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Biomedical subjects

David G I Scott

Publications and source records attributed to David G I Scott.

14 recordsLinked to original sources
PubMed2006

Pulmonary complications of infliximab therapy in patients with rheumatoid arthritis.

We describe 5 patients with rheumatoid arthritis (RA) who developed pulmonary complications following infliximab therapy; 4 patients had preexisting usual interstitial pneumonia. As the pathophysiology of the pulmonary insult is unknown, we advise caution in the use of anti-tumor necrosis factor-alpha therapy in patients with RA with underlying lung disease of sufficient severity to withhold methotrexate treatment.

Aged↗
PubMed2005

Baseline levels of C-reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year followup study of a primary care-based inception cohort.

OBJECTIVE: To test the hypothesis that the C-reactive protein (CRP) concentration at baseline is an independent predictor of death from cardiovascular disease (CVD) in newly diagnosed patients with inflammatory polyarthritis (IP). METHODS: Patients with IP (n = 506) who were recruited from the Norfolk Arthritis Register between 1990 and 1992 were followed up to the end of 2001, and complete data on mortality were obtained. At baseline, subjects underwent a structured interview and joint examination and completed a Health Assessment Questionnaire (HAQ). Blood was obtained and analyzed for rheumatoid factor (RF) and CRP concentration. Cox regression was used to calculate hazards ratios (HRs) for risk of death from CVD. RESULTS: The median followup was 10.1 years (interquartile range 9.3-10.8). There were 104 deaths, 40 of which were the result of CVD. Elevated CRP levels (> or=5 mg/liter) predicted death from CVD in univariate analyses: HR 3.9 (95% confidence interval [95% CI] 1.2-13.4) for men, and HR 4.22 (95% CI 1.4-12.6) for women. After adjusting for age and sex, the CVD mortality association was strongest in the subgroup of patients who were RF positive at baseline (adjusted HR 7.4 [95% CI 1.7-32.2]). Multivariate analysis revealed that elevated CRP levels remained a significant independent predictor of death from CVD, even after adjusting for age, sex, smoking status, HAQ score, RF positivity, and swollen joint counts (HR 3.3 [95% CI 1.4-7.6]). CONCLUSION: The CRP concentration at baseline is an important predictor of subsequent death from CVD in patients with new-onset IP and is independent of other indicators of disease severity. This supports the theory that CRP may play a direct role in the pathogenesis of CVD.

Adult↗
PubMed2005

Epidemiology of systemic vasculitis.

The systemic vasculitides are heterogeneous conditions of unknown etiology characterized by inflammation and necrosis of different sized blood vessels. Wegener's Granulomatosis, microscopic polyangiitis, and Churg Strauss syndrome are associated with anti-neutrophil cytoplasmic antibodies and affect small and medium blood vessels. They are very rare in childhood and peak in the 65 to 70 year old age group. Wegener's Granulomatosis appears to be more common in the North of Europe compared with the South. All are more common in whites compared with other populations. Genetic and environmental factors, including infection, drugs, and silica, are important in etiology. Giant cell arteritis is predominantly a disease of whites over the age of 50. It appears more common in individuals with Nordic descent. Incidence may be increasing over time and cyclical variation in disease may reflect an infectious etiology. Takayasu arteritis is a disease of the aorta and its branches, however pulmonary and cardiac arteries may be involved. Patients are usually under 40-years of age at presentation and there are no apparent differences in incidence or clinical characteristics/aortic involvement across the globe. Kawasaki disease (KD) and Henoch-Schonlein purpura are diseases of children and rarely affect adults. Both have been reported to be more common in Asians than whites. The incidence of KD is higher in Japan and China compared with other regions. No definite trigger factors have been found, but KD has been linked to infection, house dust mite and chemicals, and Henoch-Schonlein purpura to a pesticide and drugs.

Asia↗
PubMed2005

What is known about the epidemiology of the vasculitides?

The vasculitides are conditions of unknown aetiology. Until recently, relatively little was known about their incidence and prevalence, but there are now increasing data, especially from Europe. These are conditions of the extremes of age. Kawasaki disease occurs predominately in Asian children, with a peak annual incidence of 90/100,000 children aged under 5 years. Henoch-Schonlein purpura has an incidence of 70/100,000 in those aged 4-7 years and is also more common in Asians. Primary systemic vasculitis has a peak incidence 6/100,000 in those aged 65-74 years. Giant cell arteritis is most common in Caucasians aged over 70 years, with an incidence of 53/100,000. Vasculitis has been associated with malignancy, the association being strongest between haematological malignancies and cutaneous vasculitis. There is occasionally a temporal association; failure to respond appropriately to therapy should prompt a search for malignancy. Lesions suspicious of malignancy should be biopsied even if the diagnosis of vasculitis has been histologically proven.

Age Factors↗
PubMed2004

Epidemiology of the vasculitides.

The epidemiology of systemic vasculitis is becoming increasingly well understood. Giant cell arteritis is the commonest type of vasculitis with an incidence that is highest in populations of Scandinavian descent, where the annual incidence reaches 15 to 35/100,000 aged > 50 years. Takayasu's arteritis has a relatively uniform global incidence of one to two/million. The ANCA-associated vasculitides have an overall incidence of 20/million with a peak age of onset at 65 to 74 years. Wegener's granulomatosis appears to be more common in northern Europe compared with microscopic polyangiitis, which seems to be more common in southern Europe. Henoch-Schönlein purpura is the commonest form of childhood vasculitis in the West with an incidence of 20/100,000 aged < 17 years, but it is much rarer in adults (13/million). Kawasaki disease is commonest in the childhood population of southeast Asia; in Japan the incidence is 500/million aged < 5 years, 50% of cases occur in those aged < 2 years. Behçet's disease occurs along the Silk Road and in the Mediterranean littoral with a prevalence in Turkey of 380/100,000. The various types of vasculitis have very different geographical and ethnic distributions, which provide clues to the pathogenesis.

Journal Article↗
PubMed2003

Investigation of quality of life, mood, pain, disability, and disease status in primary systemic vasculitis.

OBJECTIVE: To assess quality of life (QOL) and psychological adjustment in primary systemic vasculitis (PSV), and to assess their relationship to disease-related measures. METHODS: Fifty-one PSV patients completed questionnaires assessing QOL (Short Form 36 [SF-36]), disability (Health Assessment Questionnaire [HAQ]), and mood (Hospital Anxiety and Depression Scale [HADS]). Illness-related measures, disease activity, and permanent damage scores (the Birmingham Vasculitis Damage Index [BVDI] modified, and the Birmingham Vasculitis Activity Scale modified) were collected. Aspects of the HAQ's psychometric properties were evaluated. RESULTS: PSV patients' SF-36 scores, except for mental health, were significantly lower than the norms, indicating poorer QOL. Using the HADS, 43.2% of patients reported increased anxiety symptoms and 25.5% increased depressive symptoms. Patients with increased pain when compared with those with little or no pain had significantly impaired scores in all SF-36 subscales, except for mental health; and they scored significantly worse on depression, fatigue, problems with sleep, and symptom severity. Patients with neuropathic symptoms and those taking high levels of steroids had significantly impaired scores on some of the relevant measures. There were no significant correlations between the modified BVDI scores with the SF-36 subscales or with the other self-report disease-related measures. The HAQ showed high internal consistency and high concurrent and discriminant validity. CONCLUSION: Many aspects of QOL are significantly impaired in PSV. Self-reported pain and disease symptoms, SF-36 scores, and depression and anxiety levels are significant indicators of the adverse impact of vasculitis on patients' lives that need to be assessed and managed.

Adaptation, Psychological↗
PubMed2003

Are environmental factors important in primary systemic vasculitis? A case-control study.

OBJECTIVE: To investigate the association between primary systemic vasculitis (PSV) and environmental risk factors. METHODS: Seventy-five PSV cases and 273 controls (220 nonvasculitis, 19 secondary vasculitis, and 34 asthma controls) were interviewed using a structured questionnaire. Factors investigated were social class, occupational and residential history, smoking, pets, allergies, vaccinations, medications, hepatitis, tuberculosis, and farm exposure in the year before symptom onset (index year). The Standard Occupational Classification 2000 and job-exposure matrices were used to assess occupational silica, solvent, and metal exposure. Stepwise multiple logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) adjusted for potential confounders. Total PSV, subgroups (47 Wegener's granulomatosis [WG], 12 microscopic polyangiitis, 16 Churg-Strauss syndrome [CSS]), and antineutrophil cytoplasmic antibody (ANCA)-positive cases were compared with control groups. RESULTS: Farming in the index year was significantly associated with PSV (OR 2.3 [95% CI 1.2-4.6]), with WG (2.7 [1.2-5.8]), with MPA (6.3 [1.9-21.6]), and with perinuclear ANCA (pANCA) (4.3 [1.5-12.7]). Farming during working lifetime was associated with PSV (2.2 [1.2-3.8]) and with WG (2.7 [1.3-5.7]). Significant associations were found for high occupational silica exposure in the index year (with PSV 3.0 [1.0-8.4], with CSS 5.6 [1.3-23.5], and with ANCA 4.9 [1.3-18.6]), high occupational solvent exposure in the index year (with PSV 3.4 [0.9-12.5], with WG 4.8 [1.2-19.8], and with classic ANCA [cANCA] 3.9 [1.6-9.5]), high occupational solvent exposure during working lifetime (with PSV 2.7 [1.1-6.6], with WG 3.4 [1.3-8.9], and with cANCA 3.3 [1.0-10.8]), drug allergy (with PSV 3.6 [1.8-7.0], with WG 4.0 [1.8-8.7], and with cANCA 4.7 [1.9-11.7]), and allergy overall (with PSV 2.2 [1.2-3.9], with WG 2.7 [1.4-5.7]). No other significant associations were found. CONCLUSION: A significant association between farming and PSV has been identified for the first time. Results also support previously reported associations with silica, solvents, and allergy.

Adolescent↗
PubMed2003

Epidemiology of the vasculitides.

The past year has seen some notable publications in the field of vasculitis epidemiology. The appearance of reports from several different parts of the world has permitted comparisons to be made. In Europe, Wegener granulomatosis appears to be more common at high latitudes, whereas microscopic polyangiitis shows the reverse pattern. Kawasaki disease is most common in Japan. In China, the United States, and the United Kingdom, the incidence is lower, but the incidence appears to be increasing globally. Studies of infectious triggers continue to be disappointingly negative. Immunogenetic associations with cytokine polymorphisms are beginning to be reported.

Epidemiologic Studies↗
PubMed2003

Development of resource-use and expenditure questionnaires for use in rheumatology research.

OBJECTIVE: To develop a self-completion and postal resource-use and expenditure questionnaire for use in economic studies of early inflammatory polyarthritis (IP). METHODS: Identification of cost-generating events associated with early IP through a literature review and focus groups of IP patients and their partners. The information obtained was used to inform the development of self-completion postal resource-use and expenditure data collection instruments/questionnaires in terms of structure and content. Finally, the developed questionnaire was pilot-tested and validated in populations in 2 geographically different areas. RESULTS: The main cost categories identified through the focus groups, and used in the development of the questionnaires, included forgone leisure time and activities, reliance on other people, life events, emotions, help with everyday chores, travel, and over-the-counter medication. Pilot-testing the questionnaires resulted in high unit and item response rates, and high acceptability and ease of completion by respondents, as well as generalizability to different geographical settings. Where possible, collected data were validated against alternative data sources, and agreement was good. CONCLUSION: Overall, resource-use and expenditure questionnaires developed in this study were shown to be highly acceptable to respondents, easy to complete, and generalizable to different geographical settings within the UK.

Arthritis↗
PubMed2002

New mutations of CIAS1 that are responsible for Muckle-Wells syndrome and familial cold urticaria: a novel mutation underlies both syndromes.

Mutations of CIAS1 have recently been shown to underlie familial cold urticaria (FCU) and Muckle-Wells syndrome (MWS), in three families and one family, respectively. These rare autosomal dominant diseases are both characterized by recurrent inflammatory crises that start in childhood and that are generally associated with fever, arthralgia, and urticaria. The presence of sensorineural deafness that occurs later in life is characteristic of MWS. Amyloidosis of the amyloidosis-associated type is the main complication of MWS and is sometimes associated with FCU. In FCU, cold exposure is the triggering factor of the inflammatory crisis. We identified CIAS1 mutations, all located in exon 3, in nine unrelated families with MWS and in three unrelated families with FCU, originating from France, England, and Algeria. Five mutations--namely, R260W, D303N, T348M, A439T, and G569R--were novel. The R260W mutation was identified in two families with MWS and in two families with FCU, of different ethnic origins, thereby demonstrating that a single CIAS1 mutation may cause both syndromes. This result indicates that modifier genes are involved in determining either a MWS or a FCU phenotype. The finding of the G569R mutation in an asymptomatic individual further emphasizes the importance of such modifier a gene (or genes) in determining the disease phenotype. Identification of this gene (or these genes) is likely to have significant therapeutic implications for these severe diseases.

Adolescent↗