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Biomedical subjects

L A Healey

Publications and source records attributed to L A Healey.

At least 19 recordsLinked to original sources
PubMed1992

Polymyalgia rheumatica and seronegative rheumatoid arthritis may be the same entity.

Of 159 patients with either polymyalgia rheumatica, seronegative rheumatoid arthritis (RA) or an undifferentiated syndrome with features of both who were followed for at least 30 months, synovitis recurred in 57. Twenty of the 57 patients had one episode of polymyalgia and another that looked like RA. Recurrences responded to prednisone and no joint destruction was seen. Temporal arteritis was seen with both diagnoses. These observations suggest that a benign symmetric synovitis occurs in older patients and may present as polymyalgia or as a polyarthritis that resembles RA.

Arthritis, Rheumatoid↗
PubMed1991

Relation of giant cell arteritis to polymyalgia rheumatica.

Polymyalgia rheumatica and temporal arteritis appear to be separate syndromes rather than two manifestations of an underlying giant cell arteritis. Polymyalgia rheumatica is a synovitis that may be persistent or recurrent, while temporal arteritis is almost always a single episode; documented recurrences are rare. The two syndromes frequently occur in the same patient although not necessarily at the same time and they may be separated by a long interval. In some patients with polymyalgia rheumatica, giant cell arteritis is found on biopsy of an asymptomatic temporal artery. The frequency of this concurrence is variable in different populations. It is high in Scandinavia, low in Israel and intermediate between these extremes in other populations that have been studied.

Giant Cell Arteritis↗
PubMed1990

Challenging the therapeutic pyramid: a new look at treatment strategies for rheumatoid arthritis.

Traditional therapy of rheumatoid arthritis (RA) has been dominated by the therapeutic pyramid. This approach is not working. The designation of drugs as either antiinflammatory or disease modifying is not borne out by experience. We possess a number of drugs, each only partially effective against inflammation, that work by poorly understood mechanisms. Until a major breakthrough appears, it is proposed to treat RA with a combination of these medications early in the disease course, to gain control of the inflammation, and then bridge to a simplified program by withdrawing drugs sequentially.

Anti-Inflammatory Agents↗
PubMed1990

RS3PE syndrome.

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Aged↗
PubMed1989

HLA genes associated with rheumatoid arthritis. Identification of susceptibility alleles using specific oligonucleotide probes.

We examined the association of individual HLA genes with rheumatoid arthritis (RA), using oligonucleotide probes that identified both DR4-associated and non-DR4-associated genes. Two distinct HLA-DR beta alleles (Dw4 and Dw14) were found in DR4+ RA patients compared with controls (Dw4 50% versus 17%; Dw14 35% versus 5%; total DR4 73% versus 30%), indicating that these 2 alleles are independent susceptibility genes. Remarkably, the majority of the DR4- RA patients also demonstrated a linear DNA sequence, apparently "shuffled" between different susceptibility alleles, identified with an oligonucleotide probe to a key portion of the Dw14 gene.

Adult↗
PubMed1989

Reforming the pyramid. A plan for treating rheumatoid arthritis in the 1990s.

Standard treatment of rheumatoid arthritis as illustrated by the pyramid does not prevent joint damage in most patients. The concept that slow-acting drugs are uniquely disease modifying is not supported by experience. Disease modification correlates best with control of inflammation and this has been demonstrated with prednisone. Many medications working by different mechanisms have a partial or temporary effect on inflammation. Following the example of cancer chemotherapy, we propose the step-down bridge, a therapeutic plan in which a combination of drugs is used to control inflammation early in the disease before joints become damaged. Medications are then sequentially discontinued as inflammation remains controlled.

Anti-Inflammatory Agents↗
PubMed1989

Remodeling the pyramid--a concept whose time has come.

It is clear that the traditional treatment program, as illustrated by the pyramid, does not suppress inflammation in most patients with RA to an extent sufficient to prevent joint damage. There is no basis for the concept that slow acting drugs are uniquely disease modifying. Disease modification correlates best with control of inflammation. Contrary to popular wisdom, this has been best demonstrated with prednisone. The arbitrary concept of a drug being either antiinflammatory or disease modifying serves no useful purpose and should be dropped. Many medications provide incomplete or temporary suppression of inflammation, presumably by differing mechanisms of action. Based on this rationale, a therapeutic program is proposed, employing a combination of drugs to control inflammation in the critical early stages of RA. With this step-down bridge concept, medications are sequentially withdrawn in contrast to the traditional pyramid, in which they have been sequentially added. Our early experience with patients indicates that toxicity is no greater problem with combined drugs than with the same drugs used individually. Time and comparative observations will be needed to show the optimum combination of drugs and whether the step-down bridge concept will achieve the sought-for and presently unobtained goal of early and sustained control of inflammation, improved quality of life, and prevention of bone and joint damage.

Anti-Inflammatory Agents↗
PubMed1988

The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.

The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a "classification tree" schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91-94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.

Arthritis, Rheumatoid↗
PubMed1988

Late-onset rheumatoid arthritis vs polymyalgia rheumatica: making the diagnosis.

Differentiating polymyalgia rheumatica from the onset of rheumatoid arthritis in the elderly has been the cause of much unnecessary confusion. Differential diagnosis of these disorders can be straightforward. A strategy is outlined, comprising a complete history, attention to clinical signs, and appropriate use of laboratory diagnostics. The clinical picture of each disorder is discussed, as are common obstacles to diagnosis.

Age Factors↗
PubMed1988

The relation of polymyalgia rheumatica to rheumatoid arthritis.

Sixty-four patients with the onset of rheumatoid arthritis (RA) after age 60 were followed for at least three years (mean 6.3 years); 33 patients had rheumatoid factor and 31 did not. Twenty-five of the 31 seronegative patients had an excellent response to low dose prednisone and did not require any additional medication. Six of these patients also had an episode diagnosed as polymyalgia rheumatica (PMR). These findings suggest that the synovitis currently diagnosed as seronegative RA in many older patients may not be the same disease as seropositive RA, but may be more closely related to or identical with PMR.

Aged↗
PubMed1988

The spectrum of polymyalgia rheumatica.

Polymyalgia rheumatica and temporal arteritis are common syndromes of unknown cause that afflict older patients, the great majority of whom are white. Polymyalgia, which is seen more frequently, is a benign synovitis and can be differentiated from rheumatoid arthritis by the distribution of inflamed joints and by its rapid and complete response to small doses of prednisone. Temporal or giant cell arteritis occurs in approximately 20 per cent of patients with polymyalgia rheumatica and may present with either localized or systemic symptoms. Once the diagnosis is confirmed by temporal artery biopsy, patients should be treated with a large dose of prednisone for at least 1 month. The erythrocyte sedimentation rate is a useful test in suspecting the diagnosis initially, but is a poor gauge to tapering the steroid dose.

Aged↗