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Biomedical subjects

A S Russell

Publications and source records attributed to A S Russell.

At least 37 records · Page 2Linked to original sources
PubMed2001

Clinical and radiological amelioration of refractory peripheral spondyloarthritis by pulse intravenous pamidronate therapy.

OBJECTIVE: To examine the potential therapeutic properties of an aminobisphosphonate, pamidronate, using clinical and laboratory outcome variables together with dynamic magnetic resonance imaging (MRI) and gadolinium augmentation in patients with spondyloarthropathy (SpA) refractory to nonsteroidal antiinflammatory drugs (NSAID). METHODS: We studied 9 patients (7 male, 2 female) of mean age 27.9 years (range 19-38) and mean disease duration of 5.5 years (range 0.5-20). Five had ankylosing spondylitis (AS), 3 had undifferentiated SpA, and one had reactive arthritis. Seven were HLA-B27 positive. Two had inflammatory bowel disease. Pamidronate (60 mg) was given intravenously on Days 1, 2, 14, 28, and 56, over 4 h in 500 ml of 5% dextrose. Clinical outcome assessments included the BASDAI (disease activity), BASFI (function), BASGI (global well being) composite visual analog instruments, and swollen and tender joint count. Laboratory variables included the erthrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Dynamic MRI with gadolinium augmentation of synovium and bone was performed at baseline and at Day 84 in the first 6 patients enrolled in the study. RESULTS: All patients completed the study and there was a significant improvement in all clinical and laboratory variables assessed. Mean swollen and tender joint count decreased by 93.8% (p = 0.017) and 98.2% (p = 0.012), respectively, and complete clinical resolution of synovitis was noted in 5 patients. BASDAI decreased by 44.2% (p = 0.028), BASFI by 47.3% (p = 0.015), and BASGI by 42.2% (p = 0.011). ESR and CRP declined by 49.4% (p = 0.012) and 66.9% (p = 0.008), respectively. Acute lymphopenia accompanied by elevated CRP levels was noted in 8 patients in the 48 h after first pamidronate infusion. Maximal rate and magnitude of enhanced MRI signal after gadolinium augmentation decreased after pamidronate therapy, especially in the bone marrow. CONCLUSION: Preliminary data from uncontrolled studies support the efficacy of pamidronate therapy for NSAID refractory SpA and warrant further evaluation in controlled trials.

Adult↗
PubMed2001

Management of rheumatoid arthritis: the historical context.

We review the historical highlights of the management of rheumatoid arthritis (RA). Studies of nonsteroidal antiinflammatory drugs, disease modifying antirheumatic drugs, and biological agents over 5 decades were evaluated and summarized. There is emphasis on drug therapy as it has developed and evolved from empirical relief of symptoms with salicylates to targeted intervention in the immunoinflammatory process with tumor necrosis factor inhibitors. A therapeutic paradigm has been proposed to rationalize the use of the available therapies. If one accepts the thesis that both the acute and chronic consequences of RA are due to persistent misdirected and inadequately controlled inflammation that causes tissue destruction and loss of function, then prolonged complete control of the abnormal inflammatory process is the fundamental first step in the management of all patients with RA. Unfortunately, even with the newest therapeutic options to treat RA, most patients achieve only partial suppression of inflammation and many lose therapeutic benefit after an initial good response. The management of persistent or recurrent rheumatoid inflammation and disability continues to be a challenge. It remains to be determined whether the future addition of more potent specific interventions in the immunoinflammatory process will be able to solve this problem without disarming host defenses against infections and tumors.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Effort testing in patients with fibromyalgia and disability incentives.

OBJECTIVE: To examine whether symptom exaggeration is a factor in complaints of cognitive dysfunction using 2 new validated instruments in patients with fibromyalgia (FM). METHODS: Ninety-six patients with FM and 16 patients with rheumatoid arthritis (RA) were administered 2 effort or symptom validity tests designed to detect exaggerated memory complaints as part of a battery of psychological tests and self-report questionnaires. RESULTS: A large percentage of patients with FM who were on or seeking disability benefits failed the effort tests. Only 2 patients with FM who were working and/or not claiming disability benefits and no patient with RA scored below the cutoffs for exaggeration of memory difficulties. CONCLUSION: This study illustrates the importance of assessing for exaggeration of cognitive symptoms and biased responding in patients with FM presenting for disability related evaluations.

Adult↗
PubMed2001

Physician resistance to the late whiplash syndrome.

OBJECTIVE: The biopsychosocial model of the late whiplash syndrome is based in part on the concept of symptom expectation--that the commonly held view of whiplash injury as a serious injury and anticipation of chronic pain and disability engenders a post-injury behavior that encourages chronic pain. We sought to determine if an unselected group of physicians (who might be expected to view whiplash as benign compared to most accident victims) would report a more benign outcome to their injuries than a group of nonphysicians. METHODS: This survey compares the self-reported outcome of whiplash-type injuries (neck sprain) in physicians and nonphysicians working at a university hospital. Subjects were asked to recall motor vehicle accident experiences, the presence of symptoms as a result, and the outcomes for those symptoms. RESULTS: Seventy-one percent of physicians and 60% of nonphysicians recalled being in a motor vehicle accident. About 31% of physicians recalled acute symptoms, compared to 46% of nonphysicians. Symptoms tended to be short-lived for physicians (days to weeks) while nonphysicians more often had symptoms lasting over 6 months. Only 9% of physicians recalled symptoms lasting for more than one year compared to 32% of nonphysicians. Physicians took no more than one week off work, whereas among nonphysicians, it was common to take more than 6 months off. CONCLUSION: Physicians appear to be in at least as many motor vehicle accidents as nonphysicians, and 33% suffered the acute whiplash syndrome. Physicians appear, however, to be more resistant than nonphysicians to the progression from acute pain to chronic pain and disability.

Accidents, Traffic↗
PubMed2001

Treatment of refractory symphysitis pubis with intravenous pamidronate.

Osteitis pubis is a noninfectious painful inflammatory disorder of the symphysis pubis. Etiologic factors include urologic procedures, abdomino-perineal and gynecological surgery, and spondyloarthropathies, although many cases are idiopathic. Most respond to conservative measures consisting primarily of rest and analgesic/antiinflammatory agents. We describe 3 cases, 2 with idiopathic osteitis pubis and one that was associated with a spondyloarthropathy, that failed to respond to conservative measures but experienced clinical remission with 3 to 6 monthly courses of intravenous pamidronate. Remission was also evident in 2 patients on isotope bone scan. Followup has revealed no recurrence. Intravenous pamidronate may constitute a safe and effective treatment option for patients with refractory osteitis pubis.

Adult↗
PubMed2000

Decreased dromotropic response to verapamil despite pronounced increased drug concentration in rheumatoid arthritis.

AIMS: Inflammation reduces hepatic clearance of many drugs with unknown therapeutic consequences. This study was carried out to examine the effect of rheumatoid arthritis (RA) on the pharmacokinetics and pharmacodynamics of verapamil. METHODS: Eight RA patients were age- and sex-matched with eight healthy volunteers. The disease severity was assessed, and ECG, blood pressure and verapamil enantiomers concentrations were measured for 12 h post 80 mg oral verapamil. Serum interleukin-6 (IL-6) and nitrite (NO2-) were measured in predose samples. RESULTS: IL-6 and NO2- concentrations were significantly increased in parallel with disease severity. Oral clearance of both S- and R-verapamil was significantly decreased by RA. While the unbound fraction of S- and R-verapamil decreased by 5 and 7-fold, respectively, the unbound AUC remained unchanged for the more potent enantiomer, S-verapamil. AUC of norverapamil enantiomers was increased 2-3-fold. Despite elevated serum drug concentrations in RA, the potential to prolong the PR-interval was significantly reduced by one fold and the effect on the heart rate and blood pressure did not increase. CONCLUSIONS: RA results in increased verapamil concentrations due likely to changes in protein binding, decreased clearance and/or altered hepatic blood flow. A significant decrease in dromotropic effect, despite increased serum drug concentrations, may be attributed to receptor down regulation caused by pro-inflammatory cytokines and/or NO.

Adult↗
PubMed2000

Decreased progression to rheumatoid arthritis or other connective tissue diseases in patients with palindromic rheumatism treated with antimalarials.

OBJECTIVE: To determine whether the use of antimalarials is associated with a reduction in the risk of developing rheumatoid arthritis (RA) or other connective tissue diseases in patients with palindromic rheumatism. METHODS: We conducted a retrospective cohort study based on a review of medical records to evaluate the outcome of patients with palindromic rheumatism referred to an academic center from 1986 to 1996: 113 patients complied with the selection criteria, including diagnostic criteria for palindromic rheumatism and onset of disease since 1980. After adjusting for potential confounders, Kaplan-Meier methods and Cox regression models were used to estimate the risk of developing RA or other connective tissue disease in patients who had received antimalarials compared to those who had not. RESULTS: Age of disease onset was 40+/-12 yrs, and mean disease duration 4.8+/-4 yrs; two-thirds of the patients were female. Sixty-two (55%) patients received antimalarials, for a mean duration of therapy of 28 mo. Thirty-three (29%) patients developed RA, 3 developed systemic lupus, and 4 developed other connective tissue diseases. Twenty (32%) patients in the antimalarial group developed a secondary disease, compared to 20 (39%) who did not receive therapy. Statistically significant differences were observed comparing time to event in both groups. The estimated median time to development of a chronic disease was 162 months in treated and 56 months in untreated patients. After adjusting for other variables in the Cox regression models, significant risk reduction in the development of a secondary disease was observed for antimalarial use (hazard ratio = 0.24; 95% CI 0.09-0.61). For RA, the risk reduction was 0.19 (95% CI 0.07-0.57). We conducted a sensitivity analysis around our censoring estimates. The risk reduction remained statistically significant, with 0.36 for RA and 0.41 for RA or other connective tissue disease. CONCLUSION: Use of antimalarials in patients with palindromic rheumatism is associated with a reduction in the risk of developing subsequent RA or other connective tissue disease.

Adult↗
PubMed2000

LMP2 polymorphism is associated with extraspinal disease in HLA-B27 negative Caucasian and Mexican Mestizo patients with ankylosing spondylitis.

OBJECTIVE: To determine the effects of HLA Class II genes, particularly LMP2 and previously implicated Class I genes, on susceptibility and disease expression in HLA-B27 negative ankylosing spondylitis (AS). METHODS: Patients included 41 HLA-B27 negative Caucasians from a total AS population of 546 and 17 HLA-B27 negative Mexican Mestizo. Controls included 4352 random HLA-B27 negative Caucasians. LMP2 genotype assignments were made on all patients and 282 random Caucasian controls by polymerase chain reaction-restriction fragment length polymorphism with the Cfo I restriction enzyme while HLA typing was performed on patients and controls using microcytotoxicity assays for Class I, and sequence specific probe-PCR for HLA-B60, B39, B38, and DR. RESULTS: The LMP2BB genotype was significantly decreased in Caucasian AS patients without extraspinal (ES) disease (25%) compared to AS patients with ES (64.7%) (p = 0.01) and random Caucasian controls (53.9%) (p = 0.007), even when those with colitis and psoriasis were excluded from analysis (ES+ 55.6% versus ES- 22.2%). This finding remained significant after stratification by HLA-DR. Similar trends were noted in the Mexican population. A potential role for HLA-DR8 and DR2 in susceptibility to disease was observed in Caucasian patients, although this observation requires confirmation. We could not confirm reported associations with HLA-B60 or B39. Peripheral arthritis was significantly more commonly observed in those who had had acute anterior uveitis (AAU) (75%) than in those who had not developed AAU (27.3%) (p = 0.04). CONCLUSION: HLA Class II encoded genes may have effects on disease susceptibility and/or phenotype in HLA-B27 negative individuals similar to those noted in HLA-B27 positive AS. Eccentric and axial phenotypes of disease may be immunogenetically determined.

Adult↗
PubMed2000

Pain in the neck for a rheumatologist.

Rheumatologists are frequently asked to see whiplash patients for an independent medical examination. There are many diagnostic and other assessment issues which arise in the setting of an independent assessment, and which do not usually arise in the usual physician-patient relationship. This article thus reviews aspects of the history, physical examination, radiological evaluation, and causation by way of the accident that are of importance to the rheumatologist as independent examiner. We address questions such as Was a physical injury likely to have occurred in the accident? What are the pertinent psychosocial aspects in the history? What are useful diagnostic signs on examination? and What is the significance of radiological findings? These are important and sometimes troublesome questions to answer in the setting of the independent medical examination, but rheumatologists can look to recent literature and research findings to assist in answering these questions.

Expert Testimony↗
PubMed2000

An evidence-based approach to prescribing NSAIDs in the treatment of osteoarthritis and rheumatoid arthritis: The Second Canadian Consensus Conference.

The Second Canadian Consensus Conference was convened to discuss the latest developments in the management of osteoarthritis (OA) and rheumatoid arthritis (RA), and to make evidence-based recommendations, specifically regarding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for these indications in primary care practice. The recent availability of cyclo-oxygenase-2-specific inhibitors has raised questions as to their role in the pharmacological management of OA and RA, particularly in relation to conventional treatments such as acetaminophen and nonspecific NSAIDs (with or without misoprostol or proton pump inhibitors). The recommendations in this document, which were arrived at through critical review of data from published randomized, clinical trials, deal with treatments of choice, information to discuss with patients, use of NSAIDs in patients at risk for serious upper gastrointestinal complications, renal or hepatic impairment or congestive heart failure, appropriate follow-up, and the use of NSAIDs with anti- hypertensives, warfarin, low dose acetylsalicylic acid and other medications. The goal of these recommendations is to improve patient outcomes in the primary care setting by maximizing treatment efficacy and minimizing rates of adverse events.

Anti-Inflammatory Agents, Non-Steroidal↗