Biomedical subjects
Publications and source records attributed to H Julkunen.
A 24-year-old woman developed malignant hypertension while on oral contraceptives (OCs). She was found to have incomplete systemic lupus erythematosus (SLE) with DNA antibodies and high levels of antiphospholipid antibodies (APLA). She later developed SLE and has had three miscarriages and a cerebellar infarction.
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To study the occurrence and significance of pregnancy-associated hypertension and pre-eclampsia in systemic lupus erythematosus (SLE), we studied retrospectively 34 pregnancies in 27 SLE patients in 1981-87. Eleven pregnancies (32%) were hypertensive (group A). The remaining 18 patients during their 23 pregnancies had a normal blood pressure (group B). Previous nephritis was slightly more common in the hypertensive group (54.5% vs. 26.1%, NS). Preeclampsia was present in seven of the pregnancies (21%) and of whom four were superimposed. Flare-ups of the disease were more common in the non-hypertensive group (30.4%) than in group A (9.1%) (NS). Duration of pregnancy was the same in the two groups. Intra-uterine growth retardation was present in 27.3% of the pregnancies in group A and in 13.0% of group B (NS). Fetal loss occurred only in 2 patients of the non-hypertensive group; one patient had exacerbation of SLE and the other (with two stillbirths) high anticardiolipin antibodies. Our data suggest that pregnancy-associated hypertension and pre-eclampsia do not cause increased fetal loss in pregnancies affected by SLE. There seem to be other factors that are more important, such as antiphospholipid antibodies and flare-ups of the disease.
We describe a patient with mixed connective tissue disease (MCTD), who developed pure red cell aplasia which responded favorably during treatment with corticosteroids. Pure red cell aplasia has been described in a few patients with rheumatoid arthritis and systemic lupus erythematosus, but, to our knowledge, this is the first report of an association between it and MCTD.
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Actions on performance of dextropropoxyphene (DXP) alone and in combination with amitriptyline (AMI), indomethacin (IN), and placebo were compared in 15 patients with rheumatoid arthritis. The patients were on their prescribed maintenance regimen excluding analgesics. In four randomized test sessions at two-week intervals, they received double blind and crossover single oral doses of DXP 130 mg, IN 50 mg, DXP 65 mg + AMI 25 mg or placebo, each after two days' pretreatment with the same drug. Objective and subjective effects were measured at baseline and 2 and 4 hours after drug administration. DXP impaired critical flicker discrimination, symbol copying and body balance without modifying tracking, choice reactions or attention. It rendered the subjects elated, muzzy, mentally slow and calm. Actions of AMI + DXP were about the same. IN impaired body balance and critical flicker recognition. Plasma concentrations of DXP were moderate to high whilst those of IN and AMI were fairly low. We conclude that therapeutic doses of DXP and IN are relatively safe in regard to driving skills. Small doses of AMI may not enhance the mild psychomotor effects of DXP. Earlier single dose studies carried out with healthy volunteers might have overestimated the decremental effects of analgesics on psychomotor performance.
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Nine male and fourteen female hospital in-patients aged 45-82 years and suffering from advanced osteoarthritis participated in an open pharmacodynamic and pharmacokinetic study. After the clinical examination the patients were given piroxicam 30 mg daily for one to seven days before the elective hip joint operation. Drug effects were assessed by measuring the duration of morning stiffness and scoring pains at night and on motion. Concentrations of piroxicam were measured from serum and tissue (joint capsule, cartilage, cancellous bone) samples taken during the operation. Piroxicam concentrations in tissues were negligible on the first two days; measurable concentrations appeared from the third day on. They correlated to serum piroxicam levels but were much lower. Generally, the appearance of piroxicam in joint tissues coincided with the appearance of the analgesic effect of piroxicam. Skin samples from four patients showed piroxicam concentrations which were negligible or at least definitely lower than respective concentrations in serum. It is concluded that in patients with osteoarthritis the piroxicam concentrations in joint tissues are fairly low, and their correlation to the analgesic effect of piroxicam is not convincing.
A population study with 6-year follow-up of 6 167 persons aged over 30 was carried out in nine population groups in Southern Finland. Estimation of spondylosis and DISH (Diffuse Skeletal Hyperostosis) was made from lateral chest X-rays. Reliability coefficients (kappa) in the repeat reading of 1 025 films ranged between 0.60 and 0.76. 214 cases of newly developed DISH and 1 080 of spondylosis were observed. With the exception of 4 new cases, all cases of DISH had developed in persons who had had spondylosis at baseline or developed it during the follow-up. The sexual incidence of spondylosis was fairly similar, i.e. 4 cases per 100 person years in both. Prevalence and incidence of spondylosis were highest in rural areas, in persons with strenuous occupations and in the obese. Incidence of DISH was 0.7 cases per 100 person years in men and 0.4 in women. DISH was equally common in all types of population. It was not associated with arduousness of occupation. Obesity and-to a lesser degree-diabetes mellitus and glucose intolerance were associated with DISH. Neither condition was associated with elevated serum calcium, serum cholesterol or bacteriuria. The study supports the concept that DISH is epidemiologically and pathogenetically different from spondylosis deformans.
A study of 690 osteoarthrosis (OA) patients with corresponding controls, and 475 soft-tissue rheumatism (STR) patients with the same number of controls was made in Finnish health centres. The aim of the study was to clarify certain etiological, social and therapeutical aspects. No clear differences were found in the working conditions of patients with OA, STR, or their controls, or in their occupational classes. OA patients were less satisfied with their working conditions than were the other. OA and STR patients had been more actively engaged in sports earlier in life, but during the study there were no differences; nor did the localisation of OA differ. The weight index qas slightly higher in OA, particularly when knee and ankle were affected, but not with arthrosis of the hip. There were no clear associations with other diseases. The maximum duration of a treatment period in this study was 1 month. The average sick leave in OA was 17.8 days, in STR 13.4 and in controls 15.4 days. After treatment, 31% of OA patients, and 56% of STR were recommended to resume work; 4% were recommended to change their occupation; 21% of OA and 7% of STR patients were recommended to retire on pension. Sulindac, indomethacin and many other drug combinations were used for medication. Certain side effects were found in about 5% of sulindac- and in 8-10% of indomethacin-treated patients. In 17% of OA and in 12% of STR patients, it was found necessary to consult a specialist for diagnosis or treatment.
The associations between DISH (diffuse skeletal Hyperostosis) and spondylosis deformans on the one hand and cardiovascular disease and cancer on the other were studied in a follow-up investigation of 6 167 persons in Finland. Mean duration of follow-up investigation of 6 167 persons in Finland. Mean duration of follow-up was 6.3 years. Similar methods were employed in the baseline and follow-up examination. A finding of DISH or of spondylosis was based on a reading of lateral X-ray films. Age-adjusted incidence of hypertension, ECG findings suggesting coronary heart disease (CHD), CHD history, enlargement of the heart determined by interpretation of photofluorograms, digitalis medication, cerebrovascular incidents and a history of cancer were compared in persons with and without DISH/spondylosis and free of these conditions at baseline. A further analysis, in which the data were analysed separately for DISH and spondylosis present at baseline and cases which developed during follow-up, was also carried out. A slight association between DISH and spondylosis, and hypertension probably due to obesity was observed. According to several criteria degenerative heart disease (CHD, heart enlargement, digitalis use) was associated with DISH and spondylosis, particularly in men. An association with heart enlargement was observed with DISH but not with spondylosis. No associations with cerebrovascular accidents or cancer were observed, but the paucity of cases prevents definite conclusions. Thus, there were some difference between spondylosis and DISH with regard to risk of future cardiovascular disease.
The value of low dosage heparin in preventing venous thromboembolism was studied in 150 patients with proximal femoral fractures. This was a prospective, randomized, clinical trial, consisting of 116 women and 34 men with a mean age of 73 years (38 to 92). 5000 units of subcutaneous heparin was given twice a day for a fortnight to the heparinized group and the control group was left without. The heparin was commenced on admission to hospital. Deep venous thromboses (D. V. T.) and pulmonary embolism (P. E.) was diagnosed on clinical grounds. Fatal P. E. was verified by necropsy. There was significantly less D. V. T. in the heparinized group than in the control group (p < 0.01) and the incidence of P. E. was smaller in the heparinized group, 0 and 4 per cent respectively. This difference is not statistically significant. There were no significant differences in the amount of blood needed. We recommend routine use of low dosage heparin started on admission to hospital in proximal femoral fractures.
The effect of chloroquine on bone and articular cartilage was studied in 28 rheumatoid arthritis patients. After the administration of chloroquine for a minimum of 6 months, a metatarsal bone specimen was taken at operation. The control material consisted of 24 operated patients treated in the same way, except that they had not received chloroquine. Histological investigation, in which pairs of slides were compared in a blind test, revealed that the changes in the articular cartilage in those given chloroquine were less marked. Moreover, a diminished tendency to pannus formation and a more vigorous bone regeneration were observed in this group. Chloroquine seems thus to have a prophylactic effect on the articular cartilage changes in case of rheumatoid arthritis.
The prevalence rate of hyperostosis, defined as the presence of complete bony bridges linking two vertebrae in at least two separate sites in the dorsal spine, was studied in a sample of some 9 000 persons who were 40 years of age or older and were representative of the general population of Finland. The standardized rates of hyperostosis were 3.8% for men and 2.6% for women. The prevalence rates rose sharply with age, and depending on the age group, the male-female ratio varied between 1.4 and 2.1. The adjusted rate of hyperostosis was higher in East Finland than elsewhere. There was a suggestion of hyperostosis being associated with a higher mortality rate as judged by regional variations and by analysis of matched case-controled pairs. There was no evidence that locomotor symptoms occurred in excess in subjects with hyperostosis; nor was prior traumatic experience more common.
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