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Biomedical subjects

D J McCarty

Publications and source records attributed to D J McCarty.

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

Combination drug therapy of seropositive rheumatoid arthritis.

OBJECTIVE: To determine the longterm morbidity and mortality in a cohort of 169 patients with seropositive rheumatoid arthritis (RA) treated by a single rheumatologist with remittive agents used in combination. The effectiveness of a regimen combining pulse oral methotrexate, azathioprine and an antimalarial drug (MAH) was examined in detail. METHODS: All outpatient visits by patients followed for at least one year and up to 18 years (mean 7 years) were abstracted. Remittive antirheumatic drugs were used in combination to achieve progressive improvement. Univariate and multivariate analyses of the differences between first and last visit results in 9 process or outcome variables were calculated for the entire cohort, for those patients receiving or not receiving MAH at last visit, and for those patients taking methotrexate but not in combination with both azathioprine and an antimalarial. The numbers of patients in remission (Lansbury articular index zero), and near remission (articular index < 6) were determined for each of these groups. A survival curve was calculated. RESULTS: The entire patient cohort showed improvement in every variable except hemoglobin at the time of the last visit (p < 0.0004). On multivariate analysis MAH patients were improved only in American Rheumatism Association functional class compared to the other groups (p < 0.0001). Remission and near remission rates overall were 43 and 61%; for MAH patients 45 and 69% (p = n.s.). Survival was no different from that of the general population. Herpes zoster (17 patients) and second attacks of varicella (2 patients) were the most striking side effects. Prednisone use was reduced from 34 to 19% of patients and the mean daily dose was lowered from 9.3 to 5.9 mg. CONCLUSION: Combination therapy with multiple antirheumatic agents successfully controlled joint inflammation in 167 of 169 patients with seropositive RA; complete remission was achieved in 43% of patients. Survival of this patient cohort did not differ from that of the general population.

Administration, Oral↗
PubMed1994

Crystals and arthritis.

Monosodium urate, calcium pyrophosphate dihydrate, and basic calcium phosphate (carbonate-substituted hydroxyapatite and octacalcium phosphate) crystal aggregates are associated with gout, pseudogout, and cartilage degeneration (osteoarthritis, Milwaukee Shoulder/Knee Syndrome), respectively. Hyperuricemia is a frequent but nonspecific and inconstant feature of gout just as an elevated synovial fluid inorganic pyrophosphate level is an inconstant feature of pseudogout. Monosodium urate, calcium pyrophosphate dihydrate, or basic calcium phosphate crystals can cause acute inflammation associated with phagocytosis by neutrophilic leukocytes. Each induces neutral protease synthesis and secretion and arachidonic acid metabolism by synoviocytes and macrophages in a dose-dependent fashion, postulated to produce the damage to bone, cartilage, and other joint tissues that is perceived clinically as tophaceous destruction or degenerative joint disease. Crystals containing calcium are potent mitogens. All three types of crystals are more common in older persons and will attract additional attention as the mean age of our population increases. Gout is perhaps the most treatable disease in medicine, although mistakes in diagnosis and in choice of appropriate therapy are very common. Acute pseudogout and acute calcific periarthritis are readily treated medically, but the chronic effects of crystals containing calcium are not. New approaches using drugs derived from scientific study of the biologic effects of these crystals may become useful therapeutically.

Arthritis↗
PubMed1994

RS3PE syndrome: no evidence for retroviruses.

OBJECTIVE: To determine whether human T cell lymphotrophic virus (HTLV) infection is associated with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. METHODS: Three patients presenting with RS3PE syndrome and 7 controls were examined for the presence of HTLV crossreactive antigens. RESULTS: Our patients were elderly men who presented with typical symptoms of abrupt onset of synovitis of the wrist, carpal joints, metacarpophalangeal, proximal interphalangeal, distal interphalangeal joints, and flexor tendons, associated with remarkable pitting edema of the hands. Transmission electron microscopy and immunohistochemical analysis for HTLV-1 P19 and P20 related antigens failed to detect retroviral presence in the sample specimens or controls. CONCLUSION: Our investigation suggests there is no evidence for HTLV synovial infection associated with RS3PE.

Aged↗
PubMed1994

Hemorrhagic rupture of the shoulder.

Two cases of hemarthrosis and rupture of the shoulder joint are described and 6 reported cases are reviewed; 5 of these were associated with a destructive glenohumeral joint arthropathy and rotator cuff dissolution. All have occurred suddenly, without trauma, in elderly persons. Conservative treatment is often successful, but recurrent episodes of rupture may require replacement arthroplasty.

Aged↗
PubMed1993

Rheumatology.

Explore the source record for details and available documents.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1993

Disease monitoring.

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Epidemiologic Methods↗
PubMed1993

Evidence that a 550,000-dalton cartilage matrix glycoprotein is a chondrocyte membrane-associated protein closely related to ceruloplasmin.

Cartilage matrix glycoprotein (CMGP) is a disulfide-bonded 550,000-dalton protein that is synthesized by chondrocytes and ciliary epithelial cells. We have purified the protein from bovine and porcine articular cartilage and have sequenced two peptides, which both have significant homology with human ceruloplasmin, a copper-binding oxidase. Immunolocation analysis indicates that a commercial polyclonal antiserum to human ceruloplasmin reacts with bovine cartilage CMGP. Chelating columns made with copper bind CMGP from bovine cartilage extracts. CMGP is present in bovine chondrocyte membrane preparations purified from sucrose density gradients. Oligonucleotide probes have been synthesized based on the published sequence of the 3'-untranslated region and a portion of the C terminus of human ceruloplasmin and have been used to amplify a cDNA fragment from bovine cartilage and human liver libraries. CMGP demonstrates oxidase activity towards p-phenylenediamine similar to that of ceruloplasmin. These studies suggest that CMGP is closely related to, if not identical with, ceruloplasmin. It is possible that CMGP may be involved in metal transport into and/or within the chondrocyte.

Amino Acid Sequence↗
PubMed1993

Epidemiology of hospitalization for achalasia in the United States.

Achalasia is an uncommon esophageal motility disorder of unknown etiology. To gain insights into possible etiologic risk factors, demographic and comorbidity data were obtained from Medicare hospital discharge data files from 1986-1989 on patients aged 65 and older. Age-adjusted sex- and race-specific occurrence rates were calculated for each US state. The rate of comorbid illness occurrence in achalasia patients was compared to that of the entire hospitalized Medicare population. Records of 15,000 achalasia discharges were available for analysis. Achalasia discharge rates increased linearly from age 65 to 94 years. They were similar in males and females as well as whites and nonwhites. High rates were observed in the South and low rates in most states of the East North Central region around the Great Lakes and in the Pacific region. The same geographic pattern was observed in men and women as well as in the two separate subsets of data representing the periods 1986-1987 and 1988-1989. Achalasia was associated with a significantly increased risk for pulmonary complications, malnutrition, and gastroesophageal cancer. The concordant occurrence of achalasia in patients with Parkinson's disease, depressive disorder, and various other myoneural disorders indicated a possible etiologic relationship. Achalasia appears to represent the clinical end point of several different pathways. Besides aging, different neurologic diseases may contribute to a loss in control of esophageal motility. The geographic pattern could suggest the influence of environmental factors.

Age Factors↗
PubMed1993

Personal experience in the treatment of seropositive rheumatoid arthritis with drugs used in combination.

Drug therapy for seropositive rheumatoid arthritis (RA) is entirely empiric. Single agents often fail to control synovial inflammation adequately. Combination therapy with relatively small doses of several agents shown to be effective in controlled trials when used alone often produce sustained and marked therapeutic control. Adverse effects are frequent but probably are no greater than those associated with the use of an effective dose of a single agent. As in the treatment of malignancy or tuberculosis, the use of potent drugs in combination may prevent or delay the clonal expansion of resistant cells. If this is indeed the case in the treatment of RA, then consideration should be given to the routine use of drug combinations. It is conceivable that we do patients a disservice by using potentially valuable drugs sequentially rather than in tandem. Whatever its merits, combination drug therapy for seropositive RA is clearly a stopgap measure whose usefulness will end as more specific means of controlling joint inflammation become available.

Adult↗
PubMed1993

Ascertainment corrected rates: applications of capture-recapture methods.

Accurate rates, though fundamental to epidemiology, are often very difficult to obtain. Incidence, prevalence, and mortality rates have traditionally been established through either passive reporting surveillance systems, through active surveillance systems, or by a combination of the two methods. Typically, when researchers employ these approaches they do not formally evaluate or correct for the degree of underascertainment. Undercount of cases is a potent determinant of rates which we cannot continue to ignore. We believe all rates should be adjusted for underascertainment in order to achieve a truer picture of the risk and risk factors of disease. Here, we present a procedure to ascertainment correct rates based upon well established capture-recapture methods.

Epidemiologic Methods↗
PubMed1993

Establishment of accurate incidence rates for head and spinal cord injuries in developing and developed countries: a capture-recapture approach.

Prevention of head and spinal cord injuries is defined as a reduction in the incidence of these disabilities. Accurate incidence data are fundamental to any prevention program. The current approaches toward determining incidence rates for head and spinal cord injuries are summarized. Previous research has focused on passive surveillance systems and population-based registries. An alternative system for monitoring the incidence of head injuries is discussed that uses a surveillance methodology called capture-recapture. This method employs multiple population-based sources to identify cases and uses the cases that overlap between the sources to estimate the degree of undercount in the population. This estimate in turn is used to produce an ascertainment-corrected incidence estimate. Through the use of methods such as capture-recapture, accurate monitoring of the incidence of head and spinal injuries across developing and developed countries is indeed feasible.

Bias↗
PubMed1993

Surveillance of serious recreational injuries: a capture-recapture approach.

Serious injury from sport and recreation is a leading cause of morbidity and mortality in the United States. Historically, occurrences of diseases with substantial public health impact have been monitored via surveillance systems in order to obtain information concerning the frequency with which the diseases occur. Surveillance leads to efforts that identify risk factors, and eventually, control measures to reduce the incidence of disease. Currently, the surveillance of sports injury represents only limited coverage in the U.S. It is important to begin discussions regarding approaches toward the development of surveillance of these injuries. Methods based upon the communicable disease surveillance model could potentially be used to monitor serious sports injuries. One method of surveillance, using the statistical approach of capture-mark-recapture, is presented as an example by which a national system of surveillance of serious sports injury could be established.

Athletic Injuries↗