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Biomedical subjects

H A Bird

Publications and source records attributed to H A Bird.

At least 73 records · Page 4Linked to original sources
PubMed1990

A multicentre double-blind comparison of auranofin, intramuscular gold thiomalate and placebo in patients with psoriatic arthritis.

The efficacy and safety of the oral gold compound auranofin and intramuscular gold thiomalate have been compared in a placebo-controlled, double-blind, four-centre trial in 82 patients with psoriatic arthritis requiring remittive drug therapy. There were statistically significant falls in Ritchie articular index, visual analogue pain score and ESR at 12 and 24 weeks following i.m. gold but no significant changes in the auranofin group. Intramuscular gold was safe and more effective than auranofin as a second-line, suppressive antirheumatic agent for patients with psoriatic arthritis when followed for 6 months.

Adult↗
PubMed1990

Methylsulphasalazine in rheumatoid arthritis.

Methylsulphasalazine, which differs from sulphasalazine by the addition of one methyl group, may provide the benefits of the parent drug with fewer side-effects in rheumatoid arthritis (RA). We describe the outcome of its use in RA. Of 21 patients entered into the study, 10 successfully completed 6 months of therapy; five developed adverse effects, four withdrew for reasons unrelated to drug treatment and two stopped because of inefficacy. No serious adverse effects were reported. A statistically significant improvement in most clinical assessments was observed from weeks 8-12 onwards. Significant improvement in plasma viscosity was observed and there was a trend towards improvement in serum CRP, histidine and IgM concentrations. There was a good correlation between mean serial changes in clinical and biochemical assessments indicating that the drug may exhibit the properties of a second-line agent. Median steady-state serum concentrations of methylsulphasalazine and methylsulphapyridine were 26.6 micrograms/ml and 2.85 micrograms/ml respectively.

Adult↗
PubMed1990

A double-blind crossover study to compare lysine acetyl salicylate (Aspergesic) with ibuprofen in the treatment of rheumatoid arthritis.

Lysine acetyl salicylate [1.8 g t.d.s. (Aspergesic 1,000 sachet)] has been compared to 400-mg ibuprofen tablets t.d.s. in a randomized double-blind trial in patients with rheumatoid arthritis using double-dummy technique. Both drugs proved effective in relieving symptoms. Three patients experienced drug-related side-effects with Aspergesic, and one patient with ibuprofen, that necessitated early discontinuation of treatment. Aspergesic was associated with a greater number of haemoglobin values falling below the normal range than ibuprofen. At the end of the study, eight out of 10 patients who expressed a preference selected Aspergesic for improving mobility whilst 15/24 selected Aspergesic for improving pain.

Adult↗
PubMed1990

Measurement of plasma concentrations of polymorphonuclear elastase-alpha 1 proteinase inhibitor (elastase-alpha 1 antitrypsin) in patients with rheumatoid arthritis: interference by rheumatoid factor.

The plasma concentration of granulocyte elastase in complex with alpha 1 proteinase inhibitor was determined in 32 patients with rheumatoid arthritis and eight with seronegative spondarthritis complicated by peripheral joint synovitis. Most patients had concentrations of complex which were within the range of the control group when measured by an 'in-house' enzyme linked immunosorbent assay, though several of the patients with rheumatoid arthritis had raised concentrations. When the complexes were measured by a commercially available assay, however, much higher values were obtained for many of the patients with rheumatoid arthritis. Evidence is presented indicating that the commercially available assay may suffer seriously from interference by rheumatoid factor. The possibility is discussed that most patients with rheumatoid arthritis may have plasma concentrations of elastase-alpha 1 PI which are normal or only slightly raised, and that previously published reports using assay systems similar to that available commercially might also have produced falsely raised values for many individuals with rheumatoid arthritis.

Adult↗
PubMed1990

Drug toxicity.

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Analgesics↗
PubMed1990

Comparison of the single dose pharmacokinetics of sulphasalazine in rheumatoid arthritis and inflammatory bowel disease.

The pharmacokinetics of sulphasalazine and its principal metabolites in rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) were compared. Patients with RA had a significantly greater concentration of plasma sulphapyridine than patients with IBD (medians 14.0 micrograms/ml and 7.4 micrograms/ml respectively). Patients with RA also tended to maintain a higher plasma sulphapyridine concentration with time, as determined by the area under the curve (AUC), but a lower plasma sulphasalazine AUC than patients with IBD. It is suggested that more sulphasalazine may be presented to the lower bowel for cleavage to sulphapyridine and 5-aminosalicylic acid in patients with RA than in IBD. Patients with RA may also have impaired metabolism of sulphapyridine as a consequence of their disease. Together these factors may contribute to higher peak circulating sulphapyridine concentrations and may be responsible for the higher incidence of side effects of sulphasalazine treatment in patients with RA than in patients with IBD.

Adult↗
PubMed1990

Medical treatment for rheumatic diseases.

Rest, physiotherapy, joint protection, patient education and counselling all play an important role alongside drug therapy and surgery in the management of a chronic disorder such as rheumatoid arthritis. Patients expect their physician to take the initiative in integrating the members of the multi-disciplinary team devoted to their care. The physician will also instigate drug therapy. In early disease, an analgesic ('for pain') may supplement a non-steroidal anti-inflammatory drug ('for stiffness'). A variety of such drugs are available with various advantages and disadvantages. For more severe, progressive disease a 'second-line' or disease-modifying drug may be prescribed. Typical examples are injectable gold, penicillamine, antimalarials, sulphasalazine and methotrexate. The prescription of any of these represents a calculated risk: the benefits of treatment have to be balanced against the likely side-effects. A variety of intra-articular treatments are also available for providing some localisation of response and sometimes obviating the need for surgery which should be the subject of close collaboration between the rheumatologists and orthopaedic surgeons.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

Alternative therapy for rheumatic diseases.

The wide variety of alternative therapies available for rheumatic diseases attests to the inability of the medical profession to provide patients with adequate cures. Many patients resort to alternative remedies even if these are not always declared to the physician. Our own studies have included assessments of injectable enzyme preparations, vitamins and the use of healing in conjunction with the Confederation of Healing Organisations. Other well controlled trials have been made of diet, nutritional supplements and natural remedies such as green lipped muscle preparations. Unfortunately, the controlled scientific evidence of efficacy is often eclipsed by extravagant advertising claims for subjective enthusiasm of patients who suffer from a variety of conditions, many of which undergo a natural cyclical variation in severity. The clinical assessments used in such trials require critical appraisal.

Clinical Trials as Topic↗
PubMed1990

A comparison of choline magnesium trisalicylate and acetylsalicylic acid in patients with rheumatoid arthritis.

Choline magnesium trisalicylate (3.0 g/day) and enteric-coated acetylsalicylic acid (3.0 g/day) have been compared in a double-blind, crossover study on 19 patients with rheumatoid arthritis using the double-dummy technique. Patients were allocated to receive 3-weeks' treatment with each trial drug in random sequence and were assessed at Weeks-1, 0, 3 and 6. Apart from an unexplained significant improvement in grip strength (p less than 0.01) that occurred in patients on choline magnesium trisalicylate when this followed aspirin but not when it preceded it, there was no significant clinical difference between treatments in any of the clinical parameters of improvement that were measured. There was also no clear difference in the side-effects profile produced by the two drugs, but the number of patients recruited to this study was small.

Adolescent↗
PubMed1990

A clinical and biochemical assessment of a nonthiol ACE inhibitor (pentopril; CGS-13945) in active rheumatoid arthritis.

Captopril, which is a thiol containing angiotensin converting enzyme (ACE) inhibitor that has a close structural similarity to D-penicillamine, behaves as a disease modifying antirheumatic drug (DMARD) in rheumatoid arthritis (RA). In order to ascertain whether the DMARD-like properties of captopril reside in its ability to inhibit ACE or in the thiol group, we evaluated pentopril (CGS-13945) in patients with active RA. This recently synthesized drug is a nonthiol containing ACE inhibitor. Pentopril produced little clinical improvement and no biochemical improvement in a group of 15 patients with RA, many of whom were unable to tolerate it because of in-effect or side effects. A reduction in serum ACE activity and a modest fall in blood pressure suggested that the drug was exerting its pharmacological effect. Our study strengthens the argument that the therapeutic benefit of captopril in RA probably lies in its thiol group rather than in its enzyme inhibition properties, and that the thiol group may be the effective moiety in some other DMARD.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

An assessment of tenoxicam, a nonsteroidal anti-inflammatory drug of long half-life, in patients with impaired renal function suffering from osteoarthritis or rheumatoid arthritis.

Fifty-eight patients, aged 48-87 years, with impaired renal function and mean initial creatinine clearance of 52.1 mls/min were recruited to a 12-week open study of tenoxicam 20 mg/day for osteoarthrosis or rheumatoid arthritis. Renal function was measured before and after a brief run-in period when patients discontinued all nonsteroidal anti-inflammatory drugs, taking paracetamol alone, prior to monthly monitoring thereafter. Fifty-four % of patients completed the study, the others being withdrawn from lack of efficacy (17%), adverse events (24%) or both (5%). During the run-in period the mean creatinine clearance of 28 patients completing the trial improved to 64.7 mls/min and then dropped to 57.9 mls/min during the course of 12 weeks treatment with tenoxicam. Serial analysis of haematological and biochemical safety parameters showed no drug-induced change of significance. Twenty-three% of patients felt worse and 45% better at the end of treatment. Seventeen patients withdrew because of adverse events. These were normally gastrointestinal and always unrelated to further deterioration in renal function. Tenoxicam, 20 mg/day, can be given safely for a period of at least three months in patients with mild or moderate renal impairment.

Aged↗
PubMed1989

The evaluation of a nonsteroidal anti-inflammatory drug (tenoxicam) in the treatment of sleep disturbance in osteoarthritic patients.

The effects of a nocturnal nonsteroidal anti-inflammatory drug (tenoxicam) on twelve male osteoarthritic patients were investigated in a randomised, double-blind, placebo-controlled, cross-over study. Tenoxicam produced no significant changes in any of the areas evaluated which included electroencephalographic (EEG) sleep, subjective sleep, pain and early morning stiffness. The selection of patients may have contributed to this unexpected result. There was no evidence to suggest that tenoxicam caused any unwanted side-effects or affected early morning psychomotor performance. The use of the sleep EEG as an objective pain measure is discussed.

Aged↗
PubMed1989

A clinical and biochemical assessment of prinomide in patients with rheumatoid arthritis.

Prinomide (CGS-10787B), a potential disease modifying drug, was evaluated clinically and biochemically in 15 patients with active rheumatoid arthritis. The single group study design included monthly assessments of 7 clinical measures and 22 laboratory measures. Twelve patients completed 24 weeks' therapy with prinomide 1.2 g/day. All clinical variables showed improvement which consistently reached statistical significance for articular index from Week 8 (p less than 0.01), for summated change score from Week 12 (p less than 0.01) and for pain score from Week 16 (p less than 0.05). Sustained significant improvement in laboratory variables was seen by Week 2 for erythrocyte sedimentation rate and platelet count (both p less than 0.05), and by Week 4 for plasma viscosity (p less than 0.01), IgG, IgA, IgM (all p less than 0.05).

Aged↗
PubMed1989

Drug prospects in osteoarthritis.

The traditional treatment for osteoarthritis is with analgesics, NSAIDs and intra-articular steroids. The development of novel analgesics and the reformulation of steroids to enhance local activity both deserve attention. The disease's slow course makes evaluation of new drugs difficult. More sensitive assessments or perhaps human models of accelerated progression are required. Amongst the drugs that might have fundamental action, hyaluronic acid and the so-called 'chondroprotective' agents have attracted recent interest. Their development highlights the difficulty of reconciling adequate dose-ranging pharmacokinetic studies with investigators' enthusiasm for treating a disease that may be subject to a fluctuant course with spontaneous improvement.

Humans↗