Search PubMed⌕ Search

Biomedical subjects

D G Scott

Publications and source records attributed to D G Scott.

At least 55 records · Page 3Linked to original sources
PubMed1995

Vasculitis.

The systemic vasculitides are a group of rare inflammatory conditions resulting in inflammation and necrosis of blood vessel walls. They are somewhat commoner than previously believed with an annual incidence approaching 40 per million. Furthermore the annual incidence of rheumatoid vasculitis is 12.5 per million and Wegener's granulomatosis is 8.5 per million. The first useful classification system for systemic vasculitis was published in 1952, since then a number of different schemes have been published. The major changes have been the recognition of the importance of dominant blood vessel size, the distinction between primary and secondary vasculitis and the incorporation of pathogenetic markers such as ANCA (see Table 6). Until relatively recently there were no widely agreed diagnostic or classification criteria. In 1990 the ACR published criteria for the diagnosis of polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, hypersensitivity vasculitis, Henoch-Schönlein purpura, giant cell arteritis and Takayasu's arteritis. The criteria were provided in both traditional and tree format. Sensitivity and specificity rates varied considerably: 71.0-95.3% for sensitivity and 78.7-99.7% for specificity. The criteria were not tested against the general population or against patients with other connective tissue diseases or rheumatic conditions. In 1993/94 the Chapel Hill Consensus Conference developed and published definitions for the nomenclature of systemic vasculitis based on clinical features. These have not met with universal acceptance. However, they are a useful addition, since their use should result in different centres studying more homogeneous populations of patients and facilitate comparison of data between different centres. Assessment of vasculitis comprises an activity score (BVAS), damage index and quality of life/health status (SF-36). These are recent developments which are still undergoing validation.

Humans↗
PubMed1995

Isolated nail fold vasculitis in rheumatoid arthritis.

OBJECTIVES: To establish the clinical significance of isolated nail fold vasculitis in patients with rheumatoid arthritis (RA). METHODS: Patients attending hospital with established RA were assessed by a single observer using unaided vision. Isolated nail fold vasculitis (NFV) was diagnosed as small nail edge or nail fold lesions without any evidence of other extra-articular or systemic vasculitis. Patients were followed prospectively. RESULTS: Thirty patients with isolated NFV were identified and followed for a median interval of 22 months. Three patients died within three months of diagnosis and six developed complications possibly indicative of extra-articular disease: xerostomia (three), pericarditis (one), pleural effusion and empyaema (one), pulmonary fibrosis (one). No patient developed systemic vasculitis. CONCLUSION: Isolated NFV has a favourable prognosis compared with systemic vasculitis. There is a low risk of developing systemic or extra-articular disease.

Adult↗
PubMed1995

A longitudinal study of anticardiolipin antibody in polymyalgia rheumatica and giant cell arteritis.

OBJECTIVE: To determine the incidence of elevated levels of anticardiolipin antibody (aCL) in patients with newly diagnosed polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA); and to determine the relationship between these antibodies at diagnosis and subsequent course of the disease over a period of 2 yrs. METHODS: Ninety-eight consecutive patients with PMR and/or GCA were examined for the presence of aCL, at presentation and every 6 mo for 2 yrs. Sixty-four patients had PMR alone, 22 had coexistent PMR and GCA, and 12 presented with pure GCA. Patients presenting with suspected clinical diagnosis, overt or covert, of GCA were subjected to temporal artery biopsy from the symptomatic side within 3 days of presentation. Appropriate serological, biochemical, and hematological investigations were undertaken at presentation and subsequently at times of periodic assessments. One hundred healthy age and sex matched elderly subjects were also screened for the presence of aCL as a control group. RESULTS: Elevated levels of aCL were detected in 20 patients at presentation. These included 9 patients with PMR/GCA and 11 patients with pure PMR. During followup, 10 patients with pure PMR at presentation developed GCA. These comprised 5 of the 11 patients with high aCL at presentation and 5 of the 53 patients with normal levels of aCL at presentation. This was statistically significant with relative risk (4.82, 95% CI, 1.72-13.51) of developing GCA in the presence of PMR and a high aCL at presentation. Furthermore, 3 of the 5 patients with pure GCA and high aCL at presentation progressed to severe vascular complications (stroke, 2; anterior ischemic optic neuritis, 1) compared to none of the other patients in the study. Elevated levels of antineutrophilic cytoplasmic antibody were also analyzed and detected in only 4 patients, 3 with pure PMR and one with biopsy proven GCA. CONCLUSION: This prospective study suggests that a significant number of patients with PMR and/or GCA with elevated levels of aCL at presentation have increased risk of developing GCA or other major vascular complications. It is possible that aCL may be an independent prognostic marker for future vascular complications in patients with PMR and/or GCA.

Aged↗
PubMed1994

The arthropathy of the Muckle-Wells syndrome.

Muckle-Wells syndrome (MWS) is a rare condition characterized by urticaria, arthralgias, deafness and amyloid nephropathy. The arthropathy is poorly documented. We describe the arthropathy occurring in four cases of MWS and discuss the management. Each patient developed recurrent bouts of transient synovitis. One patient developed a persistent sterile pyoarthrosis.

Adult↗
PubMed1994

A district audit on the management of polymyalgia rheumatica and giant cell arteritis.

Twenty-one hospital consultants, representing 20% of the hospital specialists and 54 general practitioners representing 22% of the general practitioners in the Norwich Health District were circulated a questionnaire on the management of polymyalgia rheumatica and giant cell arteritis, as part of a departmental audit. The wide variations in the diagnosis and treatment of these two common conditions are shown in this study. Appropriate recommendations have been made for these two common conditions in the hope of providing a useful guideline for more uniform and effective therapy. We intend to repeat this study at a later date to assess if any of the recommendations have been undertaken successfully.

Family Practice↗
PubMed1994

A randomized controlled study of post-injection rest following intra-articular steroid therapy for knee synovitis.

In order to assess the effect of 24 h observed bed rest following intra-articular steroid injection of the knee joint in patients with an inflammatory arthritis such as RA, AS or colitic arthropathy, 91 patients with inflammatory arthritis of one knee joint were randomized to receive 24 h bed rest in hospital following intra-articular steroid injection or were injected in outpatients. The clinical and laboratory assessments such as pain and stiffness on a 10-cm visual analogue scale, knee circumference (cm), 50 ft walking time (s), CRP and ESR were measured before receiving the steroid injection and at 3, 6, 12 and 24 weeks. Both groups of patients improved clinically and serologically at 3 weeks. By 12 weeks the degree of improvement in the pain score, stiffness score, knee circumference, 50 ft walking time and CRP was better in the rest group and these differences persisted to 24 weeks. For each outcome variable the summary measure of response was significantly better in the rest group compared to the no rest group. Intra-articular steroid injection of the knee joint followed by strict i inpatient bed rest for 24 h results in a greater degree of clinical and serological improvement, compared to routine outpatient injections for up to 6 months. It is therefore possible that 24-h post-injection rest will result in a prolonged duration of clinical response and reduce the need for frequent steroid injections and the risk of complications.

Adult↗
PubMed1994

The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register.

This paper provides the first data on the incidence of RA based on a prospective population-based register. All new cases of inflammatory polyarthritis in the Norwich Health Authority are notified by general practitioners to the Norfolk Arthritis Register. The patients are then clinically evaluated by metrologists and blood taken for RF estimation. Cases of RA were defined as all those notified with an onset of symptoms in 1990; who presented by 31 December 1991; and who satisfied the 1987 ARA criteria for RA at the time of presentation. Two hundred and ten patients were notified in the defined time-frame, of whom 104 were classified as having RA. The annual incidence rate was 36/100,000 for women and 14/100,000 for men. RA was rare in men aged under 45 yr. The incidence in men rose steeply with age. The incidence in women rose up to age 45 yr, plateaued to age 75 yr, and fell in the very elderly.

Adolescent↗
PubMed1994

The incidence of rheumatoid vasculitis in the Norwich Health Authority.

Systemic rheumatoid vasculitis (SRV) is an uncommon but potentially serious complication of RA. The incidence of SRV is unknown. The aim of this study was to estimate the incidence of SRV in the UK. Over a 6-yr period vigorous attempts were made to identify all patients with newly diagnosed SRV living within the Norwich Health Authority (NHA). The overall annual incidence of SRV is 12.5/million (95% CI: 8.5-17.7). The annual incidence rate for men was 15.8/million (95% CI: 9.5-24.7) and 9.4/million (95% CI: 4.8-16.4) for women. The incidence of SRV in this study is higher than previous estimates.

Adult↗
PubMed1994

Digital vasculitis associated with joint sepsis in rheumatoid arthritis.

Digital vasculitis complicating RA is not infrequent and is usually benign but may herald the onset of systemic vasculitis. A case is reported of a man with longstanding seropositive RA who developed digital vasculitis in association with septicaemia and multiple joint sepsis. Awareness that the onset of digital vasculitis in RA may be related to infection is important. This is especially so since aggressive immunosuppressive therapy is often used in patients with systemic vasculitis.

Aged↗
PubMed1994

A single infusion of bisphosphonate AHPrBP in the treatment of Paget's disease of bone.

OBJECTIVE: To assess the efficacy of single infusion of bisphosphonate AHPrPB (APD) (60 mg) in active Paget's disease of bone. METHODS: Twenty-six patients with symptomatic Paget's disease of bone were treated with a single infusion of APD (60 mg) over 12 h and were assessed for clinical as well as biochemical improvement for a mean period of 2 years. Treatments were repeated if relapse occurred during followup. RESULTS: Bone pain improved in 92% of patients within one month and over 76% of patients had no pain at 6 months. Serum alkaline phosphatase fell to normal level in 78% of patients at 6 months and about 77% at one year. Further treatment with intravenous (iv) APD (60 mg) was given for relapse in 7 patients at one year, 13 at 18 months and 2 at 24 months. CONCLUSION: Our prospective study demonstrates that 60 mg APD given iv is an effective, simple, safe and less expensive treatment for active Paget's disease of bone and this therapy may well be given in a daycare unit or an outpatient setting.

Aged↗
PubMed1994

Classical versus non-renal Wegener's granulomatosis.

We investigated whether 'limited' or 'non-renal' Wegener's granulomatosis (WG) differs from classical or 'renal' WG. Renal WG is characterized by necrotizing granulomatosis of the upper and or lower respiratory tract, accompanied by systemic vasculitis and focal segmental necrotizing glomerulonephritis. This last feature is absent in non-renal WG. In a prospective follow-up study of all identified cases presenting to a single teaching hospital, we reviewed 22 patients with non-renal WG, and compared their presentation and outcome with that of 28 patients with renal WG. Clinical and laboratory assessment of disease activity, frequency of death, relapse and end-stage renal disease were assessed. The two groups differed in clinical presentation, laboratory features and outcome. The group with non-renal WG had less cutaneous and pulmonary disease; the haemoglobin, white cell count and platelet count tended to be normal. Residual mortality was confined to the renal group. However, the groups shared many features, particularly their requirement for immunosuppressive therapy, since WG causes major tissue destruction regardless of whether it is a localized or widespread process. At the immunopathological level, the two groups appear to be part of a single disease spectrum. Importantly, the non-renal WG group may change the pattern of their disease to involve the kidney. Long-term follow-up of such patients is therefore essential.

Adult↗