Biomedical subjects

M C Britton

Publications and source records attributed to M C Britton.

3 recordsLinked to original sources

PubMed1978

Rheumatoid hand deformities: pathophysiology and treatment.

Rheumatoid disease, as it affects the hand, is a disease of the synovium lining the joints and sheaths of the tendon. The proliferating synovium destroys the articular surfaces of the joint, interferes with the gliding mechanism of the tendons and weakens the supporting ligaments of the joints. The degree and variety of deformities is multifold. Treatment of the rheumatoid hand is aimed at conservation and restoration of hand function, as well as prevention of future deformities. Rheumatologists, physical therapists and hand surgeons carry out important functions in the well-planned, integrated regimen. Surgical treatment of the rheumatoid hand deformity may alleviate pain, lessen deformity and improve function in selected cases. It should be integrated in the general medical management of a patient. Treatment of tendon ruptures includes tenorrhaphy, tendon grafting and arthrodesis in the case of mallet finger deformity. The wrist joint is improved by synovectomy and carpal tunnel release is accomplished by median nerve decompression. Metacarpal phalangeal joint deformities may be treated by synovectomy or silastic joint replacement when there is destruction of the articular joint surface, severe subluxation, or persistent painful motion.

Arthritis, Rheumatoid↗

PubMed1976

Some problems in the interpretation of clinical trials: longterm parallel study of fenoprofen in rheumatoid arthritis.

Fenoprofen calcium was compared with acetylsalicylic acid in the treatment of 27 patients with definite or classic rheumatoid arthritis, over a period of one year. Both drugs appeared efficacious, with a slight edge to fenoprofen in the doses employed. Fewer side effects were noted with fenoprofen. Effectiveness continued undiminished throughout the year, and mean values of most parameters continued to improve in both groups over the entire period. Three problems which influence extrapolation of results from this and similar studies to the general setting are discussed. (1) Individual patients show great variation from the mean and from one observation point to another. Thus, expectations developed from mean values will seldom be accurate in a particular patient. (2) The relative doses chosen for two drugs in the clinical trial can profoundly influence both efficacy and toxicity. The qualification "at the doses employed" is seldom emphasized in clinical reports. (3) Patient compliance in the general clinical setting is importantly different from that in a clinical trial, and this potential problem must be assessed by the physician choosing an appropriate medication for a particular patient.

Arthritis, Rheumatoid↗

PubMed1975

Rheumatoid synovitis: complement and immune complexes.

The pattern of complement component utilization within the joint space of patients with RA is consistent with activation by immune complexes. Immunogluorescent studies of SF leukocytes revealed intracytoplasmic inclusions of immunoglobulins and complement components, particularly in cells from SF with low complement levels and containing materials which precipitated with either C1q and/or rheumatoid factor. RA patients with low levels of SF complement tended to have an unremitting course, subcutaneous nodules, and to have been treated with gold. Their joints had more periarticular demineralization, joint space narrowing, cortical impaction by X-ray; and synoviocytic giant cells, fibrosis, lymphocytes, congestion, and fibrin exudation by pathologic examination than did joints of RA patients without low levels of SF complement. Patients with systemic hypocomplementemia had active classical RA with evidence of severe joint involvement and vasculitis. These findings suggest that rheumatoid inflammation of joints is mediated by immunologic activation of the complement system.

Antigen-Antibody Complex↗