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D L Scott

Publications and source records attributed to D L Scott.

At least 163 records · Page 9Linked to original sources
PubMed1990

Radiological progression in rheumatoid arthritis: do D-penicillamine and hydroxychloroquine have different effects?

We studied 43 patients with active rheumatoid disease of less than 4 years' duration: 23 were given hydroxychloroquine and 20 penicillamine. Efficacy was assessed using clinical and laboratory variables. Radiological progression was measured using Larsen's method for scoring plain radiographs of the hands and feet. Twenty-four patients received 2 years' continuous therapy. Clinically both drugs were effective with falls in articular index and C-reactive protein. Initial radiological damage was less with penicillamine (P less than 0.05 by Wilcoxon rank sum test). By 2 years there were no significant differences between the two drugs; mean increases in Larsen score were 20.3 with penicillamine and 27.5 with hydroxychloroquine. Both groups progressed at a rate likely to give severe joint destruction over 10-20 years.

Arthritis, Rheumatoid↗
PubMed1990

Tolerability of enteric-coated sulphasalazine in rheumatoid arthritis: results of a co-operating clinics study.

One thousand three hundred and eighty-two patients with rheumatoid arthritis requiring second-line therapy at 108 centres were entered into an open 6-months prospective tolerability study of enteric-coated sulphasalazine 2 g/day (Salazopyrin EN-tabs). Clinical and laboratory variables were measured, any adverse reactions and the reasons for withdrawal of medication were recorded. The outcome of therapy was known in 87.5% of patients entered of whom 65% continued with sulphasalazine beyond the 6-month study period. 3.2% withdrew for reasons unrelated to treatment, 5% for lack of effect and 26.8% due to an adverse event; gastrointestinal/central nervous 66.6%, rash 15.4%, haematological 5.1%, hepatic 4.7% and miscellaneous 8.1%. 1.2% of patients experienced potentially serious reactions: anaphylactic, haematological and hepatic. The majority of adverse events occurred early and were reversible upon cessation of medication. No clear relationship between withdrawal due to an adverse event attributed to sulphasalazine and the nature of the concomitant non-steroidal anti-inflammatory drug was identified.

Arthritis, Rheumatoid↗
PubMed1990

Can we develop simple response criteria for slow acting antirheumatic drugs?

The conventional assessment of response to slow acting antirheumatic drugs depends on multiple clinical and laboratory measures. Each measure is analysed separately. For clinical practice and therapeutic trials a single unified classification of response is preferable, based on the most sensitive and simple current measures. Whether or not this was practical was determined in a prospective study of two cohorts of patients: 145 given penicillamine 250-500 mg daily in a single dose; 98 sulphasalazine at an initial dose of 500 mg rising after one month to 2 g daily. Both groups were followed up for 12 months. A panel of 11 clinical and laboratory measures were evaluated every three to six months. Most changes had occurred by six months, and this was the optimum time to classify response. Four measures were used to devise a five point (0-4) classification of response from no change to remission. The objective was to evaluate if this approach is appropriate; the best level of each measure to use was not determined. The response index was based on: erythrocyte sedimentation rate less than 30 mm/h; articular index less than 3; morning stiffness less than 15 min; greater than 50% reduction in joint pain. Similar results were obtained with both drugs. The other clinical and laboratory measures gave limited information. This response index is simple and appropriate. It is suitable for use in clinical practice and drug studies, though the optimal values for dividing each clinical and laboratory variable need to be determined.

Arthritis, Rheumatoid↗
PubMed1990

Effect of fibronectin on the Crithidia luciliae test for anti-double-stranded DNA antibodies.

The various tests for anti-double-stranded DNA antibodies do not always agree. Plasma fibronectin specifically binds DNA, is a component of immune complexes, and shows variations in concentration with disease activity in systemic lupus erythematosus. It may therefore interfere with the detection of DNA autoantibodies. This possibility was examined in a series of studies using the Crithidia luciliae test. Studies were based on serum samples received during one year (250 samples). Serum samples from 50 patients which were positive or weakly positive in the C luciliae test were used. In blocking experiments fibronectin was added either to the wells or to the serum. In a second series of experiments fibronectin was depleted by affinity chromatography from six serum samples with weak anti-DNA staining. Preincubation of wells with fibronectin or addition of fibronectin to serum invariably blocked the interaction of anti-DNA antibodies with the C luciliae kinetoplast. When fibronectin was removed from serum the intensity of staining was increased. These results indicate that fibronectin influences the detection of anti-double-stranded DNA antibodies using C luciliae and may explain the disparity between the results of different tests for DNA antibodies. Furthermore, the unmasking of positive reactivity when fibronectin is removed from serum has implications for the diagnosis and treatment of systemic lupus erythematosus.

Animals↗
PubMed1990

Lymphoedema of the limbs as an extra-articular feature of rheumatoid arthritis.

Seven patients with lymphoedema of the hands and arms, an unusual extra-articular feature of rheumatoid arthritis, are described. In all cases the lymphoedema persisted throughout follow up--in one case for more than five years--and was resistant to treatment with slow acting drugs, steroids, or cytotoxic agents. There was no correlation with severity of disease. It is concluded that the lymphoedema in these patients may be associated with reduced numbers of lymphatic vessels; increased capillary permeability or abnormal fibrinolysis may also be contributory factors. Conservative management of such patients is recommended.

Adult↗
PubMed1990

CountyCare summary.

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Contract Services↗
PubMed1989

Fragmented fibronectin and other synovial fluid proteins in chronic arthritis: their relation to immune complexes.

Fibronectin, an opsonic glycoprotein has been shown to exist in fragmented forms in serum and synovial fluid. Some fragments in synovial fluid appear to be polyethylene glycol (PEG) precipitable, suggesting incorporation into immune complexes (IC). PEG precipitation, SDS-PAGE and immunoblotting were used to determine whether PEG precipitable fragments are real or artefactual. Disease specificity of fragmentation and IC incorporation of fibronectin and other proteins were also studied using these techniques. PEG precipitable fragments do not appear to be artefactual, although some fibronectin fragments are cryoprecipitable. Protein fragments showed similar distributions in whole serum and synovial fluid, disease specific differences being confined to PEG precipitates. Rheumatoid arthritis (RA) synovial fluid PEG precipitates displayed the greatest array of fragmented immunoglobulins and fibronectin. No PEG precipitates contained albumin fragments. Protein fragments in IC may impair their effective removal from RA joints. Accumulated IC could lead to tissue damage via complement activation.

Adult↗
PubMed1989

Lymphoid irradiation in intractable rheumatoid arthritis. Long-term followup of patients treated with 750 rads or 2,000 rads.

Twenty patients with intractable rheumatoid arthritis were randomized to receive 750 or 2,000 rads of lymphoid irradiation (LI) in a double-blind comparative study, and were followed for a maximum of 48 months (mean 40 months) after treatment. During followup, sustained immunomodulation (including lymphopenia, particularly of the T helper cell subset; reduced ratio of helper cells to suppressor cells; and impaired in vitro lymphocyte proliferation in response to phytohemagglutinin and pokeweed mitogen) was observed. Significant improvements in early morning stiffness, Ritchie articular index, pain score, grip strength, and 15-meter walk time were observed in both treatment groups, but these were not sustained through the followup period. Progressive joint damage was observed radiologically in both groups during followup. Thus, LI induced sustained immunosuppression, but resulted in only short-lived clinical improvement and was associated with progressive joint erosion in these patients.

Arthritis, Rheumatoid↗
PubMed1989

Determination of cytidine deaminase activity in synovial fluid by HPLC.

A reversed-phase high-performance liquid chromatographic method for the determination of cytidine deaminase activity in synovial fluid is described. Diluted synovial fluid was incubated for 10 min at 56 degrees C with 0.4 mM cytidine. The protein in 5 vol of incubate was then precipitated using 1 vol of trichloroacetic acid (20% m/v) and the substrate, cytidine, and the product, uridine, were determined in the resultant supernatant. These substances were separated by reversed-phase HPLC using 0.05 M potassium dihydrogen orthophosphate (pH 6.5) containing methanol (3% v/v) and were detected at 280 nm. The enzyme activity was determined by measuring uridine formation. The effects of substrate concentration, pH and reaction temperature on uridine formation are described.

Ammonia↗
PubMed1989

Combination therapy with gold and hydroxychloroquine in rheumatoid arthritis: a prospective, randomized, placebo-controlled study.

We studied combination therapy with two slow-acting antirheumatic drugs given concurrently in active rheumatoid arthritis (RA). A 12-month prospective randomized controlled trial compared gold and hydroxychloroquine in 52 patients to gold and placebo in 49. The patients continued to receive non-steroidal anti-inflammatory drugs and analgesics. They were selected from three rheumatology centres in the West Midlands. Combination therapy led to a greater number of withdrawals due to adverse reactions (18 cases compared to 10 receiving gold/placebo). Patients completing 12 months' therapy (27 taking gold/hydroxychloroquine and 32 on gold/placebo) were compared using five clinical, seven laboratory, and one radiological measure. All 13 variables favoured gold/hydroxychloroquine with an overall advantage of 20-25% for the combination. This only reached statistical significance (at the 1% level) for C-reactive protein. An overall disease activity index was better at 12 months (at the 5% level) and showed a more rapid response with gold/hydroxychloroquine. This is the first randomized prospective placebo-controlled trial to show a significant advantage from a combination of two slow-acting drugs. There are many different ways of giving such combinations and we consider these should be explored to maximize the effectiveness of treatment for RA.

Adult↗
PubMed1989

Peripheral arthritis in the elderly: a hospital study.

One hundred consecutive patients admitted to an acute geriatric unit were examined for evidence of peripheral arthritis with recognised criteria used to define osteoarthritis, rheumatoid arthritis, pyrophosphate arthropathy, gout, and disorders of the shoulder joint. The presence of arthritis and its severity were related both to functional independence and to a recognition by the patient that joint problems were impairing independence. Seventy six patients had clinical peripheral arthritis; 48 had arthritis contributing to loss of function, and 19 of these did not volunteer evidence of their joint disease. The common occurrence of arthritic conditions in the elderly, with consequential disability and dependency, suggests that increased medical awareness may be required to prevent unnecessary morbidity. Our findings need confirmation in community based studies.

Aged↗