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Biomedical subjects

A Calin

Publications and source records attributed to A Calin.

At least 127 records · Page 7Linked to original sources
PubMed1987

Non-steroidal anti-inflammatory drugs and the classical arthritides: focus on five-years of piroxicam experience.

In recent years, we have seen immense progress in our understanding of rheumatic diseases. As we learn more about the pathogenetic mechanisms of disease, we can begin to classify the disorders more rationally. However, treatment lags behind understanding; we still direct our attention toward inflammation in a non-specific manner. At the beginning of the century, aspirin became a widely used treatment for all forms of arthritis. By the early 1960s, phenylbutazone and then indomethacin were introduced, and later, ibuprofen, naproxen, sulindac, and a variety of other agents had become available. Within the last five years two new agents were introduced that were characterised by a once-a-day regimen. One piroxicam - worked by attacking the cyclooxygenase pathway. The other--benoxaprofen--inhibited both the cyclooxygenase and lipoxygenase pathways, but had to be withdrawn because it was toxic. Since piroxicam was introduced in 1980, eight nonsteroidal anti-inflammatory drugs (NSAIDs) have been withdrawn from the market in the United Kingdom. By contrast, piroxicam is now available in over 90 countries and has been used safely and successfully in millions of people of different ages and in different clinical settings. Short-term open studies, controlled studies, and more recent long-term studies lasting over periods of more than three years give further evidence of effectiveness and tolerance.

Arthritis↗
PubMed1987

Drugs and the relationships between university, industry and legislation.

The situation in Britain between the drug industry and the government is compared with that in the United States of America. The aggravating effect of the Media is demonstrated and the contents of a letter submitted by the author to a British newspaper draws attention to the biased reporting which frequently occurs and to the deleterious effect this may have on patients. Means of improving the situation in Britain are suggested.

Drug Industry↗
PubMed1986

A placebo controlled, crossover study of azathioprine in Reiter's syndrome.

Eight patients with intractable Reiter's disease were entered into a double blind, placebo controlled, crossover study of azathioprine versus placebo--each patient serving as his own control. Drug therapy was administered for 16 weeks, patients receiving azathioprine (eight weeks) or placebo (eight weeks) in random order. Azathioprine was given as 1 mg/kg body weight for the first month and 2 mg/kg body weight for the second month. Six individuals completed both arms of the crossover. One withdrew because of nausea during the first week (azathioprine), and a second subject withdrew at four weeks because of lack of efficacy (placebo). At the end of the 16 weeks five out of six preferred azathioprine and one placebo. The mean unweighted joint score decreased from 19.8 to 2.7 during the azathioprine medication but increased from 13.4 to 19.9 during the placebo period. Patients were unable to reduce their analgesic or non-steroidal anti-inflammatory drug requirements during the placebo period, but four out of six were able to do so during azathioprine therapy. There were no drug related laboratory abnormalities. The data suggest that azathioprine may work rapidly in Reiter's disease. If these essentially anecdotal findings of efficacy are confirmed, long term toxicity may not be an over-riding factor since for some patients therapy can be rapidly tapered at eight weeks--either because of adequate improvement or failure to respond.

Adult↗
PubMed1986

The epidemiology of rheumatoid disease: past and present.

The epidemiology of rheumatoid arthritis is poorly defined. We know neither how long rheumatoid arthritis has been a major disease, nor whether its incidence is decreasing. If it is decreasing, is this because of the contraceptive pill or some other variable? We do know that the disease occurs worldwide and that there may be increased prevalence among urban living individuals, compared to their rural counterparts. To some extent the disease 'runs in families', but heritibility is low. Concordance among monozygotic twins is only 32 per cent. Women develop the disease more frequently than men. The prognosis for black males is said to be better than for white females. Whether seronegative 'rheumatoid arthritis' should be considered part of the same disease process is unknown. An agreed definition for rheumatoid arthritis is essential before meaningful genetic and immunogenetic data can be developed. However, it is unclear whether the term rheumatoid arthritis should only be given to those individuals with seropositive erosive disease or whether we should include a self-limiting process of poorly characterized change that is sometimes seen, for example, in the first degree relatives of index cases with disease. The ARA criteria for rheumatoid arthritis are unhelpful since 'possible' and 'probable' rheumatoid arthritis patients almost certainly do not have rheumatoid disease. Moreover, the majority of patients with 'definite' rheumatoid arthritis are seronegative. These subjects may be differentiated from seropositive patients on epidemiological, familial, clinical, immunogenetic, and perhaps radiological grounds. The consensus view is that the DR4 allotype occurs more frequently in severe seropositive disease than in severe seronegative 'rheumatoid arthritis'.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗
PubMed1986

Seronegative spondyloarthritides.

Recently, there has been enormous growth in the clinical importance of the spondyloarthropathies, in part because of their close association with HLA, and in part because of the recognition that a substantial number of patients suffer from different forms of these disorders. Over the years, immunogeneticists, geneticists, epidemiologists, bacteriologists, membrane biologists, and clinicians have joined in the attempt to clarify our understanding of ankylosing spondylitis, Reiter's disease, psoriatic arthropathy, and other interrelated conditions. This article provides a summary of clinical and research developments in what is now recognized as a major area in rheumatology.

Adult↗
PubMed1986

Degenerative joint disease.

Management of degenerative joint disease depends on the nature of the process and distribution of the joint disease. Simple modalities such as rest or exercise may be appropriate. Analgesics have a role to play, as do anti-inflammatory drugs and intraarticular corticosteroid injections.

Aging↗
PubMed1985

Geode development and multiple fractures in rheumatoid arthritis.

The radiological development from normal bone of geodes and subsequent fractures in phalanges of two adjacent fingers is described in a patient with classical rheumatoid arthritis. Presentation was as a septic, discharging focus, but infection was excluded; the pathology is described.

Aged↗
PubMed1985

Efficacy of total lymphoid irradiation in intractable rheumatoid arthritis. A double-blind, randomized trial.

Twenty-six patients participated in a randomized, double-blind study of the efficacy of total lymphoid irradiation in the treatment of intractable rheumatoid arthritis. All 26 patients, for whom therapy with gold compounds and penicillamine had failed, would ordinarily have been considered candidates for cytotoxic or antimetabolite drug therapy. Thirteen patients randomly assigned to receive full-dose total lymphoid irradiation (2000 rad) and 11 patients assigned to receive control low-dose total lymphoid irradiation (200 rad) completed radiotherapy. Alleviation of joint disease activity was significantly greater in the high-dose group as judged by morning stiffness, joint tenderness, and functional assessment (global composite score) at 3 and 6 months after radiotherapy. The high-dose group had a marked reduction in both T-lymphocyte function and numbers, but this finding was not observed in the low-dose group. Complications seen in the high-dose but not low-dose group included transient neutropenia, thrombocytopenia, pericarditis, and pleurisy.

Adult↗
PubMed1985

X-radiation in the management of rheumatoid disease.

Few topics are more emotive than the use of radiotherapy for nonlethal diseases. Memories of Hiroshima and of patients with ankylosing spondylitis dying of leukaemia following irradiation haunt the physician. Nevertheless, there are exciting developments in our understanding of total lymphoid irradiation - a modality that results in striking immunosuppression. Should total lymphoid irradiation be used for rheumatoid disease?

Arthritis, Rheumatoid↗
PubMed1984

Pain and inflammation.

The traditional "aspirin first" approach to the treatment of osteoarthritis and rheumatoid arthritis is undergoing serious reappraisal. Aspirin and acetaminophen are equipotent in their analgesic efficacy; however, aspirin is associated with a higher incidence of side effects. Acetaminophen should therefore be used as first-line therapy for the treatment of osteoarthritis since reduction of pain is the primary therapeutic objective. Analgesic doses of aspirin (up to 3,900 mg per day) do not produce an anti-inflammatory effect and thus are not beneficial in the treatment of rheumatoid arthritis. Only high doses of aspirin (4 to 6 g per day) used for a sustained period produce an anti-inflammatory effect. Since many patients with rheumatoid arthritis cannot tolerate long-term use of anti-inflammatory doses of aspirin, it may be preferable to initiate therapy with one of the newer nonsteroidal anti-inflammatory drugs.

Acetaminophen↗