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Biomedical subjects

B McConkey

Publications and source records attributed to B McConkey.

At least 19 recordsLinked to original sources
PubMed1993

Glomerulonephritis in rheumatoid arthritis.

We present data on 10 patients with RA who developed glomerulonephritis which was not related to gold or penicillamine therapy. Although two of these patients had received gold this had been discontinued 13 and 18 yr before the diagnosis of glomerulonephritis. Seven patients presented with nephrotic syndrome and three with proteinuria and microscopic haematuria. Renal histology showed a membranous nephropathy (five patients), mesangial IgA nephropathy (two patients), focal segmental necrotizing glomerulonephritis (two patients) and focal segmental glomerulosclerosis (one patient).

Adult↗
PubMed1991

Disease-modifying antirheumatic drugs: gold, penicillamine, antimalarials, and sulfasalazine.

In the assessment of the effects of disease-modifying antirheumatic drugs, three or four clinical measurements supported by the erythrocyte sedimentation rate, and sometimes radiographs, are generally agreed to be correct. Some advocate functional assessments also, or even alternatively. Several studies compared gold, penicillamine, antimalarials, and sulfasalazine either with each other or with placebo, and occasionally with methotrexate. No important differences between the general performance of the four drugs were found. More work was reported on sulfasalazine than on the other three drugs; the data support that it has a place in our armamentarium. Several important contributions concerned strategies of treatment. It is considered that disease-modifying antirheumatic drugs should be used earlier and more aggressively in rheumatoid arthritis. This aspect was perhaps the key note of the 1990 literature on this topic. As part of the new strategies, combination therapy is urged by some rheumatologists, whereas others urge caution on the grounds that we do not yet know enough about the effects of combinations, or by how much the risks of adverse effects are increased in combination.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

Chain breaking antioxidant status in rheumatoid arthritis: clinical and laboratory correlates.

The ability of fresh sera to resist attack by peroxyl radicals (TRAP) was found to be significantly lower in 20 patients with rheumatoid arthritis (RA) than in 20 healthy controls, consistent with the existence of a redox stress in RA imposed by inflammation. TRAP values in RA varied inversely with a combination of visual analogue pain scale, duration of early morning stiffness, grip strength, and articular index (reflecting inflammatory activity) using multiple linear regression analysis. The concentration of the antioxidant vitamin ascorbic acid was lower in RA plasma and the oxidation-reduction equilibrium of ascorbic acid was disturbed, giving further support to the existence of a redox stress. The major determinant of TRAP in vitro was found to be serum uric acid in RA and serum vitamin E in controls. Serum urate concentration in RA correlated inversely with oxidative changes in serum albumin and IgG. It is suggested that serum urate might have an antioxidant role under certain conditions by limiting free radical induced oxidative changes to protein during inflammation.

Arthritis, Rheumatoid↗
PubMed1990

It is said that elevated erythrocyte sedimentation rate and the elevation of C-reactive protein (CRP) may be indicators of continuing joint destruction in rheumatoid arthritis. What then is the explanation for joint destruction in some patients in whom there is no such apparent elevation of either the sedimentation rate of CRP?

It is said that elevated erythrocyte sedimentation rate and the elevation of C-reactive protein (CRP) may be indicators of continuing joint destruction in rheumatoid arthritis. What then is the explanation for joint destruction in some patients in whom there is no such apparent elevation of either the sedimentation rate or CRP?

Arthritis, Rheumatoid↗
PubMed1990

Measurement of conjugated diene lipids by derivative spectroscopy in heptane extracts of plasma.

A series of experiments are described which show that second derivative spectroscopy can be used to quantify conjugated lipid dienes as markers of lipid peroxidation in heptane extracts of plasma from patients with rheumatoid arthritis, osteoarthritis, and healthy controls. Results obtained by this method gave reasonable agreement with those derived from the measurement of simple absorbance in chloroform/methanol extracts. Two minima were observed in the derivative spectrum of plasma lipid extracts. These minima occurred at 233 and 241 nm and corresponded to absorbance maxima in the conventional UV spectrum. Using a combination of phospholipase hydrolysis, reverse phase high performance liquid chromatography (HPLC) and second derivative spectroscopy we confirmed that these two minima can be attributed to a single fatty acid (9 cis-, 11 trans-linoleic acid) shown previously to account for greater than 90% of diene conjugation in human plasma samples. When the biological isomer 9 cis-, 11 trans-linoleic acid was separated by reverse phase HPLC from the mixture of other plasma phospholipid-2-esterified fatty acids we observed a change in derivative spectroscopy minima from 233 and 241 nm to 228 and 237 nm. Minima at the latter two wavelengths were also seen with pure preparations of the Paint Research Isomer (9 trans-, 11 trans-linoleic acid) which eluted later than biological 9 cis-, 11 trans-linoleic acid using reverse phase HPLC, suggesting that the absorption spectra of these pure cis-, trans and trans, trans dienes are similar but can be altered by the presence of other fatty acids in the extract.

Adult↗
PubMed1990

Clinical and laboratory effects of prolonged therapy with sulfasalazine, gold or penicillamine: the effects of disease duration on treatment response.

Serial observations for up to 5 years of clinical score (a subjective global assessment), serum C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were analyzed in 3 groups of patients with active rheumatoid arthritis (RA) requiring treatment with a second line drug. The groups comprised 315 patients (243 women, 72 men) who had sulfasalazine (SAS); 203 patients (141 women, 62 men) who had sodium aurothiomalate (gold) and 163 patients (131 women, 32 men) who had penicillamine. The groups matched in most respects but the gold group had a smaller proportion of women, a shorter median disease duration and a higher median CRP than the remaining 2 groups. The penicillamine group contained a higher proportion of seropositive patients. In each group there were significant improvements in clinical score, CRP and ESR for all time points from 6 to 30 months; these improvements were maintained for longer (up to 60 months for SAS) in the SAS and gold groups but the differences between the drugs after 30 months were probably a consequence of falling number of patients, not differing drug potencies. The mean ESR and CRP levels fell to about 30 mm/h and 20-30 mg/l, respectively. Response was defined as (1) treatment duration greater than 6 months, (2) clinical score improvement greater than 4 by 6 months, (3) ESR fall to less than 30 mm/h by 6 months. By these criteria 142 of 681 patients (20.9%) responded; the response rates were SAS 20.3%, gold 24.1%, penicillamine 17.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗
PubMed1988

Effects of rifampicin with and without isoniazid in rheumatoid arthritis.

A patient with rheumatoid arthritis (RA) experienced great improvement in her RA when given antituberculous treatment for pulmonary tuberculosis (TB). Two of the drugs used in TB, rifampicin and isoniazid, include immunomodulatory effects among their properties. To investigate whether these drugs have any effect in RA, we studied 20 patients who were given either rifampicin 600 mg daily (10 patients) or rifampicin 600 mg with isoniazid 300 mg daily (10 patients). Eighteen patients completed at least 3 months' treatment. Six of the 7 patients with early RA (less than 3 years) improved; their median erythrocyte sedimentation rate fell from 43.5-10 mm/h (p = 0.036) and median serum C-reactive protein from 40-0 mg/l (p = 0.036). Eleven patients with longer histories of RA did not improve. Our results suggest rifampicin with or without isoniazid may be effective in RA.

Adolescent↗
PubMed1987

Rheumatoid arthritis and IgA nephropathy.

We describe four patients with seropositive rheumatoid arthritis who developed proteinuria and microscopic haematuria. Renal biopsy demonstrated a mesangial proliferative glomerulonephritis with mesangial deposits of IgA. These data suggest a possible causal relationship between rheumatoid arthritis and IgA nephropathy.

Adult↗
PubMed1987

Long-term treatment of rheumatoid arthritis with sulphasalazine, gold, or penicillamine: a comparison using life-table methods.

Life-table analysis was applied to the records of 317 patients with rheumatoid arthritis (RA) treated with sulphasalazine (SAS), 201 treated with sodium aurothiomalate (gold), and 163 with penicillamine. They comprised all those treated in our department with these drugs between January 1973 and July 1984. Risks of treatment termination for all reasons were similar for each drug at five years (gold 92%, penicillamine 83%, SAS 81%). The risk of treatment termination due to inefficacy was less for gold (29.5%) than for penicillamine (38.1%) or sulphasalazine (41.2%). Adverse effects, however, led to withdrawal of gold in 57%, penicillamine in 41.2%, and SAS in 37%; the most effective drugs appeared most toxic. Serious adverse effects were much more common in association with gold (17.4%) and penicillamine (12.3%) than with SAS (1.6%). Sulphasalazine appears as well tolerated over long periods in RA as gold or penicillamine and is associated with fewer serious adverse effects; of these drugs, it might therefore be considered the agent of first choice.

Actuarial Analysis↗