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Biomedical subjects

J G Hardin

Publications and source records attributed to J G Hardin.

At least 37 records · Page 2Linked to original sources

The nature of the onset of rheumatoid arthritis: a reassessment.

A total of 300 consecutive patients referred to a tertiary-care center and fulfilling the American Rheumatism Association criteria for definite-classical rheumatoid arthritis, (with a mean disease-duration of 10.3 +/- 9 years) were studied by structured interview and medical record review. The type of onset (rapid or insidious), type of joint involved (small, medium, large or combined joints) and pattern of joint involvement (monarticular, pauciarticular or polyarticular) at onset, and the interval between the first symptom and development of established disease were determined from the interview (based on the patient's memory). The onset was rapid in 46%. Initial involvement occurred in small joints in 31%, medium joints in 16%, large joints in 28% and combined sites in 25%. The pattern of joint involvement at onset was monarticular in 21%, pauciarticular in 44% and polyarticular in 35%. The time for disease to become established was less than 1 month in 25%, 1-6 months in 35%, 6-12 months in 14% and over 1 year in 26%. The monarticular pattern of onset was associated with slower development of established disease than the other patterns of joint involvement; polyarticular disease tended to be associated with polyarticular onset; involvement of large joints was associated with pauciarticular onset.

Arthritis, Rheumatoid↗

Acute non-infectious arthritis of the hip in patients with rheumatoid arthritis.

Five patients with rheumatoid arthritis and no previous hip joint disease developed an acute disabling arthritis in one hip joint. Roentgenograms were negative and synovial fluid from the hip joint was inflammatory, but no crystals were seen and cultures were negative. Four of the five patients responded rapidly to intra-articular corticosteroids, and none of the five has had further hip joint symptoms during a mean follow up period of two years.

Acute Disease↗

Small joint involvement: a systematic roentgenographic study in rheumatoid arthritis.

Standard hand and foot roentgenograms from 200 consecutively hospitalised patients with definite or classical rheumatoid arthritis (RA) were read for marginal erosions by three independent observers. For each joint or group of joints analysed the degree of symmetry (S = absolute symmetry, U = unilateral, PS = partial symmetry) was determined. The total number of joints affected significantly correlated only with disease duration; symmetry of erosions and number of affected patients were not influenced by seropositivity. Metatarsophalangeal erosions (in 70%) were the most common and were classified as S in 16%, U in 21%, and PS in 63%. Metacarpophalangeal erosions (in 68%) were also common, with a symmetry pattern of S in 19%, U in 21%, and PS in 60%. Proximal finger interphalangeal erosions (in 42%) were unilateral in 42% (S in 8% and PS in 50%). The only site where symmetry was usual (90%) was the wrist, but radiocarpal and intercarpal joints were considered together. Erosions also occurred in about 16% of the finger distal interphalangeal and 28% of the great toe interphalangeal joints. In RA roentgenographic asymmetry is usual and unilateral involvement common.

Adult↗

Nonreducible rotational head tilt and atlantoaxial lateral mass collapse. Clinical and roentgenographic features in patients with juvenile rheumatoid arthritis and ankylosing spondylitis.

Nonreducible rotational head tilt resulting from predominantly unilateral collapse of the lateral mass of the atlas (C1) and/or axis (C2) has been characterized in patients with rheumatoid arthritis. An identical phenomenon is reported in five patients with juvenile rheumatoid arthritis (JRA) and in six with ankylosing spondylitis (AS). Most patients had neck pain and crepitus, all had a fixed head tilt deformity, and most also had a rotational deformity. Roentgenographically, all had predominantly unilateral collapse of the lateral masses of C1 and/or C2, and the head always tilted toward the most collapsed side. The patients with JRA had polyarticular disease of long duration and generally mild neck symptoms, with only one requiring neck surgery for pain. The patients with AS tended to have proximal peripheral joint involvement and long-standing disease with more severe neck symptoms; four underwent posterior cervical fusion for intractable pain. None of the 11 patients had demonstrable neurologic deficits.

Adolescent↗

Nonreducible rotational head tilt and lateral mass collapse. A prospective study of frequency, radiographic findings, and clinical features in patients with rheumatoid arthritis.

Of 126 hospitalized, but otherwise unselected, patients with rheumatoid arthritis, 12 (10%) had a persisting nonreducible rotational head tilt deformity (NRRHT). These 12 were grouped with an additional 12 similar subjects, previously found to have the same condition, and all 24 were compared with the remaining 114 who did not have head tilt. Patients with NRRHT differed significantly from the others in that the former were more likely to have a destructive peripheral arthritis, headache, limited neck motion, and various cervical subluxations. All 24 subjects with NRRHT had predominately unilateral collapse of the lateral masses of the atlas and/or axis, compared with only 2 of the 114 with normal head position. The head always tilted to the side of the lateral mass collapse, which appeared to be the sole or major cause of the abnormal head position.

Aged↗

Sequential gold and penicillamine therapy in rheumatoid arthritis.

Ninety patients with rheumatoid arthritis who had received courses of gold followed by penicillamine for their disease were evaluated to determine the predictiveness of a certain response or adverse reaction to gold for the same response or adverse reaction to penicillamine. Most patients who were considered gold-responders also responded to penicillamine, and most patients who did not respond to gold responded to penicillamine as well. Regarding toxicity, gold reactions did not predict reactions to penicillamine except that that patients with gold-induced proteinuria were at a higher risk for development of proteinuria during penicillamine therapy (p less than 0.001), and this usually occurred within the first six months of treatment. Patients with penicillamine-associated mucocutaneous reactions tended to have low gamma globulin levels (p less than 0.05) and were less likely to have subcutaneous nodules (p less than 0.05).

Adult↗

Chronic tenosynovial hand infection from Mycobacterium terrae.

A 23-year-old healthy man suffered a puncture wound from the fin of a catfish. Chronic tenosynovitis subsequently developed. Synovectomy was performed and cultures yielded Mycobacterium terrae. This organism, usually considered nonpathogenic, has only rarely been associated with human disease. This case further supports the role of this organism as a potential human pathogen and further suggests that M terrae should be considered in aquatic-associated hand tenosynovitis.

Adult↗

Clinical features of the arthritis of mixed connective tissue disease.

Seventeen of 19 patients with mixed connective tissue disease (MCTD) had arthritis as a significant initial feature of their disease; 8 were given an initial diagnosis of rheumatoid arthritis (RA) and 4 received chrysotherapy. RA-like hand deformities were present in 35% and contractures and/or persistent loss of joint motion in 47%. Joint radiographs showed abnormalities in 41% and included erosions and/or cysts in 30%. The arthritis of MCTD may be both erosive and deforming and this disease should be considered in patients presenting as RA with unusual features.

Adolescent↗

Immune complex detection and complement activity in rheumatoid arthritis: a comparative study of a radioimmunoassay using monoclonal rheumatoid factor, gel diffusion techniques and C4 activity.

Paired sera and synovial fluids from forty-nine patients with rheumatoid arthritis and twenty-five with other forms of arthritis were tested for immune complexes by a radioimmunoassay using monoclonal rheumatoid factor and gel diffusion procedures with monoclonal rheumatoid factor and C1q. Synovial fluid hemolytic C4 and C4 adjusted for IgG concentration were determined in both groups of patients. Immune complexes were detected at similar high frequencies in the rheumatoid synovial fluids by precipitin formation with monoclonal rheumatoid factor (68%) and C1q (71%). In contrast, immune complexes in rheumatoid sera were detected in low frequency by precipitin reactions with monoclonal rheumatoid factor (10%) and C1q (0%). Using the monoclonal rheumatoid factor radioimmunoassay, thirty-one (63%) synovial fluids exceeded the mean non-RA binding activity by one standard deviation. Similarly, twenty-four (49%) rheumatoid sera exceeded the mean non-RA binding activity to one standard deviation. Synovial fluid C4 adjusted for IgG as well as IgG alone distinguished between the two groups of patients whereas the C4 values did not. The C4/IgG value showed a strong negative correlation with the monoclonal rheumatoid factor radioimmunoassay and C1q precipitin formation.

Antigen-Antibody Complex↗