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Biomedical subjects

E B Hamilton

Publications and source records attributed to E B Hamilton.

At least 37 records · Page 2Linked to original sources

Anti-keratin antibodies in rheumatoid arthritis: frequency and correlation with other features of the disease.

Anti-keratin antibodies (AKA) were detected in 68 out of 98 patients (69%) with classical or definite rheumatoid arthritis (RA). The intensity of the AKA reaction correlated significantly with articular index (AI), grip strength (GS), erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) concentration, serum amyloid A (SAA) protein concentration, the level of antibodies against single stranded DNA (ssDNA) and the IgM rheumatoid factor (RF) titre. A significantly higher number of patients with nodules and Sjögren's syndrome were AKA positive compared with patients without extra-articular features (EAFs) and the AKA titre was significantly greater in the former group. The mechanisms underlying appearance of AKA are not known but may relate to an as yet unidentified structural alteration of keratin in this disease or may just reflect the rheumatoid autoimmune diathesis.

Adult↗

Naproxen sodium, diflunisal, and placebo in the treatment of chronic back pain.

Thirty-seven patients with chronic back pain were entered into a randomised, 3-way, double-blind, cross-over comparison of naproxen sodium 550 mg twice daily, diflunisal 500 mg twice daily, and placebo. Each treatment was given for 14 days after a preadmission wash-out week during which only paracetamol was allowed. Patients were assessed on admission and at the end of each treatment with respect to global pain, night pain, pain on movement, and pain on standing. Both visual analogue scales and simple descriptive scales were used to measure pain. Side effects were elicited by a nonleading question. Both methods of pain measurement gave similar results and were highly correlated. Naproxen sodium was superior to placebo in relieving global pain and depending on the method of measurement, in relieving night pain and pain on movement. Diflunisal showed no significant differences from placebo. Side effects were similar on all 3 treatments. The final preference of the patients was significantly in favour of the active treatments.

Adult↗

Indoprofen compared with naproxen and placebo in rheumatoid arthritis.

Thirty-six patients suffering from rheumatoid arthritis took part in a double-blind controlled cross-over trial, in which they received either indoprofen 800 mg daily, naproxen 500 mg daily, or a matching placebo. Each treatment was administered for two weeks. Indoprofen was shown to be significantly superior as an analgesic and in improving grip strength, and was the drug the patients preferred. Adverse effects were comparable, although indigestion was seen slightly more often during indoprofen treatment. Indoprofen is therefore at least as effective as existing anti-inflammatory drugs in rheumatoid arthritis and should be used as an alternative.

Adult↗

The natural history of arthritis in idiopathic haemochromatosis: progression of the clinical and radiological features over ten years.

The natural history of arthritis associated with idiopathic haemochromatosis was studied in 18 male patients over a 10 year period. Chondracalcinosis was present radiologically in at least on joint in seven patients initially and developed later in 13, with the articular cartilages of the wrists and knees affected most frequently. During the period of observation seven patients developed chondrocalcinosis in the wrists, seven in the knees, three in the hips, one in the symphysis pubis and two in the spine. In no patient did the chondrocalcinosis decrease or disappear. The development and progression of chondrocalcinosis was not affected by treatment of iron overload by venesection. The presence of chondrocalcinosis in at least one joint was not related to the age of the patient at the initial or follow-up examination or to the amount of iron removed by venesection (p greater than 0.05, Wilcoxon rank sum test). Arthritis (loss of joint space, cysts, destruction of articular surfaces) usually with associated symptoms and signs affected the hands in eight patients initially and developed later in 13. Arthritis of large joints was uncommon and none of the patients in the present series developed destructive arthritis of hips or knees. This contrast with the finding in a retrospective survey of 93 patients with idiopathic haemochromatosis seen since 1967 at King's College Hospital in which seven patients had destructive arthritis affecting the hips.

Adult↗

Antirheumatic activity of fenclofenac.

This study has set out to establish whether fenclofenac has an antirheumatic effect in addition to its anti-inflammatory and analgesic activity. The results show that during the course of a 6-month study the drug improved clinical parameters, including the articular index, early morning stiffness, ring sizes, and grip strength, and produced changes in laboratory measurements such as the levels of C-reactive protein, IgG, and rheumatoid factor.

Adolescent↗

Expectation and patient preference -- does it matter?

Admission to clinical trials is often based on the assumption of homogeneity of the population. A group of 60 patients, all with pain in the neck or shoulder of at least 3 months duration, were studied. Expectation was graded before treatments were started by sharing out 100 points between freedom from side effects, pain relief, depression relief, improved mobility, improved sleep and speed of action. A double-blind crossover study of two established anti-inflammatory analgesics and placebo was carried out. Using analogue scales, patients were asked to grade their response. Side effects were recorded, and preference was established at the end of the study.Although all the patients were in sufficient pain to require medical attention, some rated relief of depression, improvement in sleep or lack of side effects as more important than pain relief. Differences between drug and placebo were most clearly demonstrated in those patients whose main concern was improved mobility. In our view it is important to select patients who are in need of a dominant property of a drug for a trial of this property and this may have ramifications across the medical spectrum.

Apazone↗

Clinical study comparing acupuncture, physiotherapy, injection and oral anti-inflammatory therapy in shoulder-cuff lesions.

In a single-blind trial, five treatments for painful stiff shoulder were compared for a 4-week assessment period in 60 patients. The treatments were acupuncture, steroid injection with placebo and with active tolmetin sodium, physiotherapy in the form of ultrasound and 'placebo' physiotherapy with placebo tolmetin sodium. Objective assessment was gained by use of goniometer readings to monitor shoulder abduction. Pain was measured by visual analogue scales and by a 4-point scale. Comparative assessment was also recorded and at the end of the study a success or failure was recorded for each patient's treatment. With very few exceptions all patients improved markedly, both in terms of the subjective and objective parameters. No differences between the treatments were detected. The incidence and severity of side-effects was low. It is suggested that the results show that the painful stiff shoulder may be a self-limiting condition and that any beneficial effect was really due to natural recovery. This is an important consideration because patients do not always receive immediate attention when referred to an out-patient department and the use of physiotherapy and acupuncture in such cases, perhaps, should be critically examined.

Acupuncture Therapy↗

Dose-range studies of benoxaprofen compared with placebo in patients with active rheumatoid arthritis.

The new nonsteroidal antiinflammatory drug benoxaprofen was compared with placebo in separate double-blind crossover studies in patients with active rheumatoid arthritis given 400 mg, 600 mg, or 800 mg a day. Benoxaprofen was significantly better than placebo at all doses studied. The 800 mg dose was the most effective but there were slightly more gastrointestinal side effects with this dose. The 600 mg dose was more effective than the 400 mg dose with an acceptably low incidence of side effects at both these doses. For most patients, 600 mg once daily will probably be the usual dose of the drug, but some will need the higher dose to 800 mg, while the condition of others may be satisfactorily controlled with just 400 mg daily.

Adolescent↗

Studies on the frequency and pathogenesis of liver involvement in rheumatoid arthritis.

A systematic prospective survey of 100 outpatients with rheumatoid arthritis revealed that 45 had biochemical evidence of liver disease. In most cases this was due to increases in total serum alkaline phosphatase (ALP) and/or gammaglutamyl transpeptidase (GGT). Examination of serum ALP isoenzyme profiles in 50 of the patients showed that the liver isoenzyme was the sole or major component in 44 patients, including many with normal total ALP levels. 18% had raised serum liver ALP together with raised GGT, suggestive of an underlying hepatobiliary lesion. No correlation could be detected between raised serum levels of liver enzymes and the age or sex of the patient, duration or severity of arthritis, and drug or alcohol history. However, there was a significant correlation between raised serum ALP and lacrimal or salivary gland dysfunction. It is suggested that immunological mechanisms may be involved in the development of hepatic abnormalities in rheumatoid arthritis.

Adult↗

Gold lung.

Explore the source record for details and available documents.

Adult↗

Indoprofen and naproxen in the treatment of rheumatoid arthritis: a clinical trial.

Thirty-six patients suffering from rheumatoid arthritis took part in a double-blind crossover trial, in which they received either indoprofen 800 mg/day, naproxen 500 mg/day, or a matching placebo. Indoprofen was shown to be significantly superior as an analgesic and in improving grip strength and the patients preferred it. Adverse effects were comparable, although indigestion was seen slightly more often during indoprofen treatment. Indoprofen is therefore at least as effective as existing anti-inflammatory drugs in rheumatoid arthritis and seems to be better tolerated.

Adult↗

Rheumatic disorders in primary biliary cirrhosis.

Eighty-three patients with primary biliary cirrhosis were investigated to determine the prevalence of rheumatic disorders. 14 had scleroderma, which tended to be mild but in several patients produced severe systemic manifestations. The CRST syndrome (calcinosis, Raynaud's phenomenon, sclerodactyly, telangiectasia) was only identified twice. There was an increased incidence of HLA A1+B8 in those patients with scleroderma. As well as those with scleroderma, 4 patients had a destructive arthropathy resembling avascular necrosis. 4 patients had an inflammatory arthritis, without specific features, but the frequency was no greater than might be expected in the general population.

Adult↗

Radioisotope scanning using a gamma camera.

Sixteen outpatients with rheumatoid arthritis took part in a placebo controlled double-blind crossover study. In addition to conventional measurements, a radioactive index was measured using a gamma camera that indicated a radioactive count over the measured joints and a comparable area of normal adjacent bone. This index showed poor correlation with other conventional measurements of change in the clinical trial.

Arthritis, Rheumatoid↗

Alclofenac and D-penicillamine. Comparative trial in rheumatoid arthritis.

Forty-six patients with rheumatoid arthritis, 22 receiving D-penicillamine and 2j alclofenac, took part in a 6-month single-bind external observer trial to compare the efficacy and toxicity of these drugs in the treatment of severe rheumatoid arthritis. Both drugs were active and similar in their efficacy at 6 months as judged by clinical and laboratory measurements. Penicillamine was active therapeutically by 3 months, one month before alclofenac. 9 patients, 8 on alclofenac and one on D-penicillamine, had to stop treatment because of lack of effect or toxic effects. Skin rashes within the first week of treatment were a major problem with alclofenac and led to 6 withdrawals.

Arthritis, Rheumatoid↗