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Biomedical subjects

J T Gran

Publications and source records attributed to J T Gran.

At least 37 records · Page 2Linked to original sources
PubMed2000

Incidence and prevalence of rheumatoid arthritis in the county of Troms, northern Norway.

OBJECTIVE: To investigate the population incidence and prevalence of rheumatoid arthritis (RA) in persons above the age of 20 in the county of Troms, northern Norway, during the period 1987-1996. METHODS: All records of patients with RA registered at the Department of Rheumatology at the University Hospital of Tromsø during the years 1987 to 1996 were reviewed. The diagnosis of RA was set in accordance with the 1987 American Rheumatism Association criteria, and the population data were based on the 1989 and 1994 census. Total and age-specific incidence rates were calculated as number of new cases per 100,000 inhabitants and year. Age adjusted incidence rates were obtained by the direct method. Prevalence rates of RA for January 1, 1989, and January 1, 1994, were estimated. RESULTS: The total annual incidence rate for the period 1987-1996 was 28.7/100,000 per year (36.0/100,000 in women and 21.4/100,000 in men). No significant difference in incidence rates was found between the periods 1987-1991 and 1992-1996. Total prevalence of RA was 0.39% in 1989 and 0.47% in 1994. The corresponding data for women and men were 0.54% and 0.24% in 1989, and 0.63% and 0.30% in 1994, respectively. CONCLUSION: We found a rather low incidence and prevalence of RA in the county of Troms in northern Norway. Females contracted RA significantly more often than males. There was no change in incidence rates during the observation period, lending no support to suggestions of a continuously decreasing occurrence of RA.

Adult↗
PubMed1999

A 5.5 year prospective study of self-reported musculoskeletal pain and of fibromyalgia in a female population: significance and natural history.

In order to investigate the significance and outcome of self-reported pain and fibromyalgia (FM) in a female population, 214 women with initially self-reported pain were interviewed and examined in 1990 and 1995. In 1990 the sample was categorised into four pain status groups: 46 individuals (21%) with nonchronic (recurrent) pain, 69 (32%) with chronic regional pain 42 (20%) with chronic multifocal pain and 57 with chronic widespread pain (CWP). The last group comprised 39 (18%) women with FM, fulfilling the American College of Rheumatology 1990 criteria. The frequency of tender points, associated symptoms called historical variables and individuals with low education increased statistically significantly with increasing pain status. In 1995, 48 women had non-chronic pain (23%), 46 (21%) chronic regional pain, 39 (18%) chronic multifocal pain and 81 (38%) CWP; of these, 71 (33%) had FM. Eleven of the 39 women initially with FM no longer fulfilled the criteria. The risk of developing CWP among the 157 individuals with initially a lower pain status was statistically higher in women with chronic multifocal pain than in women with less pain extension. Self-reported pain constitutes a continuum of pain severity and thus of clinical and social significance. The overall outcome was poor with an increase of individuals with CWP and FM. The prognosis of chronic multifocal pain, CWP and FM was especially poor. About half of the women with non-chronic pain or chronic regional pain did not deteriorate. However, because the process of developing FM started with localised pain in most cases, self-reported pain of any severity confers a risk for developing FM. Identifying possible risk factors for FM are at present under study and will be presented separately in another report.

Adult↗
PubMed1999

Current therapy of polymyalgia rheumatica.

Polymyalgia rheumatica is characterized by muscular pain and stiffness developing almost exclusively in individuals older than 50 years. Most likely, survival is similar to that of the general population, and perceivably neither malignant diseases nor cardiovascular disorders occurs more frequently than expected. Thus, the main aim of treatment is symptomatic relief and the benefit of such interventions should always be weighed against the possible risks of drug induced side effects. The review addresses the therapeutic options in polymyalgia rheumatica, and focuses on oral corticosteroids, intramuscular and intravenous methylprednisolone, deflazacort, and methotrexate.

Adrenal Cortex Hormones↗
PubMed1999

An overlap syndrome with features of atypical Cogan syndrome and Wegener's granulomatosis.

A 48 year old women developed serous otitis, scleritis, myalgia, vertigo, polyneuropathy, crescentic glomerulonephritis, general cerebral dysrythmia, hilar adenopathy, and retroorbital granulomatous inflammation. Pulmonary manifestations were absent and antibodies against neutrophilic cytoplasmic antigens (ANCA) could not be detected. The clinical picture was classified as an overlap syndrome with features of both atypical Cogan syndrome and Wegener's granulomatosis. The patient responded to treatment with high dose corticosteroids and pulse cyclophosphamide.

Cyclophosphamide↗
PubMed1999

Prognostic factors for the development of fibromyalgia in women with self-reported musculoskeletal pain. A prospective study.

OBJECTIVE: To estimate the risk of developing fibromyalgia (FM) in women with self-reported pain and to estimate the relative risk of a series of variables. METHODS: As part of a population study, 214 women with self-reported pain were interviewed and examined in 1990 and 1995. In 1990, 39 of these women fulfilled the American College of Rheumatology criteria for FM. The other 175 women represented a continuum of pain extent from nonchronic pain to chronic widespread pain, and were assessed as individuals at risk for developing FM. Potential risk factors for FM were registered in 1990 and analyzed by bivariate and multiple statistical methods in the total sample and also in a subgroup of 115 women with limited pain. RESULTS: Forty-three (25%) women developed FM. Having > or = 4 associated symptoms, pain of > or = 6 years' duration, back pain, alternately hard/loose stools, and self-assessed depression were found to be predictors. Pain in the lower arm and a feeling of swelling were more weakly associated. In women with limited pain, pain > or = 6 years' duration, > or = 4 associated symptoms, not feeling refreshed in the morning, and paresthesia were found to be predictors. A weaker association was found with self-assessed depression and a lack of formal education. CONCLUSION: A high cumulative incidence of FM was found and a diversity of predictors for FM were identified in the total sample and also in women with limited pain. Of the variables that were part of the FM syndrome, back pain predicted FM, while tender points and pain in the neck did not. Moreover, > or = 4 associated symptoms, self-assessed depression, and longlasting pain were shown to be important predictors.

Adult↗
PubMed1998

[Behcet syndrome].

We present a survey of Behçet's syndrome based on three case reports and a review of the literature. Behçet's syndrome is a systemic connective tissue disease affecting arteries and veins. The basic pathological findings are vasculitis, aneurysms and thrombosis. The disease is rarely observed in Norway, but occurs rather frequently in Turkey and Japan. It affects males and females, most often in the age group 20-35 years. The main clinical manifestations are oral and genital aphthae and eye inflammation. The disease may also involve a number of other organs. Depending on the severity of the disease, corticosteroids and immunosuppressive agents are employed.

Adult↗
PubMed1998

[Pathogenesis of Bechterew disease].

The etiopathogenesis of ankylosing spondylitis is still incompletely understood. HLA-B27 is important as more than 90% of the patients possess the antigen, but how this genetic marker confers disease susceptibility is yet to be understood. Recent studies of families and twins affected by ankylosing spondylitis have shown that additional non-HLA-B27 genes are necessary for disease development. The exogenous agent initiating chronic inflammation is yet to be identified, but Klebsiella pneumoniae remains a candidate. The microorganism may act through the intestinal canal as more than 60% of the patients exhibit inflammatory changes in the bowel.

Animals↗
PubMed1998

[Mortality and risk of cancer in systemic connective tissue diseases].

The systemic connective tissue diseases represent a broad spectrum of multiorgan disorders. This report reviews our current knowledge of mortality and the risk of cancer in these diseases. The relationship between clinical manifestations and reduced survival in systemic sclerosis, systemic lupus erythematosus and polyarteritis nodosa is addressed in detail. Moreover, we outline the increased risks of cancer in dermatomyositis and lymphoma in primary Sjögren's syndrome, as well as cancer of the bladder in patients with Wegener's granulomatosis who have been treated with cyclophosphamide. Finally, the conflicting results regarding mortality in temporal arteritis are discussed.

Connective Tissue Diseases↗
PubMed1998

Spondyloarthritides in females.

Few studies have been performed regarding clinical, radiological and prognostic features of females with spondyloarthropathies other than ankylosing spondylitis (AS). In AS, clinical manifestations appear similar in men and women, whereas radiological features appear more frequent and severe in males. However, no consistent differences in outcome and mortality between men and women have been disclosed. Although fetal outcome is not compromised in women with spondyloarthropathy (SpA), the interaction of pregnancy and SpA has been studied in detail only in AS. Spinal disease is unchanged while peripheral arthritis and uveitis are suppressed during childbearing. Due to possible maternal and fetal side-effects, NSAIDs must be discontinued during the last 8 weeks of pregnancy, but during lactation several NSAIDs can be used. Treatment with sulphasalazine is compatible with pregnancy and lactation. Children of AS patients exhibit a slightly increased risk of developing SpA later in life.

Adult↗
PubMed1998

Severe intestinal involvement in Wegener's granulomatosis: report of two cases and review of the literature.

The clinical and pathological manifestations of severe intestinal involvement in Wegener's granulomatosis were studied by a review of the literature and reports of two patients. Altogether, six cases, two females and four males, were studied. One patient developed two episodes of bowel manifestations necessitating immediate surgical interventions. The average age at onset of intestinal symptoms was 43.3 yr (26-55 yr) and, in all cases, the first signs of such manifestations developed within the first 2 yr of disease. Prior to the onset of intestinal symptoms, immunosuppressive therapy was administered in six of seven instances. Acute abdominal pain with signs of peritonitis or distention only constituted the main clinical picture in six of the seven events. The last episode was manifested clinically with profuse diarrhoea with blood and mucus. Of the seven instances of severe intestinal manifestations, the small bowel was involved in two, the large bowel in three, and both the small and large bowel were affected in two episodes. Histological evidence of vasculitis in the bowel was demonstrated in three of the seven biopsy specimens, while in four, ischaemia, inflammation and ulceration were the pathological findings. Intestinal perforation was seen four times and surgery was performed in six of seven episodes. Severe intestinal involvement is rare in Wegener's granulomatosis. The initial bowel manifestations occur within the first 2 yr of disease, and affect both the large and small bowel. Histologically, vasculitis, ischaemia, inflammation and ulceration are the prevailing findings. Death due to intestinal catastrophy occurred in one of the six patients reported. Most likely, the manifestations are associated with the disease process rather than related to the use of immunosuppressive agents.

Adult↗
PubMed1998

Wegener's granulomatosis: long-term follow-up of patients treated with pulse cyclophosphamide.

Treatment with daily oral cyclophosphamide (CY) has improved survival in Wegener's granulomatosis (WG), but is associated with severe and potentially lethal adverse effects. Less toxic treatment regimens, such as pulse CY, have been used, but the effect has been questioned. We have treated 11 patients with WG with pulse CY (15 mg/kg initially every second week, gradually increasing the pulse interval). After 4.5 yr follow-up and a total of 501 pulses of CY, one patient died and eight patients (73%) were in complete remission. Remission was induced in 91% of the patients after a median period of 3.5 months and relapses were seen in 60%. With the same treatment protocol, a new complete remission was induced in 75% of those relapsing. Except for one patient who died, no patient developed end-stage renal failure. Haemorrhagic cystitis was not observed and no malignancies recorded. Severe infections were seen in 36%, but none caused by Pneumocystis carinii. Nausea was the most frequent side-effect, seen in 64% of the patients. We conclude that treatment with pulse CY every second week is safe and effective in inducing remission and treating relapses in WG. The relapse rate seems to be higher than with low-dose oral CY, but the cumulative dose of CY is less.

Adult↗
PubMed1998

Clinical, epidemiologic, and therapeutic aspects of ankylosing spondylitis.

Ankylosing spondylitis (AS) almost invariably starts before the age of 50, and clinical features suggestive of AS in older age should lead to consideration of other rheumatic disorders. Clinical manifestations of extraskeletal tissue such as renal amyloidosis and lung disease may occur. However, the detection of amyloidosis may not invariably infer poor prognosis, and associated lung disease may include apical fibrosis and also interstitial lung disease. Although the clinical significance and pathogenesis of osteoporosis in AS remain unclear, reduced bone mass may be found in a significant number of patients. Population surveys on AS have shown a correlation between the population frequency of HLA B27 and prevalence of AS. However, neither B27 subgroup distribution nor low frequency of B27 can explain the rarity of AS among certain African regions. Also representing an area of future research is the detection of both disease-related variables and sociomedical factors influencing the final outcome of this disease.

Humans↗
PubMed1997

[Systemic rheumatoid arthritis].

The term systemic rheumatoid disease refers to patients with rheumatoid arthritis who have clinical or histological evidence of vasculitis or serositis, or both. Males are affected more often than females, and vasculitis may develop in almost any organ. Rheumatoid nodules, joint deformities and erosions are often present, even though the arthritis may be inactive. The condition is associated with high titers of IgG rheumatoid factor. An intermittent bolus regimen of cyclophosphamide and corticosteroids appears to be effective. Two patients with systemic rheumatoid arthritis are presented.

Arthritis, Rheumatoid↗
PubMed1997

[Thrombocytopenia induced by auranofin treatment].

Thrombocytopenia is an infrequent side effect of treatment with auranofin occurring in 0.7% of the patients. Three patients who developed serious thrombocytopenia after three months treatment with auranofin are described. No other side effects were noted. The treatment was discontinued and two of the patients were treated with oral corticosteroids. Platelet counts were normalised within eight weeks. The pathogenesis of the thrombocytopenia is unknown. It is, however, a potentially serious side effect and may develop rather suddenly. Patients should therefore be monitored with regular haematological tests and be instructed to report immediately on any unusual bleeding.

Aged↗