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Biomedical subjects

G O Littlejohn

Publications and source records attributed to G O Littlejohn.

At least 37 records · Page 2Linked to original sources
PubMed1994

Fibromyalgia syndrome: assessment of the severity of the condition 2 years after diagnosis.

OBJECTIVE: To review the outcome of patients with fibromyalgia syndrome (FMS) diagnosed and treated with minimal intervention in community rheumatology practice. METHODS: Forty-four ambulant patients with FMS, first seen in a 2-month period and treated with a simple management program, were identified and reviewed 2 years after diagnosis. A variety of clinical and psychological features were assessed using standard techniques. RESULTS: Forty-seven percent no longer fulfilled Smythe or ACR criteria for FMS. Remission was objectively identified in 24.2% of assessed patients. Significant differences in objective clinical signs, in symptoms, and in self-described disability were found between patients with and without FMS. Regular physical exercise, rather than drug or specific physical therapies, correlated highly with low FMS activity scores. Analysis of mood and coping strategies at the 2-year review showed low correlations with current FMS activity. CONCLUSION: Community FMS has a better prognosis than the literature suggests. Simple intervention may be associated with good outcome in a significant number of patients with FMS.

Activities of Daily Living↗
PubMed1994

Single anticardiolipin measurement in the routine management of patients with systemic lupus erythematosus.

OBJECTIVE: To examine the usefulness of a single measurement of anticardiolipin antibodies (aCL) in systemic lupus erythematosus (SLE) in routine clinical practice. METHODS: All 127 patients with SLE currently followed by our rheumatology unit had an aCL measurement on routine clinic review. Their charts were then reviewed for specific disease manifestations. Basic statistical correlations of the aCL result and the specific disease manifestations were performed, and the clinical utility of the aCL test assessed using Bayesian analysis. RESULTS: aCL was positive (> 2 SD) in 24% and was associated with recurrent fetal loss, thrombosis, cerebrovascular disease, livedo reticularis and digital infarcts. Bayesian analysis showed that a single positive aCL test increased the relative and absolute risk of all the above complications. The criterion of aCL positivity as > 15 units (2 SD) was associated with the highest relative risk. CONCLUSION: A single positive aCL test in routine management of SLE is a useful predictor of important clinical events.

Adult↗
PubMed1993

A comparative study of clinical signs in fibromyalgia/fibrositis syndrome, healthy and exercising subjects.

Pain threshold to pressure, skinfold tenderness, reactive skin hyperemia and tissue compliance were assessed in 60 subjects with fibromyalgia (FS) and 60 pain free [total control, (TC)] subjects comprising 30 normal controls (NC) and 30 exercising fit (FC) subjects. Pain threshold was significantly lower in FS than in TC (p = < 0.001) and NC (P = < 0.001). Skinfold tenderness was present in 95% of FS and 33% of the NC but was absent in all FC. In patients this tenderness was present both in painful and nonpainful sites, and when positive was significantly (P = < 0.001) more painful than in controls. Reactive skin hyperemia to pressure was significantly (p = < 0.001) increased in patients with FS compared to TC, but not to NC. Tissue compliance at trapezius, thoracic and lumbar locations was significantly (p = < 0.001) lower in patients than in any other controls. The fit subjects significantly differed from the unfit for pain threshold (p = < 0.001), reactive skin hyperemia (p = < 0.001), tissue compliance at right trapezius (p = < 0.001) and right thoracic (p = < 0.001) levels, and for the skinfold test (p = < 0.01). These 4 clinical signs could differentiate patients from controls with a mean accuracy of 86%. Our study indicates that there are clinical signs, apart from the tender points, which are abnormal in FS that appear to be useful as objective signs in the assessment of patients with FS, whether for diagnostic, therapeutic or research purposes.

Adult↗
PubMed1993

Methotrexate therapy in rheumatoid arthritis: a life table review of 587 patients treated in community practice.

To determine whether methotrexate (MTX) maintains its effectiveness in rheumatoid arthritis (RA) in the setting of community based private rheumatology practice we used life table analysis to review the combined experience of a group of these practices. Of 587 patients with RA who started to take MTX, total termination rate at 70 months was 24.4% with most terminations prompted by drug toxicity. Older age (greater than 65 years) was associated with higher rates of toxicity. Treatment termination rates varied substantially between rheumatologists. We conclude that MTX therapy for RA is well tolerated and maintains effectiveness for at least 70 months.

Adult↗
PubMed1992

Continuation of long term treatment with hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis.

BACKGROUND: Hydroxychloroquine is used for the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Long term studies have shown a high rate of termination of hydroxychloroquine treatment in patients with RA. Although it has been shown that discontinuation of treatment with hydroxychloroquine is associated with exacerbation of SLE, long term maintenance rates of treatment with hydroxychloroquine in patients with SLE have not been investigated. METHODS: Hydroxychloroquine use in patients with RA and SLE in a group of patients in a single community rheumatology practice was studied. Information was drawn from a computer drug use database containing details of the beginning and end of treatment. Data were analysed using life table methods. RESULTS: Four hundred and three treatment episodes (366 patients with RA, 37 patients with SLE) were observed over eight years. In patients with RA, the cumulative probability of discontinuing treatment was 37% at 12 months and 54% at 24 months. In contrast, hydroxychloroquine treatment of patients with SLE continued over significantly longer periods of time (p < 0.001); the discontinuation probabilities at 12 and 24 months were 8 and 24% respectively. Treatment terminations were predominantly for inefficacy; terminations for toxicity were limited to the first 19 months of treatment. No ocular toxicity was observed. CONCLUSIONS: Treatment of patients with RA in a community rheumatology practice with hydroxychloroquine has a low probability of long term continuation, mostly because of inadequate control of disease manifestations rather than toxicity. In patients with SLE, treatment with hydroxychloroquine has a significantly higher probability of long term continuation.

Adult↗
PubMed1992

Life table analysis of 879 treatment episodes with slow acting antirheumatic drugs in community rheumatology practice.

In 596 patients with RA managed over a decade in a community practice setting, 879 slow acting antirheumatic drug (SAARD) treatment episodes were analyzed using 5-year life tables. The probability of continuation of therapy was 50% by 9-24 months for all drugs except for methotrexate (MTX), which was 62% by 5 years [corrected]. MTX treatments were of significantly longer duration than those of all other SAARD (p less than 0.001); terminations for both inefficacy (p less than 0.001) and toxicity (NS) were less likely. These findings concur with recent evidence suggesting that MTX is a superior SAARD in this setting.

Adult↗
PubMed1992

Peripheral arthralgic presentation of fibrositis/fibromyalgia syndrome.

Of 216 consecutive new referrals to a general rheumatology clinic 22 (10.2%) had generalized fibromyalgia syndrome (FS). In 12 cases (5.6% of all referrals, 54.5% of patients with FS) the initial presentation was with pain in the region of the hand or wrist joints, but many other joints were painful or tender. Although there may be initial confusion with rheumatoid or osteoarthritis, the positive features of FS confirm the correct diagnosis.

Adult↗
PubMed1991

Lung function abnormalities and decline of spirometry in scleroderma: an overrated danger?

To document the prevalence and progression of pulmonary involvement in scleroderma (systemic sclerosis including the CREST syndrome), the clinical notes and lung function records of 113 cases were reviewed. Lung function was normal in 39 cases, isolated impairment of DLCO was found in 38 patients, a restrictive defect was present in 27 cases and there was evidence of airflow obstruction in 9 cases. The median duration of symptoms was 10 years. Dyspnoea and an interstitial pattern on chest X-ray were associated with impaired lung function. Death during the period of review was significantly related to initial impairment of the DLCO. Sixty-six patients (53 women and 13 men) underwent repeat spirometry at least 1 year after initial testing. The rates of change in VC and FEV1 were no more rapid than would be expected for normal subjects. There was no significant difference in rates of change between men and women or between dyspnoeic patients and those who were asymptomatic. The extent of skin involvement and the presence of interstitial fibrosis on chest X-ray were unrelated to the rate of loss of lung function. It is concluded that most scleroderma patients in this study had abnormal lung function when first tested, but overall significant worsening of spirometry was not found.

Adolescent↗
PubMed1991

Measurement of anti-DNA antibodies by ELISA: a comparative study with Crithidia and a Farr assay.

One hundred and twenty six sera from 116 patients with systemic lupus erythematosus (SLE) and from 51 control patients were assayed for the presence of anti-DNA antibodies, using a commercial enzyme linked immunosorbent assay (ELISA). Fifty three sera (42%) from SLE patients were positive and a further 13 sera (10%) fell in the 'equivocal' positive range. Three control sera were positive. In a standard 14C DNA Farr assay, 67 sera (53%) from SLE patients were positive. One control serum was weakly positive. There was a good linear correlation between absorption in the ELISA and the 14C DNA binding result (r = 0.73). Results in the ELISA and Farr assays were concordant in 96 of the 126 SLE sera, and 47 of 51 control sera. Sequential sera from a further 6 patients with fluctuating clinical activity of SLE showed similar patterns of change of anti-DNA antibodies in both assays. The ELISA was more sensitive than the Crithidia luciliae immunofluorescence assay which detected 44 positive sera (35%) in the SLE group. These results suggest that this ELISA assay may be a useful alternative to the Crithidia assay or an effective screen prior to testing in the more technically difficult and time consuming Farr assay for the measurement of anti-DNA antibodies.

Animals↗
PubMed1990

Medical problems in joint replacement patients: a retrospective study of 243 total hip arthroplasties.

Two hundred and forty-three total hip arthroplasties were performed in 217 patients over a five-year period in one institution. Seventy-one per cent had one or more significant preoperative medical problems, 22% being referred for preoperative management to a specialist physician. Thirty per cent of patients experienced re-activity of medical problems after operation; in 41% of patients a physician review was sought while in a further 40% the problems were apparently unnoticed or not acted upon. There was a positive correlation between preoperative and postoperative medical problems (P less than 0.001). Fifteen per cent of patients developed complications and one patient died. There was a highly significant trend towards longer hospital stay in patients with medical problems and complications (P less than 0.001). It is concluded that there is a high incidence of medical problems in joint replacement patients, that these problems have an influence on the morbidity and cost of the procedure, and that management of these problems can be improved.

Acute Kidney Injury↗
PubMed1990

Current thinking on fibromyalgia syndrome.

Fibromyalgia (fibrositis) syndrome (FS) is a common and chronically painful form of non articular rheumatism. A high count of tender points is characteristic, but there are no confirmatory laboratory tests--the diagnosis is clinical. The cause is unknown, although a number of recognised factors are important in the expression of the condition.

Diagnosis, Differential↗
PubMed1989

Female adolescent rheumatological presentations: the importance of chronic pain syndromes.

The clinical features of 60 female adolescents (mean age 15 +/- 0.3 years) presenting consecutively to a rheumatologist are reviewed. Thirty-five per cent met criteria for well-defined chronic pain syndromes, 19 having fibrositis syndrome and two having a reflex sympathetic dystrophy syndrome. Other diagnoses were inflammatory arthritis (30%), anterior knee pain syndromes (13.3%), tendinitis (8.3%) and miscellaneous conditions (13.3%). The high prevalence of chronic pain syndromes in this patient group is highlighted and an approach to management is suggested.

Adolescent↗
PubMed1989

The scleroderma neck sign.

The scleroderma neck sign, as described by Barnett, is a visible and palpable tight band over platysma in the hyperextended neck. A recent survey of 76 patients with scleroderma revealed that more than 90% had the scleroderma neck sign. Our study was performed using 15 patients with scleroderma and 30 controls including 3 with primary Raynaud's disease to examine the specificity of the scleroderma neck sign, and to look for a correlation between the presence of the scleroderma neck sign and histological changes of scleroderma in the skin overlying platysma. The scleroderma neck sign was present in 12 of the 15 patients with scleroderma but in none of the 30 controls. It was found both in patients with diffuse (5 out of 5) and limited (7 out of 10) scleroderma. In 10 of the 12 cases where the scleroderma neck sign was positive, there were characteristic histological changes of scleroderma on biopsy of the skin overlying platysma, in 1 there were nondiagnostic abnormalities, and in 1 the biopsy was unsatisfactory. The 3 patients with scleroderma in whom the scleroderma neck sign was absent had either nondiagnostic changes (1) or normal biopsies (2). The 3 patients with Raynaud's disease had normal skin biopsies. The scleroderma neck sign appears to be produced by scleroderma changes in the skin of the neck. In limited or early scleroderma where these changes are otherwise clinically inapparent, the scleroderma neck sign may be diagnostically useful.

Adult↗
PubMed1989

Fibrositis/fibromyalgia syndrome in the workplace.

A recent major epidemic of localized fibrositis/fibromyalgia syndrome occurring in the workplaces of Australia is reviewed. The clinical features are described and the important provoking factors are detailed. A neurogenic model is proposed to explain this localized phenomena and also encompass primary generalized fibrositis/fibromyalgia syndrome.

Australia↗