABELLED: One hundred and thirty-five patients with juvenile-onset ankylosing spondylitis (JAS: less than 16 years at onset, mean 12.8 years) were compared to 135 adult-onset spondylitics (AAS: greater than 21 years at onset, mean 26.1 years), controlled for disease duration (24.5 and 23.5 years, respectively), to assess the outcome of juvenile-onset disease. Review was by postal questionnaire and health-assessment measures. The sex distribution was similar: 73% and 74% males, respectively. All parameters showed comparable outcome with the exception of the numbers in full-time employment (JAS 74%, AAS 56%; p less than 0.01) and total hip replacements (JAS 17%, AAS 4%; p less than 0.01). IN CONCLUSION: (a) the premature hip is particularly at risk in ankylosing spondylitis; (b) there are few differences between the outcome of JAS and AAS; (c) overall, JAS patients do well in adulthood.

Adolescent↗
PubMed1988

The relationship between pelvic, spinal and hip involvement in ankylosing spondylitis--one disease process or several?

UNLABELLED: One hundred and one consecutive patients with ankylosing spondylitis (males 85%) were reviewed by radiographic evaluation after a mean disease duration of 21.2 years (mean age at onset 22.9 years). Osteitis pubis occurred in seven cases of varied duration and severity of disease. Hip involvement (grade 2-4) occurred in 19%. Their mean age of onset (19.6 years) was younger than for those with normal hips (25.1 years; p = 0.003). Lone sacroiliitis (grade 3 and 4) without ascending spinal disease occurred in 11 patients. The mean age at onset for those with lone sacroiliitis and marked spinal disease was similar (23.3 and 24.9 years respectively; NS). By contrast, disease duration was 13.3 and 28.4 years respectively (p = 0.0007). Five patients (three women) had severe pelvic and cervical spine disease with normal lumbar spine. IN CONCLUSION: 1. Osteitis pubis occurs as an unusual, random event. 2. Hip involvement is an expression of young age at onset. 3. Lone sacroiliitis is uncommon and progression to ascending spinal disease is primarily a function of disease duration. 4. Skip lesions occur rarely and particularly in women. 5. Sacroiliitis and ascending spinal disease are part of the same spectrum.

Adult↗
PubMed1988

Bacterial endocarditis presenting as acute monoarthritis.

The presentation of a pig farmer with acute arthritis of the shoulder, cardiac murmurs, and Streptococcus suis growing on blood cultures highlights one of the rheumatological presentations of bacterial endocarditis. The need for a thorough general medical examination together with synovial fluid and blood culture in patients with acute monarthritis is emphasised. The suggestion that acute arthritis related to endocarditis is in nature truly septic, rather than mediated by circulating immune complexes, is supported.

Arthritis, Infectious↗
PubMed1988

Leadership role of the rheumatologist: toward reaching a consensus.

The rheumatologist is in the position to take a leading role in organizing interdisciplinary activities to unravel the confusion about treatment of rheumatologic disorders. Patients realize that all drugs carry some risk of side effects, but they are confused by input from conflicting sources - family members, neighbors, media, and nonmedical 'alternative' practitioners - as well as differing views from general practitioners, orthopedic surgeons, and rheumatologists. Only the rheumatologist is in a position to deal with the confusion, information, and misinformation. The rheumatologist understands that 'risk' is an expression of drug toxicity, patient expectation, and potential for improvement. Specifically, it is the rheumatologist who can best appreciate the benefits that many patients experience with nonsteroidal antiinflammatory drug (NSAID) therapy. In deciding whether to use an NSAID, the rheumatologist must decide for whom such agents are effective, when treatment should begin, which agent to use, and for how long therapy should continue. Relevant risk and benefit analysis is necessary for such decisions. The rheumatologist has to take the initiative in organizing interdisciplinary discussions and take active steps to educate society in general, the media, government, and colleagues. Only then will the approach to a vast problem be a sensible one.

Humans↗
PubMed1988

Multicentre double-blind comparison of sustained action formulations of tiaprofenic acid and indomethacin in osteoarthritis.

In a randomised double-blind, multicentre, crossover study, the short term efficacy and tolerance of a sustained action preparation of tiaprofenic acid 600 mg once daily was compared with sustained release indomethacin 75 mg once daily in 98 patients with osteoarthritis. After a minimum washout period of 3 days, patients were randomly allocated to receive each treatment in turn for a period of 4 weeks. There were no significant differences between the 2 treatments in the clinical assessments of pain level, duration of morning stiffness, articular index and functional impairment performed at the end of each treatment period. High pain levels on movement were reduced by both treatments, and reduction was also seen in night pain, where initial levels were lower. There was no significant difference between the number of patients who reported side effects on the 2 treatments. 37 patients (39%) reported 49 side effects while taking sustained release tiaprofenic acid, and 35 patients (37%) reported 53 side effects while taking sustained release indomethacin. Daily diary cards showed that both treatments provided improvements in duration of morning stiffness and in pain relief. Thus sustained action tiaprofenic acid and sustained release indomethacin were shown to be equally well tolerated and efficacious.

Adult↗
PubMed1988

Ankylosing spondylitis--an analytical review of 1500 patients: the changing pattern of disease.

To avoid biases inherent in the study of referral patients seen at a single unit, we investigated a group of 1500 patients (males 71%), members of the UK National Ankylosing Spondylitis Society (NASS). Patients were divided into 15 cohorts by year of onset (mean size 91). The median delay in diagnosis for these cohorts was greater than 6 years until 1974. Thereafter, there was a marked improvement with the most recent cohort waiting a median of 2 years for diagnosis (e.g., 1969/72 cohorts vs 1979/82 cohorts; mean delay 7.4 years vs 2.3 years, p less than 0.0001). Until 1974 the median delay for women was 9 years compared to 6 years for men (e.g., 1956/62 cohorts 11 and 7 years, p less than 0.0015, falling to 3 and 2.5 years, respectively by 1979/82, p = NS). Major differences were seen when the 14 health regions were taken separately; the median delay ranged from 9 years for the 3 "worst" regions to 4 years for the 3 "best" (p = 0.022). This was reflected in the percentage with delay in diagnosis longer than 2 years (80 and 58%, respectively; chi 2 = 11.31, p less than 0.01). Strikingly, the median age of onset of symptoms steadily increased from 18 years in 1930/40 to 28 years in 1981/82 (e.g., 1956/62 vs 1969/72; mean ages 21.4 vs 23.5 years, p less than 0.004 and 1969/72 vs 1979/82; 23.5 years vs 28.7 years p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗