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Biomedical subjects

H Zeidler

Publications and source records attributed to H Zeidler.

At least 163 records · Page 9Linked to original sources
PubMed1990

[Concept and criteria of spondylarthritis].

Since several rheumatic disease share common features, they led to the concept of the spondarthritides: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritides, juvenile oligoarthritis (type II), and questionable pustolotic arthro-osteitis and Behçet's disease. Furthermore undifferentiated spondarthritides have to be considered. They occur more frequently than ankylosing spondylitis. Definite ankylosing spondylitis is classified according to the New York-criteria, which, however, do not identify the early stage of the disease. In these cases early diagnostic criteria proved to be useful. In a multicenter study the so-called ESSG-criteria were recently introduced for the classification of the whole group of spondarthritides. They are also helpful for the nosological classification of undifferentiated spondarthritides.

Arthritis, Rheumatoid↗
PubMed1990

[Rheumatologic emergencies].

Contrary to the widely assumed opinion there exist rheumatological emergency situations that affect patients hazardously. These cover complications of the antirheumatic therapy as well as complications of the disease itself. The paper gives an overview of rheumatological emergency situations and tries a systemic approach to a rheumatological emergency medicine.

Anti-Inflammatory Agents↗
PubMed1990

Yersinia enterocolitica in the synovial membrane of patients with Yersinia-induced arthritis.

Using a monospecific rabbit antibody against Yersinia enterocolitica outer membrane protein 1, we examined synovial biopsy specimens from 7 patients with Yersinia-induced arthritis. Yersinia were demonstrated in the synovial membrane by indirect immunofluorescence in 4 patients with Yersinia-induced arthritis, but not in 6 control patients with Salmonella-induced arthritis or with rheumatoid arthritis. These findings suggest the persistence of Yersinia in the joints of patients with Yersinia-induced arthritis.

Adult↗
PubMed1990

A three year comparative study of auranofin and gold sodium thiomalate in rheumatoid arthritis.

UNLABELLED: One hundred twenty-one patients with active RA were randomly assigned to receive 6 mg auranofin (AF)/day (60 patients) or 50 mg gold sodium thiomalate (GST)/week (62 patients) in a double-blind fashion. There were no intergroup differences with respect to sex, age, duration (median 2 years), stage and activity of the disease. In the case of "striking improvement" after 24 weeks a dose reduction to 50 mg GST/month or 4 mg AF/day was allowed and carried out in all GST patients and no AF patient. The serum gold levels were 5 times higher with weekly GST, they approached those of the AF group with monthly GST injections. The clinical parameters--number of swollen joints, activity index, articular index, grip strength, ESR--improved significantly in both groups, but grip strength, articular index and ESR improved more pronounced in the GST group. The X-ray progression (hands and forefeet) was significantly greater in the AF group. Forty-eight AF patients (80%) and 39 GST patients (36%) completed the first year. Thereafter the study was continued as an open study but the patients were allowed to switch from GST to AF. After the first and second year 14/7 GST patients switched to AF. The second/third year was completed by 37/22 AF pat. (62%/37%) and by 15/8 GST pat. (24%/13%). Skin reactions were more common with GST (41.9%/26.7%), diarrhoea was more common with AF (36.7%/19.4%), proteinuria occurred in 10% in both groups, leucopenia and thrombocytopenia were rare in both groups (1.7%). The withdrawal rate due to adverse events was 10%/26% in the AF/GST group during the first year (p less than 0.05) and 25%/32% over the three year period (n.s.). CONCLUSION: Both AF and GST are effective in the long-term treatment of RA, but GST is more so in radiological progression and ESR.

Arthritis, Rheumatoid↗
PubMed1990

German drug monitoring studies with nabumetone.

Although randomised controlled comparative trials concerning the efficacy of the drug tested can produce reliable results in a limited number of selected patient groups, drug monitoring studies involving 10,000 patients or more are the methods of choice to detect rare adverse events. The aim of this drug monitoring study was to evaluate the efficacy and safety of dispersible nabumetone tablets. 8865 patients (46.2% male, 53.5% female, mean age 55 years, range 14.95) were involved in the investigation carried out by 1172 general practitioners. The disease indications comprised osteoarthritis (69.8%), soft-tissue rheumatism (11.3%), rheumatoid arthritis (9.9%) and soft tissue injuries (7.7%). Most of the patients (67.3%) received a daily dose of nabumetone 1 g for up to 6 weeks. Efficacy was evaluated at baseline, and after 1 week, 3 weeks and 6 weeks of treatment. With regard to global efficacy, overall improvement (symptoms resolved or markedly improved) was assessed in 82% of the patients. Elimination or at least significant improvement of pain on movement occurred in 95%, pain on pressure in 90% and pain at rest in 89% of the patients with symptoms. In relation to swelling, morning stiffness and joint mobility, elimination or at least significant improvement occurred in 79%, 80% and 82% of patients, respectively. 1846 patients (20.8%) had frequent periods of NSAID-related symptoms before treatment with nabumetone. A total of 1174 adverse events occurred in 850 patients (9.6%), most comprising minor gastrointestinal complaints. Considering that at least 25,000 patients have been documented in 2 German drug monitoring studies, it is therefore unlikely that any unexpected side effects will occur in the future. Consequently, nabumetone can be classified as an effective and safe NSAID.

Adolescent↗
PubMed1989

[Clinical and serological characterization of Chlamydia-induced arthritis].

Chlamydia-induced arthritis was diagnosed in 32 patients (18 men and 14 women; mean age 33 [17-54] years). 13 were HLA-B27 positive. In 19 patients the arthritis was largely confined to one joint. Enthesopathies occurred in 14 patients, and in 13 sacroiliitis was diagnosed radiologically. The most frequent extra-articular changes affected the urogenital system (26 cases). The full Reiter syndrome was present in seven patients (four men, three women). All patients had serum antibodies against Chlamydia. In 16 patients Chlamydia was diagnosed as the causative organism by urogenital swab. Chlamydia-induced arthritis differs from other arthritides in the high proportion of HLA-B27 negative patients.

Adolescent↗
PubMed1989

Benign polyarthritis and undifferentiated arthritis an epidemiological terra incognita.

Introduction of new diagnostic criteria and the development of HLA-typing and microbiological--serological techniques have aided in classifying and differentiating inflammatory rheumatic diseases. Reviewing epidemiological prevalence studies shows that inflammatory rheumatic diseases are often so called benign polyarthritides and that arthritides, classified as definite and probable rheumatoid arthritis (RA), may belong to a group of benign or undifferentiated arthritides. Own data show that only 25% of patients of an early synovitis out-patient clinic have definite or probable RA, 25% have an undifferentiated arthritis. The term "undifferentiated" refers to the heterogeneity of diseases included. We conclude that few epidemiologic studies exist concerning undifferentiated arthritis and spondarthritis and combined efforts are needed to distinguish RA from the multitude of other well characterized or yet unknown arthritides.

Arthritis↗
PubMed1989

NSAIDs: new approaches to limiting gastropathy.

An extensive literature search on non-steroidal anti-inflammatory drug (NSAID)-induced gastropathy in rheumatic conditions has been carried out. A reduced incidence of gastropathy has been observed among newly developed NSAIDs such as etodolac and the non-acidic nabumetone. An alternative prophylactic therapy to avoid NSAID-induced gastroduodenal mucosal damage which has been successfully tested in several trials is co-medication with the prostaglandin analogue misoprostol. The cytoprotective agent sucralfate also appears to be effective. Recent observations of Campylobacter pylori infections in NSAID-induced gastropathy introduces the question as to whether simultaneous antibacterial medication should be routinely administered during NSAID therapy. At present the invasive technique of endoscopy is used to ascertain gastroduodenal mucosal damage. However, a new technique which merely requires blood sampling is being investigated. This involves measurement of serum levels of the precursor molecules for the gastric enzyme pepsin, pepsinogen I and II. In future this assay could constitute a non-invasive method for detecting gastroduodenal mucosal damage.

Adenosine Triphosphatases↗
PubMed1989

[Social medicine results of expert assessment of work disability].

Disability for work is both a medical and a socioeconomic problem. Hence, a great number of publications on this item can be found in scientific literature. These evaluations are mostly based on case statistics. Individualised evaluations, that means, personal statistics, are comparatively rare. This is also a matter for the medical advisory service of the German sickness insurance (MDK), charged with sociomedical expertising for disability to work, particularly in respect of an assured curative effect and additional aftercare measures if necessary. An individualised evaluation (follow-up study) of expertises of disability with regard to frequency of prescribed additional measures is presented.

Adolescent↗
PubMed1988

Auranofin and gold sodium thiomalate in the treatment of rheumatoid arthritis: a one-year, double-blind, comparative multicenter study.

In a 48-week, double-blind trial, 122 patients were randomly assigned to treatment with auranofin (60) and gold sodium thiomalate (GST) (62) at five centers. Both groups showed significant improvement (P less than 0.05) from baseline in parameters of disease activity. Results of the covariance analysis for all patients who completed the trial showed no significant differences (P less than 0.05) in efficacy between the two groups. The proportions of patients showing 50% or greater improvement in tender joints, swollen joints, activity index, severity of pain, general health rating, and erythrocyte sedimentation rate (ESR) were similar for both auranofin-treated and GST-treated patients who completed the 48-week trial. When all patients who entered the trial were evaluated, a slightly greater proportion of patients on auranofin had improved. Diarrhea occurred more frequently with auranofin (32%) compared to GST (19%), whereas rash and pruritus were twice as common in those patients treated with GST compared to those treated with auranofin. The withdrawal rate due to adverse reactions was 10% for auranofin vs 26% for GST. It was concluded that the efficacy of auranofin was comparable to that of injectable gold and was better tolerated, as evidenced by the lower withdrawal rate from adverse events for the auranofin patients.

Adult↗
PubMed1988

Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup.

Eighty-eight patients with possible ankylosing spondylitis (AS) were selected for this followup study. They showed normal or at most suspicious radiographic findings of the sacroiliac joints. After 5 years' followup, 24, and after 10 years 32 patients (59% of the 54 finally available, 36% of the 88 original patients) had definite AS. In 12 individuals, AS could be excluded. Of the 10 remaining patients, 6 still had possible, and 4 had undifferentiated spondyloarthropathy. A comparison between HLA-B27 positive and negative patients showed a significantly increased frequency of definite AS or possible and undifferentiated spondyloarthropathy (p less than 0.05) in the group of HLA-B27 positive patients. The development of AS was characterized by a prolonged course: radiological sacroiliitis became evident after at least 9 +/- 6 years, radiological signs of spinal involvement after 11 +/- 6 years mean disease duration. After 18 +/- 6 years 25 (78%) of 32 patients with AS still maintained good or sufficient functional capacity, indicating a good functional prognosis in the great majority of the patients.

Adult↗
PubMed1988

HLA antigens in ankylosing spondylitis associated with Crohn's disease. Increased frequency of the HLA phenotype B27,B44.

In a consecutive case study 231 patients with Crohn's disease were investigated for ankylosing spondylitis (AS) and HLA-A, B, C, DR antigen association. Eighteen patients (7.8%) had definite AS according to the New York criteria; 13 (72%) were HLA-B27 positive. The phenotype B27,B44 was seen in 8 patients (44%) compared to only 3 (1%) of 300 controls (p less than 10(-7), and 1 (0.5%) of 213 patients with Crohn's disease without AS (p less than 10(-7). We conclude that patients with the phenotype B27,B44 are highly at risk (relative risk = 68.8) for the common manifestation of Crohn's disease and AS.

Adult↗
PubMed1987

Outcome of possible ankylosing spondylitis in a 10 years' follow-up study.

Of 88 selected patients with possible ankylosing spondylitis (AS) 54 (61%) participated in two phases of a 10 years' follow-up study. Thirty-two (59%) developed definite AS according to the New York criteria, 10 (19%) had possible/undifferentiated seronegative spondylarthropathy (SSA) and 12 patients had other diagnoses. Only 3 (9%) of 35 patients with sacroiliitis did not fulfill the New York criteria for definite AS until the last examination. Sacroiliitis and radiological spinal signs of AS appeared rather late above a mean age of 40 years and after a mean disease duration of more than 10 years. After 18 years mean disease duration 25 (78%) of 32 AS patients had good or sufficient functional capacity indicating an overall good functional prognosis. HLA B27 typing proved to be useful in patients with possible early AS: 29 (71%) of 41 B27 positive and 3 (23%) of 13 B27 negative patients developed definite AS (p less than 0.005). A combination of the B27 test with data of the history, clinical, laboratory, and radiological examination proposed as early diagnostic criteria detected patients with the outcome diagnosis of definite AS with even higher significance (p less than 0.001). These criteria were also useful in the identification of patients with possible or undifferentiated SSA. The recently recognized entity of undifferentiated SSA should only be diagnosed after long term follow-up.

Adult↗
PubMed1987

Undifferentiated arthritis and spondylarthropathy as a challenge for prospective follow-up.

Diagnosis of arthritis with recent onset is still an unresolved problem. In 1984 we started an outpatient clinic for patients with early arthritis of less than one year duration. Of a total of 226 patients seen 149 (66%) had definite (n = 76; 34%) or probable (n = 73; 32%) inflammatory rheumatic disease, and 77 (34%) had degenerative or extraarticular rheumatic disease. Thirtynine patients were classified as undifferentiated arthritis. This undefined arthritis was often monoarticular (12%) and oligoarticuler (44%). One patient met 5 ARA-criteria for rheumatoid arthritis, 14 (36%) met 3-4 ARA-criteria and 25 (64%) only 1-2 ARA-criteria. ESR was elevated in only 23 (59%) patients, rheumatoid factor was positive in 7 (19%) patients and HLA-B27 was positive in 9 (23%) patients. Seventeen (44%) patients had a history of recent infections preceding the beginning of joint symptoms. Thus undifferentiated arthritis represents a heterogeneous group of diseases. Despite diagnostic progresses in recent years a high proportion of early arthritis cannot be diagnosed definitely.

Arthritis, Rheumatoid↗