Acne fulminans with arthritis in identical twins treated with isotretinoin.
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Acne Vulgaris↗
Biomedical subjects
H L Currey
Publications and source records attributed to H L Currey.
Is rheumatoid arthritis becoming less severe?
Clinical and laboratory data from 2088 successive outpatient attenders with rheumatoid arthritis (RA) were analysed to determine whether there is a trend to decreasingly severe disease. The results, after allowing for the difficulties in this type of analysis suggest that successive generations of patients with RA are decreasingly likely to become seropositive, erosive or develop subcutaneous nodules. There are no obvious explanations for these findings.
Adult↗
Clinical judgement analysis--practical application in rheumatoid arthritis.
Clinical judgment analysis has been used to investigate differences in assessing disease activity in rheumatoid arthritis. Rheumatologists as a group do not adopt a single underlying policy for the assessment of changes in disease activity; each has his or her own approach to such judgements. Some rheumatologists are inconsistent in applying their judgment policies, leading to disagreements even when underlying policies are similar. Having identified these problems of assessment, clinical judgement analysis may be employed to reduce clinical disagreement and to improve coordination and consistency between rheumatologists in different centres during clinical investigations.
Arthritis, Rheumatoid↗
Which drugs should we test?
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Adrenal Cortex Hormones↗
HLA-B27, ankylosing spondylitis and polymorph motility.
Polymorphonuclear leucocyte functions were tested in 29 patients with ankylosing spondylitis (AS). Twenty of these were HLA-B27 positive and 9 B27 negative. Thirty matched controls were also studied and of these, 15 were B27 negative. Random and directed cell migration were measured both by migration through a micropore filter and also by migration under an agar film. The attractant was serum activated either by casein or by zymosan. By both techniques, directed motility (chemotaxis) was increased in subjects with B27 and/or AS when compared with the B27 negative controls. This suggests that the disease AS and the possession of B27 are both associated with increased chemotaxis.
Adolescent↗
Spontaneous rupture of the spleen in rheumatoid arthritis.
Two patients with rheumatoid arthritis without splenomegaly or Felty's syndrome developed spontaneous rupture of the spleen. The histological appearance was consistent with involvement of the splenic capsule by the rheumatoid process, and this may have predisposed to splenic rupture.
Aged↗
Ultrasound has no anti-inflammatory effect.
The use of therapeutic ultrasound within the Health Service is widespread and growing. The most common indication is to reduce inflammation. We have tested the influence of ultrasound on a model of acute inflammation in the rat, and we have found a complete absence of any anti-inflammatory action.
Animals↗
Clinical judgment in rheumatoid arthritis. I. Rheumatologists' opinions and the development of 'paper patients'.
Opinions about the importance of various measures of disease activity in rheumatoid arthritis gathered from a survey of 20% of British rheumatologists showed a wide diversity for all clinical variables. 'Paper patients' have been developed as a method of investigating actual clinical decisions rather than expressed opinions. Assessments based on 'paper patients' correlate highly (r = +0.901) with those made on the equivalent real patients when seen in person.
Arthritis, Rheumatoid↗
Clinical judgment in rheumatoid arthritis. II. Judging 'current disease activity' in clinical practice.
Two rheumatologists made judgments about 'current disease activity' in real patients and 'paper patients' with rheumatoid arthritis. Analysis of each set of judgments provides a model of judgment policy which contains only 3 clinical variables but explains over 94% of the variance in judgments. The judgment policy models differ markedly from each other and from the clinicians' own perceptions of their behaviour. Judgment policy modelling offers a means of improving co-ordination between clinical investigators within and between centres.
Arthritis, Rheumatoid↗
Rheumatoid arthritis: disease-modifying antirheumatic drugs.
A review of the trials in which 'disease-modifying' drugs have been tested leads to the following conclusions: (a) Most of these trials do not provide acceptable evidence of the efficacy of these drugs. (b) A well-designed, placebo-controlled, study of gold (Empire Rheumatism Council, 1960, 1961) provides strong evidence that the drug has a beneficial effect lasting about 18 months. It does not establish any advantage beyond that period. Two reports which claim to show a favourable influence of gold on radiological progression are suspect because of faults in trial design. (c) There has been only one placebo-controlled study of penicillamine (Multicentre Trial Group, 1973). This also provides evidence of medium-term efficacy. No information is available about x-ray progression. (d) Studies of other drugs for which 'disease-modifying' activity has been claimed (antimalarials, antiproliferative agents, corticosteroids, etc.) have similarly provided evidence only of medium-term efficacy. With information now available it is possible to identify some of the reasons why these trials have failed to answer the fundamentally important question of whether the drugs can modify the long-term course of RA. (a) Trial designs have concentrated on following process measures (e.g., ESR) rather than outcome measures (e.g., disability and deformity). Observers have thus come to accept the former as being important in themselves, to the neglect of the latter. (b) Psychological pressures to provide relief for patients, combined with unjustified assumptions about the long-term efficacy of these drugs, have produced a climate of expectations amongst both clinicians and patients which makes it difficult to sustain long-term trials against placebo. (c) Traditional radiological assessment methods have proved insensitive. (d) Recent advances in clinical trial design and analysis (developed largely in specialties outside rheumatology) were not available at the time of most of these trials. At this stage clinical trials of 'disease-modifying' drugs should seek to answer the following questions: (a) Is it worth giving drugs such as gold and penicillamine for periods longer than 6 months? (b) How long does the effect of such treatment last? (c) Is any information obtainable before or during treatment which predicts favourable or unfavourable responses? To answer these question, trial designs, will need to include: (a) Larger numbers of patients. (b) Longer duration of treatment and follow up.(ABSTRACT TRUNCATED AT 400 WORDS)
Adrenal Cortex Hormones↗
Binding of immunoglobulins and immune complexes to cartilage derived extracts.
Cartilage extracts with affinity for heat aggregated immunoglobulins were prepared from human articular and bovine nasal cartilage. These extracts, containing predominantly collagen, also bound both to immune complexes (IC) prepared in vitro and to immunoglobulins from sera of many patients with rheumatoid arthritis (RA). Cryoprecipitation of rheumatoid sera removed material reacting with the extract and density gradient fractionation of a positive serum showed correlation between binding to the extract and to C1q. These results indicate that the binding materials in rheumatoid sera were likely to be IC. We suggest that some assays which apparently demonstrate anti-collagen autoantibodies in fact measure IC. These findings also have implications for models of the pathogenesis of RA.
Animals↗
Measurement of polymorphonuclear leucocyte motility under agarose by computer-linked image analysis.
We have applied computer-linked image analysis to the measurement of polymorphonuclear leucocyte motility under agarose. A high degree of correlation was found between manual and machine values of cell numbers migrating and leading front measurements. This method permits a more complete analysis of cell motility than current methods. It is quick and reliable and allows cell distribution profiles to be studied.
Behcet Syndrome↗
Polymyalgia rheumatica in a defined elderly community.
Responses to a symptom questionnaire, together with an erythrocyte sedimentation rate (ESR) estimation, were used to screen for polymyalgia rheumatica (PMR) in 247 elderly people receiving social services care. Three cases of PMR were discovered of whom two were previously undiagnosed. The prevalence of PMR in this study is higher than that estimated from hospital ascertained cases.
Aged↗
Conversion from daily to alternate daily corticosteroids in rheumatoid arthritis.
An attempt was made to convert 24 patients on corticosteroid treatment from a daily to an alternate daily regimen. Ten patients were successfully converted, 11 failed to convert, and 3 had to be withdrawn for irrelevant reasons. A simple tetracosactrin stimulation test gave some indication of which patients were more likely to convert successfully. Success was not influenced by severity or duration of disease, nor by dose of duration of steroid therapy. Conversion did not influence various clinical and laboratory measures of undesirable steroid side effects, but the follow-up period was probably too short to judge this. The evidence of others suggests that conversion is worth attempting.
Adrenal Cortex Function Tests↗
Sideroblastic anaemia with iron overload presenting as an arthropathy.
We report on 2 patients with sideroblastic anaemia an secondary iron overload whose presenting symptom was an arthropathy of small an large joints. One patient had marked spinal symptoms which were severe enough to suggest ankylosing spondylitis, and the pattern of arthritis in the other resembled seronegative rheumatoid arthritis. We believe these to be the first cases described of an arthropathy associated with iron overload secondary to sideroblastic anaemia.
Adult↗
Polymorphonuclear function in Behçet's syndrome.
Three aspects of polymorphonuclear leucocyte (PMN) function were studied in 19 patients with Behçet's syndrome (BS). By 2 different techniques directed motility was found to be increased. This increase was largely due to the subgroup of patients with ocular involvement. Counts of absolute numbers of cells migrating highlighted this finding. No difference was found in the phagocytic or adherent properties of PMN in Behçet's syndrome. Increased PMN motility in Behçet's syndrome may contribute to the expression of the syndrome. It remains to be tested whether altered PMN motility in this syndrome is genetically linked.
Adult↗
Backache in pregnancy II: prophylactic influence of back care classes.
Back care advice similar to that used in "low back pain schools' was made available to a group of primiparous women as early in their pregnancy as possible. Subsequently it was shown that they experienced significantly less "troublesome' and "severe' backache (P = less than 0.01) than a control group for whom such advice was not available.
Aging↗
Azathioprine in rheumatoid arthritis: double-blind study of full versus half doses versus placebo.
To test whether azathioprine in effective in rheumatoid arthritis in doses smaller than those normally used the drug was tested at 2 dosage levels, 2.5 and 1.25 mg/kg/day (2.5 AZ and 1.25 AZ), against placebo under double-blind conditions over 24 weeks. Dropouts were 7 out of 15 in the 2.5 AZ group, 4 out of 14 in the 1.25 AZ group, and 2 out of 13 in the placebo group. Some significant improvement occurred in all 3 groups, including those on placebo. However, the 2.5 AZ group fared significantly better than the placebo group, while the 1.25 AZ group results tended to fall between the other 2 groups. We conclude that, in order to obtain the reported effectiveness of azathioprine in rheumatoid arthritis, it is necessary to start treatment with 2.5 mg/kg/day. Halving this dosage reduces the effectiveness of the drug.
Arthritis, Rheumatoid↗