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M Boers

Publications and source records attributed to M Boers.

144 records · Page 8Linked to original sources
PubMed1990

Subclinical renal dysfunction in rheumatoid arthritis.

We studied renal function in 35 patients with chronic, seropositive rheumatoid arthritis (RA), of whom 7 had vasculitis, 10 had hypergammaglobulinemia, and 18 had neither of these 2 conditions. Findings included a decreased glomerular filtration rate in 8 patients, (micro)proteinuria in 11, a defective urine concentration in 10, and increased urinary tubular enzyme levels in 15. These results indicate that subclinical renal dysfunction is common in patients with chronic, seropositive RA. In addition, vasculitis and hypergammaglobulinemia were not identified as risk factors for renal dysfunction in the RA patients studied.

Arthritis, Rheumatoid↗
PubMed1990

Renal disorders in rheumatoid arthritis.

Renal disorders are a frequent cause of death in patients with rheumatoid arthritis (RA), but are less apparent in living RA patients. In part, this may be because of insensitive screening methods. In this review, some of the relations among renal pathology, renal function, and antirheumatic therapy are clarified. A classification of renal disorders according to etiology is proposed. Two categories of disorders are distinguished: those related to RA and its complications, and those related to drug therapy. The disorders belonging to these categories are reviewed. Finally, a case is made for the existence of a third category, "RA nephropathy." It is hypothesized that this mild and nonspecific nephropathy is the result of cumulative minor insults caused by the disease and its therapy. The presence of such a "subclinical" nephropathy would explain the greater sensitivity of RA patients to other renal insults, and the high prevalence of renal failure at death.

Anti-Inflammatory Agents↗
PubMed1990

Raised plasma renin and prorenin in rheumatoid vasculitis.

The value of plasma renin and its inactive precursor, prorenin, were examined as a marker for vasculitis in rheumatoid arthritis (RA). Plasma renin and prorenin rise when the renin-angiotensin system is activated; an isolated increase of prorenin may be a marker for microvascular complications in diabetes mellitus. Renin concentrations in plasma obtained from 34 patients with RA (seven with vasculitis, 27 controls) were measured under standard conditions, before and five days after stopping non-steroidal anti-inflammatory drugs; creatinine clearance was also measured. At first the median renin concentration in the patients with vasculitis was 19 (range 12-63) mU/l (normal less than 61 mU/l) and in the controls 9 (3-43) mU/l. The median prorenin concentration in patients with vasculitis was 233 (144-428) mU/l (normal less than 358 mU/l) and in the controls 144 (25-364) mU/l. Renin and prorenin concentrations increased significantly in both groups after withdrawal of nonsteroidal anti-inflammatory drugs. The creatinine clearance was similar in both groups and did not correlate with renin concentrations. In conclusion, it was found that, unlike patients with diabetes mellitus, patients with RA with vasculitis had slightly raised concentrations of both renin and prorenin. These findings signal activation of the renin-angiotensin system and might indicate early cardiac or renal involvement by vasculitis.

Aged↗
PubMed1990

Reversible nephrotoxicity of cyclosporine in rheumatoid arthritis.

Irreversible nephrotoxicity has limited the use of cyclosporine in rheumatoid arthritis (RA). In a randomized clinical trial we compared 26 weeks of cyclosporine (5 mg/kg) and D-penicillamine (250 mg) treatment in 92 patients with RA with a serum creatinine less than 100 mumol/l. We adjusted the starting dose according to clinical response and side effects. During cyclosporine treatment the serum creatinine increased by median 15% (p less than 0.0001 vs baseline), quickly reversible after stopping (median followup: 1.6 years). Six patients stopped cyclosporine prematurely because of nephrotoxicity. In the D-penicillamine group the values remained at baseline.

Adult↗
PubMed1988

Errors in the prediction of creatinine clearance in patients with rheumatoid arthritis.

The accuracy of two equations used to predict creatinine clearance was assessed in 27 patients with rheumatoid arthritis (RA) and 34 controls. Both equations were accurate in controls, but overestimated the clearance in RA patients. The degree of overestimation was not related to patient characteristics. Uncritical use of these equations in RA patients may lead to serious error.

Adult↗
PubMed1988

Value of autopsy in internal medicine: a 1-year prospective study of hospital deaths.

In a university Department of Internal Medicine, we compared the clinical information, as written down immediately post mortem, with the demand for autopsy and with the autopsy findings during one complete year. Autopsies were performed in 143 of 306 consecutive deaths. In autopsied patients clinicians had recorded more diagnoses per patient, but with less certainty than in non-autopsied patients. Patients with a diagnosis of a solid tumour were autopsied less often, and patients with infections or gastrointestinal disease more often than the average patient. These findings indicate selection of cases for autopsy. In 41% of patients erroneous diagnoses were detected that might have influenced management of the patient. In 28% of patients autopsy offered no additional information about one or more diagnoses. Both the proportion of errors and the proportion of uninformative autopsies increased with decreasing clinical certainty about the diagnosis. We conclude that autopsy offers useful information in most cases, and that selection of cases for autopsy is probably not justified.

Adolescent↗
PubMed1987

Renal findings in rheumatoid arthritis: clinical aspects of 132 necropsies.

Renal abnormalities in 132 necropsied patients with rheumatoid arthritis were studied. Clinical findings before death included extra-articular manifestations of the disease (86% of patients), systemic vasculitis (6%), and uraemia (23%). Necropsy findings included nephrosclerosis (90%), systemic vasculitis (14%) with kidney involvement in 8%, amyloidosis (11%), membranous glomerulopathy (8%), and focal glomerular disease (8%). Association with clinical data suggests that both rheumatoid and non-rheumatoid disease may play a part in the cause of these abnormalities.

Adult↗
PubMed1983

Two membrane oxygenators and a bubbler: a clinical comparison.

We compared the hemocompatibility of the Polystan bubble oxygenator and the Travenol TMO and SciMed spiral-coil membrane oxygenators in 43 patients undergoing aortic valve replacement. In a subgroup of 27 patients, we collected hematological data and correlated platelet behavior with hemostasis. We found no differences in blood loss or blood (product) requirements among the groups. Platelet and erythrocyte damage was less in the membrane oxygenator groups than in the bubble oxygenator group. Differences in adenosine diphosphate-induced platelet aggregation were equivalent. Drops in this function concurred with intensified cardiotomy suction and administration of protamine. Leukocytosis after bypass was most marked in the SciMed group. Duration of bypass correlated with blood loss and blood requirements in the operating theater. Platelet counts shortly after bypass correlated negatively with duration of bypass and blood loss in the intensive care unit. Platelet function correlated with none of the factors just mentioned. We conclude that platelets and erythrocytes are preserved better by the membrane oxygenator than by the bubbler. The TMO system causes more erythrocyte damage than the SciMed oxygenator, probably due to TMO's dual-pump system. Clinical evidence for these improvements was not found, and this will be possible only when the other factors responsible for blood damage can be controlled.

Adult↗
PubMedDate not supplied

Cytomegalovirus infection with perfusion defects on the lung scan.

A patient with dyspnea, skin rash, hypoxemia and mononucleosis was shown to have acute cytomegalovirus infection. The chest X-ray was normal, but the lung scan showed perfusion defects. Although pulmonary embolism cannot be ruled out, it seems likely that the CMV infection was responsible for the abnormalities observed.

Cytomegalovirus Infections↗
PubMedDate not supplied

Combination DMARD therapy including corticosteroids in early rheumatoid arthritis.

A number of reports indicating the growing acceptance of simultaneous therapy with multiple disease-modifying anti-rheumatic drugs (DMARDs), as well as the use of more aggressive treatment measures in the early phases of disease to combat rheumatoid arthritis (RA), have appeared during the last decade. However, only a few randomized controlled clinical trials have been conducted on the use of DMARD combinations in early RA. We review these trials in this article. In two separate one-year studies combination therapy with sulphasalazine (SSZ) and methotrexate (MTX) seemed to offer no benefits compared to either drug used as monotherapy. On the other hand, the DMARD combinations so far proven to be superior to single DMARDs have initially also included a corticosteroid component. In the COBRA study (Combinatietherapie Bij Reumatoide Artritis) the combination of SSZ (2 gm/day), MTX (7.5 mg/week for 40 weeks), and prednisolone (Prd) (initially 60 mg/day, tapered in 6 weekly steps to 7.5 mg/day and stopped after 28 weeks) compared to SSZ alone (2 gm/day) resulted in significantly better clinical outcomes at week 28. Although the difference in clinical response between the treatment arms was lost at week 58, the progression of joint damage remained statistically significantly slower at week 80 in the patients initially assigned to the combination therapy. Furthermore, in the FIN-RACo trial (Finnish Rheumatoid Arthritis Combination Therapy Trial), therapy using a "tailored-steps" strategy with SSZ (1-2 gm/day), MTX (7.5-1.5 mg/week), hydroxychloroquine (300 mg/day), and Prd (up to 10 mg/day) yielded a significantly increased remission rate and less peripheral joint damage at two years than the single DMARD treatment strategy (initially SSZ 2 gm/day), with or without Prd. Adverse effects in both study arms were comparable. Two additional preliminary reports (in abstract form) suggest that intensive local therapy in the form of intra-articular injections added to single or combination therapy improves both local and systemic disease control, with increased remissions and less damage. Although still preliminary, these results should encourage the rheumatological community to treat selected RA patients with DMARD combinations from the very start.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Reliability of spot samples for assessment of urinary excretion of pyridinoline in patients with rheumatoid arthritis.

OBJECTIVE: To determine how well a spot urine sample of patients with active rheumatoid arthritis (RA) can predict 24-hour urinary pyridinoline and deoxypyridinoline excretion. METHODS: Urine samples of 11 hospitalized RA patients taken on 2 consecutive days at 8 a.m. and 4 p.m. were compared with samples from 24-hour collections (gold standard). High-performance liquid chromatography was used to measure the collagen crosslink concentrations. RESULTS: Sampling time was the only significant factor (repeated measurement ANOVA). Significant differences were found between morning and 24-hour samples and between morning and afternoon samples, but not between afternoon and 24-hour samples. CONCLUSIONS: Samples collected in the afternoon (4 p.m.) give the best approximation of 24-hour urinary pyridinoline excretion in patients with active rheumatoid arthritis. In longitudinal studies the sampling time should be fixed.

Adult↗
PubMedDate not supplied

OMERACT: an international initiative to improve outcome measurement in rheumatology.

OMERACT is the acronym for an international, informally organized network aimed at improving outcome measurement in rheumatology. Chaired by an executive committee it organizes consensus conferences in a 2-yearly cycle that circles the globe since 2002. Data driven recommendations are prepared and updated by expert working groups. Recommendations include core sets of measures for most of the major rheumatologic conditions. Since 2002 patients have been actively engaged in the process. OMERACT 8 will take place in Malta, May 2006 (www.omeract.org).

Clinical Trials as Topic↗
PubMedDate not supplied

Low disease activity state in rheumatoid arthritis: concepts and derivation of minimal disease activity.

With recent advances in therapy, the proportion of patients achieving a satisfactory state of minimal disease activity (MDA) is becoming a more important measure with which to compare different treatment strategies. MDA is between high disease activity and remission and anyone in remission will also be in MDA. This paper summarizes the process of coming to a definition of minimal disease activity in rheumatoid arthritis. Two equivalent preliminary definitions of minimal disease activity for use as secondary outcome measures in clinical trials in RA are proposed: a core-set definition based on the WHO/ILAR core set and a DAS-based definition based on the DAS28.

Antirheumatic Agents↗