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Biomedical subjects

M Guttadauria

Publications and source records attributed to M Guttadauria.

6 recordsLinked to original sources

Methotrexate in rheumatoid arthritis. Impact on quality of life assessed by traditional standard-item and individualized patient preference health status questionnaires.

In a double-blind, randomized trial of methotrexate vs placebo in rheumatoid arthritis, the effect of treatment on physical, social, and emotional function was measured in two different ways: the same, standard measurements in all patients, and individualized measurements selected by the patients at the start of the trial as representing the functions they most wanted to have improved by treatment. On the standard measurements, methotrexate-treated patients fared better than placebo-treated patients in their physical, social, and emotional function by 11%, 5%, and 6%, respectively, results that, although statistically significant, were small. However, methotrexate-treated patients were 29% better in the individualized measures, a result that was both highly statistically significant and greater than the differences in the standard measurements or in joint counts, grip strength, proximal interphalangeal joint circumference, morning stiffness, or walking time. Because the individualized measurements were as efficient as the best direct joint examination measures, yet reflected functional outcomes of greatest importance to individual patients, they constitute useful measures for such trials.

Adult

Pulmonary function in scleroderma.

Pulmonary function tests were performed in 45 patients with scleroderma. Thirteen patients (29%) were found to have restrictive disease, 12 patients (27%) were found to have obstructive disease, and 19 patients (42%) had small airway disease (SAD). Smoking did not seem to be a factor underlying either obstructive or small airway disease in these patients. A low diffusing capacity was most common in patients with restrictive disease and rarely the only abnormality in pulmonary function. SAD was usually found in patients who had normal chest radiographs and no pulmonary symptoms and was often the only abnormality. SAD is therefore an early and sensitive indicator of pulmonary involvement in scleroderma.

Adult

Colchicine in the treatment of scleroderma.

We treated 10 patients with well established scleroderma with colchicine in the highest tolerated dose for one year. We could determine no clinical or laboratory improvement in any patient. Progression of disease was suggested by the development of new skin ulcers and telangiectasia, by an increase in musculoskeletal complaints, and by a significantly diminished ability to make a fist. In addition, there was deterioration of pulmonary function as demonstrated by a statistically significant fall in FEV1, and diffusing capacity. Colchicine was not of value in the treatment of scleroderma in this group of patients.

Adult

Prednisone and azathioprine compared to prednisone plus low-dose azathioprine and cyclophosphamide in the treatment of diffuse lupus nephritis.

A 1-year double-blind crossover study comparing prednisone and azathioprine to prednisone plus low-dose azathioprine and cyclophosphamide was carried out in 14 patients with diffuse lupus nephritis. Low-dose triple therapy had no apparent therapeutic advantage over prednisone plus azathioprine. Cyclophosphamide-induced ovarian failure and hematuria were not avoided by its use in low dose.

Adolescent

A clinical evaluation of piroxicam gel: an open comparative trial with diclofenac gel in the treatment of acute musculoskeletal disorders.

An open, parallel trial was conducted to compare the efficacy and toleration of piroxicam 0.5% gel and diclofenac 1.16% topical gel preparations in the treatment of 173 patients with well-defined, acute sprains and tendinitis of the ankle, shoulder, or elbow. Therapy was begun within three to five days of the injury and continued for up to 14 days. Piroxicam gel was applied to the injured area four times daily by 84 patients and diclofenac gel was similarly applied by 89 patients. Pain, tenderness, and restriction of joint movement were markedly improved with both drugs after three days of treatment. Further improvement was noted after 14 days of treatment and patients generally resumed normal activities in nine days. There was no difference in the response to treatment or in the global impressions of efficacy between piroxicam and diclofenac. Toleration was regarded as good or excellent by 98% of patients receiving piroxicam and 94% of patients receiving diclofenac. There were few adverse effects reported by either group. The type and incidence of these effects were similar for both drugs, with the majority consisting of mild or moderate local skin reactions at the site of application. The results of this study show that piroxicam 0.5% gel and diclofenac 1.16% gel are equally effective and well tolerated in the treatment of selected acute sprains and tendinitis.

Acute Disease