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Biomedical subjects

E C Huskisson

Publications and source records attributed to E C Huskisson.

At least 37 records · Page 2Linked to original sources
PubMed1991

Joint space in radiologically normal knees.

Joint space loss is a characteristic feature of rheumatoid arthritis and osteoarthritis. It cannot be fully evaluated, however, without knowledge of the normal variability of joint space size. We have measured joint space size using digital image analysis in a population of radiologically normal individuals. Anteroposterior films of the knee were studied from 685 consecutive patients attending Casualty with unexplained knee pain or following trauma, but with no clinical or radiological evidence of arthritis. Results show that in a radiologically normal population, men have larger joint spaces than women and there is a steady decline in joint space size with age. We found no significant difference in joint space size between weight bearing and non-weight bearing women. There was also no difference in patients presenting with pain and those presenting following an injury. Normal joint space size was not related to height, weight or body mass index in a subgroup of 213 patients. We suggest that patients lose joint space with increasing age and eventually reach a 'pain threshold' at which symptoms of osteoarthritis occur. This explains the increase in joint symptoms in those who begin with smaller joint spaces; that is in women and in the elderly.

Adolescent↗
PubMed1991

A clinical comparison of two leading non-steroidal anti-inflammatory drugs.

One hundred patients with rheumatoid arthritis were entered into a randomised, double-blind, cross-over study of naproxen (500 mg b.d.) and diclofenac (50 mg t.i.d.). Each treatment period lasted four weeks with a wash-out period of up to one week on admission and again between periods of active therapy. Compared with baseline, both treatments significantly reduced the duration of morning stiffness, Ritchie Articular Index, daytime and night-time pain and produced a significant improvement in the disease status. Forty-two non-serious presumed side-effects were reported in 21 patients (21%). All were characterised by common everyday signs and symptoms. These largely related to the upper gastrointestinal tract and typical of those commonly reported for non-steroidal anti-inflammatory agents. There were no statistically significant differences between the two treatments for any of the efficacy parameters or in the incidence of side-effects. Patients also expressed an equal preference for the two drugs.

Adult↗
PubMed1991

Four commonly prescribed non-steroidal anti-inflammatory drugs for rheumatoid arthritis.

A four-way single-blind crossover study was used to compare the efficacy and tolerance of four non-steroidal anti-inflammatory drugs. In addition, pain intensity was compared during the day, at night, at rest, on walking, in the most painful joint, and with the patients most painful activity. Ninety-six patients with rheumatoid arthritis took single daily doses of controlled release naproxen (N), diclofenac S.R. (D), indomethacin S.R. (I) and standard piroxicam (P). The greatest changes from baseline after treatment were seen in those patients with the highest initial pain measurement scores. Assessments of pain in the morning, in the most painful joint and the most painful activity were more discriminating than those at noon or at rest. Of the treatments, 'N' and 'P' were the most effective in reducing pain, with statistically significant differences from baseline. 'I' was the most effective in reducing morning stiffness. Adverse experiences were generally mild, occurring more frequently on 'I' than on other treatments.

Administration, Oral↗
PubMed1991

The use of radiographs in assessing the severity of knee osteoarthritis.

Conventional radiographic grading of the knee has been used for 30 years and is based around the presence of osteophytes. About 50% of subjects from the general population meeting traditional radiographic criteria are asymptomatic or have no signs of clinical disease. Recent development in the use of different radiographic grading systems involve more attention to joint space and categorization of discrete radiographic findings. These techniques include new grading scales that use a combination of separate radiographic features; microfocal radiography and digitized image analysis of joint space. It is hoped these might reflect more closely the pathological processes and correlate more closely with clinical severity.

Female↗
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

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↗
PubMed1989

The automatic assessment of knee radiographs in osteoarthritis using digital image analysis.

We have developed an automatic system for the measurement of joint space in the knee using computerized analysis of digital stored images of knee radiographs. PA X-rays of the knee are positioned on a conventional viewing box. A video image of the radiograph is converted to digital form, stored and displayed on a closed circuit television monitor. This is edited and analysed by a microcomputer. After careful positioning under a computer generated grid on the television screen, automatic measurements are made using an edge detection facility. Two different edge detection algorithms were compared. Reproducibility is very good. Inter- and intra-observer relationships are also good with no significant difference between observers using a paired t-test and very good correlations. Results show that rapid, reliable and accurate measurement of joint space size can be achieved using digital image analysis. The application of image handling computers to radiological scoring is important in our understanding of joint destruction and the progression of the rheumatic diseases.

Algorithms↗
PubMed1989

Development of a new radiographic scoring system using digital image analysis.

A scoring system using computerised analysis of digital stored images of knee radiographs has been developed. Measurement is based on the assessment of joint space size. It is sensitive, rapid, and reproducible. Plain radiographs are positioned on an acetate grid; a computer generated grid is superimposed on a digital image of the radiograph viewed on a closed circuit television monitor and the joint space measured automatically. Area and distance have been assessed; area measurements are more reproducible. Application of microcomputer based digital image analysis to radiological scoring systems is an important step in understanding the nature and progression of arthritis.

Arthritis↗
PubMed1989

A rational approach to the prevention and treatment of postmenopausal osteoporosis.

Postmenopausal osteoporosis is a common disorder. Its importance is measured by the mortality and morbidity associated with increasing numbers of fractures and the enormous social and economic cost to the community. Although the precise aetiology of postmenopausal osteoporosis remains unclear, prevention is now possible and treatment may be effective if commenced early enough in the course of the disease. Combination therapy with oestrogens and progestogens is currently the treatment of choice for prevention, in conjunction with calcium supplementation and changes in lifestyle. Prophylaxis should be offered to women at 'high risk', although the identification of this group is difficult at present. Treatment of existing disease is less effective, although oestrogens should be tried first, with calcitonin as a second choice. There is no place at present for vitamin D, anabolic steroids or parathyroid hormone. The use of fluoride or diphosphonates cannot be recommended outside research centres until further long term studies are completed, which will enable a comparison of the relative risks and benefits. Postmenopausal osteoporosis is now a preventable disease; however, further knowledge of risk factors and the identification of those at risk is essential. Treatment can then be directed at women who need it and healthy women can be spared a lifetime of unnecessary medication.

Estrogens↗
PubMed1988

Progressive joint damage during penicillamine therapy for rheumatoid arthritis.

Progressive joint damage characterises rheumatoid arthritis despite treatment with slow-acting drugs such as penicillamine. We examined a cohort of 145 RA patients, treated with 250 or 500 mg penicillamine daily for 18 months to study progressive joint damage measured using Larsen's standard radiographs. Overall damage increased significantly over 18 months at both doses of penicillamine. Radiological changes between 6-18 months were studied in detail in 55 cases. They were divided into rapidly progressive (increases in Larsen score of more than 5) or slowly progressive (increases in Larsen score of 5 or less). Overall clinical response, visual analogue pain score, ESR, haemoglobin and platelet count were significantly lower in the slowly progressive patients; articular index and duration of morning stiffness were slightly lower; latex titre, RAHA titre, joint size and white cell count showed no differences between groups. There is an indirect relationship between progressive joint damage and some clinical and laboratory measures. The reasons underlying our failure to control progression in some cases need further definition.

Adult↗
PubMed1988

The clinical value of measuring immunoglobulins when assessing penicillamine therapy in rheumatoid arthritis.

Immunoglobulins are often high in active rheumatoid arthritis and fall when treatment with a slow-acting anti-rheumatic drug is instituted. We assessed the value of monitoring immunoglobulins during penicillamine therapy; 145 patients were followed for up to 5 years, IgA, IgM and IgG levels were compared to 12 other clinical and laboratory variables on 903 occasions. Mean levels of IgA and IgG fell by 10-30%. These changes were less than with ESR or clinical measures such as articular index and duration of morning stiffness. Immunoglobulin levels showed weak correlations with other variables. Only a small number of patients had hypogammaglobulinemia. Initially, 5 cases had low IgA with subsequent falls in 3 more. Initially, 2 cases had low IgG with subsequent falls in 5 more. No patients had low IgM levels. These changes seemed clinically irrelevant. Radiological progression was related to IgA levels. Patients with persistently high rates of radiological progression had persistently higher serum IgA. We conclude that IgM gives the most "acute phase" pattern of response. IgA gives more theoretically interesting information, especially concerning radiological progression. There is only a limited amount of clinically valuable information gained from measuring immunoglobulins.

Adult↗
PubMed1988

99Tcm-labelled leucocyte imaging in active rheumatoid arthritis.

A simplified technique of labelling leucocytes with technetium-99m is described and applied to patients with active rheumatoid arthritis. The clinically active and less active knees in seven patients were imaged and the uptake of labelled leucocytes was measured. The measurements were repeated after local steroid injection into nine painful knees. A 50-80% reduction in leucocyte uptake localized to the region of the synovium was demonstrated in the eight knees which showed clinical responses and a rise of 8% in the non-responder. There was a variable response in the knees that were not injected. 99Tcm leucocyte imaging in rheumatoid arthritis is able to assess objectively joint inflammation and its response to treatment.

Aged↗