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Biomedical subjects

D L Goldenberg

Publications and source records attributed to D L Goldenberg.

At least 73 records · Page 4Linked to original sources
PubMed1985

The clinical features of elderly-onset rheumatoid arthritis. A comparison with younger-onset disease of similar duration.

Patients with elderly-onset rheumatoid arthritis (EORA) may represent a clinical subset of individuals who differ prognostically and therapeutically from patients with younger-onset disease (YORA). In order to test this hypothesis, we reviewed the records of 212 patients with rheumatoid arthritis and grouped them according to age at onset above or below 60 years old. Seventy-eight EORA patients and 134 YORA patients with disease duration of less than or equal to 10 years were used for a comparison of presenting features and disease outcome. Abrupt onset occurred somewhat more frequently in EORA, but was not associated with a significantly different clinical course than was an insidious presentation in this older group. There were no differences between the EORA and YORA groups in terms of mean initial joint score, although the scores for the YORA group had wider variation. An initial clinical presentation resembling polymyalgia rheumatica (PMR) was 4 times as frequent in EORA. Elderly patients were less likely to have subcutaneous nodules or rheumatoid factor at disease onset. At the final examination, the EORA patients had lower joint scores and higher health assessments despite similar courses of treatment. These outcome differences persisted when patients with PMR-like presentations were excluded. Multivariate analyses indicated that joint scores and disease duration made important contributions to a better outcome of EORA, whereas PMR presentation and abrupt onset did not. After an adjustment was made for these 4 features, age at onset was an important contribution to joint score outcome. These results confirm the existence of important differences in onset, clinical features, and prognosis between patients with EORA and those with YORA.

Adrenal Cortex Hormones↗
PubMed1985

Fibromyalgia and major affective disorder: a controlled phenomenology and family history study.

Fibromyalgia is a form of nonarticular rheumatism characterized by diffuse musculoskeletal pain. To investigate the relationship between fibromyalgia and major affective disorder, the authors evaluated 31 patients with fibromyalgia and 14 patients with rheumatoid arthritis for rates of current or past major affective disorder and family history of major affective disorder. Both the rate of major affective disorder and the familial prevalence of major affective disorder were significantly higher in the fibromyalgia patients than the rheumatoid arthritis patients. The results suggest that fibromyalgia may be related to major affective disorder.

Adult↗
PubMed1984

Arthritis in rabbits induced by killed Neisseria gonorrhoeae and gonococcal lipopolysaccharide.

Intraarticular injections of viable N, gonorrhoeae, killed N. gonorrhoeae or gonococcal lipopolysaccharide (LPS) in rabbits' knees caused an acute, polymorphonuclear synovitis with abscess formation 24-72 h after the injection. At 5-7 days, a mononuclear infiltration with synovial lining cell hyperplasia developed, which in some rabbits persisted for one month. Gonococcal LPS, in amounts of 5 micrograms or greater, always caused a marked synovitis indistinguishable from that produced by viable N. gonorrhoeae. Gonococcal outer membrane protein used as a control in these experiments caused no or minimal synovitis in concentrations 50-fold higher than those used in the LPS inoculation experiments. These studies should provide a model to investigate the role of LPS in the arthritis associated with gonococcal infection.

Abscess↗
PubMed1983

The educational impact of a rheumatology elective.

We used a newly developed evaluation strategy to compare the performance of 12 medical residents who received ambulatory care rheumatology training and 12 who received inpatient consultative training. There was no significant difference in the cognitive test scores or the patient examination skills of the 2 groups. The ambulatory care residents saw more patients with common rheumatic diseases and performed more joint aspirations and injections. Both groups performed significantly better in all education impact measurements than did a control group of medical residents who received no formal rheumatology elective training. The control group of residents performed no better than did fourth-year medical students who had no formal rheumatology elective training. The study demonstrated that formal rheumatology training is essential if medical residents are to achieve adequate skills in rheumatology. This training can be provided through ambulatory care or inpatient-oriented electives.

Ambulatory Care↗
PubMed1983

Experimental models of bacterial arthritis: a microbiologic and histopathologic characterization of the arthritis after the intraarticular injections of Neisseria gonorrhoeae, Staphylococcus aureus, group A streptococci, and Escherichia coli.

We report the first reproducible experimental model of gonococcal arthritis, utilizing the intraarticular injection of virulent strains of N. gonorrhoeae. An acute, purulent synovitis with a marked polymorphonuclear leukocyte infiltrate developed during the 1st 24 h and persisted for at least 72 h, followed by a more chronic, mononuclear, proliferative synovitis. The histopathologic characteristics of this acute, then chronic synovitis were comparable to that after the intraarticular injection of other bacteria. N. gonorrhoeae could not be recovered from the injected joints 24 h after their inoculation, whereas Staphylococcus aureus, hemolytic streptococci, and E. coli could be recovered for days to weeks after the intraarticular injection.

Animals↗
PubMed1983

Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms.

Forty-nine patients with disseminated gonococcal infection (DGI) hospitalized at Boston City and University Hospitals over a 7-year period were studied. Patients with clinical manifestations of DGI and with cervical, urethral, rectal, pharyngeal, synovial or blood cultures positive for Neisseria gonorrhoeae were separated into two groups based on the presence or absence of suppurative arthritis. There were 19 cases of suppurative arthritis (Group II) and 30 cases with only tenosynovitis, skin lesions, or both (Group I). Blood cultures were positive only in Group I patients (43%) and synovial fluid cultures only in Group II patients (47%). Polyarthralgia was the most common initial symptom in both groups of patients. Twenty-six Group I patients had tenosynovitis (87%), while only 4 Group II patients (21%) had tenosynovitis (p less than 0.001). The knee was the most commonly involved suppurated joint. Twenty-seven Group I patients (90%) had skin lesions compared to 8 Group II patients (42%) (p less than 0.001). Some of these lesions progressed on treatment; some patients were unaware of their lesions. Genitourinary symptoms were unusual in both groups of patients. Eleven women (33%) were menstruating or were pregnant at the onset of DGI. Thirteen patients had histories suggestive of previous gonococcal infections; one had recurrent DGI. This patient and one other were found to have complement abnormalities. There were no cases of endocarditis or meningitis. Four patients had unexplained liver function abnormalities. All patients recovered uneventfully. Strains isolated from disseminated sites were predominantly of the transparent phenotype (90%). Many strains (58%) required arginine, hypoxanthine and uracil for growth. They were also more susceptible to penicillin than reported strains that cause pelvic inflammatory disease. Most strains were of a single outer membrane protein coagglutination serogroup, WI (85%). These characteristics did not vary between the Group I and Group II isolates. The two groups of strains, however, did vary in their complement-dependent bactericidal reactivity to normal human sera. Eighteen of 24 Group I strains (75%) versus 9 of 19 Group II strains (47%) resisted killing by all normal human sera tested (p less than .05). Likewise, convalescent sera from Group II patients were able to kill their infecting strains more often than did sera from Group I patients (70% vs 17%) (p less than 0.01). Thus, variations in the clinical expression of disease in patients with DGI may be explained, in part, by differences in certain phenotypic and immunologic features of infecting strains.

Arthritis, Infectious↗
PubMed1982

An evaluation strategy for rheumatology education.

The number of professional education programs in rheumatology is increasing at a rapid rate. All efforts to establish such programs should include a formal evaluation plan to assess their value. Clear definitions of program objectives and an understanding of the concepts of education program evaluation should be the basis of planning. We have developed an evaluation approach that focuses on education impact as the key measure of program benefits. Impact is measured in three critical areas: Knowledge, clinical performance, and professional behavior. The tools use in this approach include two questionnaires and a trained patient. Educators may use these measure together to generate an overall estimate of education benefits, or they can use them separately to evaluate specific program objectives. This theory-based strategy can serve as a general model for approaching the evaluation of professional education programs in rheumatology.

Clinical Competence↗
PubMed1982

The association of amyloid deposits and osteoarthritis.

Ten of eighteen consecutive patients who underwent total knee or hip arthroplasty for osteoarthritis had amyloid present in the surgically removed articular tissues. It was found in 6 of 13 cartilage specimens, 4 of 18 articular capsules, and 2 of 16 synovial membranes. In 3 of the cartilage specimens, the amyloid was adjacent to focal deposits of calcium pyrophosphate dihydrate crystals. Therefore, deposits of amyloid are not uncommon in osteoarthritis and may be more than incidental findings.

Age Factors↗
PubMed1981

Rheumatology education in United States medical school.

Although rheumatology manpower in United States medical schools has dramatically increased in the past decade, 13% of medical schools did not have a full-time staff rheumatologist in 1980. Thirty-eight percent of medical schools had 2 or less full-time rheumatologists. Staff rheumatologists and rheumatology fellows provided the majority of medical student education in the clinical aspects of rheumatic disease; however, rheumatologists in less than 50% of medical schools taught in the basic science curriculum or in related fields such as collagen biochemistry, metabolic bone disease, and orthopedic intervention in arthritis. The staff rheumatologists' time commitment to medical student education was inversely proportional to the rheumatology faculty size. At medical schools with no rheumatologists, however, there was little, if any, formal education in the rheumatic diseases. Most subjects are taught in systems-oriented lectures. Education is currently limited to the common rheumatic conditions such as bursitis and back pain. Only 62% of medical schools provide a structured course on the musculoskeletal examination. Elective rotations in rheumatology, usually offered in the third or fourth year, are currently being provided to only 15% of U.S. medical students.

Curriculum↗
PubMed1981

Clinical manifestations of disseminated infection caused by Neisseria gonorrhoeae are linked to differences in bactericidal reactivity of infecting strains.

Twenty-nine patients with disseminated gonococcal infection were classified into two clinical groups at the time of hospitalization: 13 with suppurative arthritis and 16 with only tenosynovitis, dermatitis, or both. Patients with suppurative arthritis had significantly less tenosynovitis and dermatitis (p less than 0.02). Strains of Neisseria gonorrhoeae isolated from the two groups of patients were each repetitively tested in a bactericidal assay using fresh frozen sera obtained from 10 normal human volunteers. Although strains causing disseminated gonococcal infection in general are serum resistant, those isolated from patients with suppurative arthritis were significantly less resistant (p less than 0.01) than those isolated from patients with only tenosynovitis and dermatitis. Differences in strains as reflected by variation in resistance to normal human sera may cause these strains to produce diverse clinical manifestations.

Arthritis, Infectious↗
PubMed1981

Arthritis in Whipple's disease.

Synovial fluid and membranes were studied in two patients with Whipple's disease. In the first, arthrocentesis revealed 28,350 white blood cells/mm3, 96% of which were polymorphonuclear leukocytes. A dense neutrophilic infiltrate, periodic acid-Schiff, positive macrophages and bacilliform structures were present in the synovial membrane. The synovial fluid and membrane findings in the second case, and during intercritical periods in the first case, showed mild to moderate nonspecific inflammation. Since polyarthritis and other systemic manifestations often precede the gastrointestinal features of Whipple's disease by many years, a closed synovial membrane biopsy should be obtained in the appropriate clinical setting.

Arthritis↗
PubMed1979

The effect of a primary-care pathway on internal medicine residents' career plans.

There has been no evidence that primary-care pathways, a recent innovation in internal medicine residency programs, have affected the career choices of their trainees. We report the experience of the first four cohorts of primary-care trainees in internal medicine compared with traditional-pathway trainees at Boston City Hospital. Primary-care residents remained committed to their plans for a career in general internal medicine throughout training. In contrast, two thirds of the traditionally trained residents who were planning a career in general internal medicine at the beginning of their training changed their plans to subspecialty medicine. Thus, the primary-care pathway reinforced the career plans of trainees in general internal medicine, whereas traditional training influenced potential generalists toward subspecialty medicine.

Boston↗