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M Hochberg

Publications and source records attributed to M Hochberg.

At least 55 records · Page 3Linked to original sources
PubMed1992

Validity and reliability of lupus activity measures in the routine clinic setting.

As part of a cohort study of 150 patients with systemic lupus erythematosus (SLE), we investigated the validity and reliability of several indices of lupus activity, including the UCSF/JHU Lupus Activity Index (LAI), the SLE Disease Activity Index (SLEDAI), and a simple Core Index combining common elements. Validity was assessed by measuring correlations of these indices at the first cohort visit with the physician's global assessment (PGA) of SLE activity. The correlation of M-LAI (LAI modified so as not to contain PGA) and SLEDAI with PGA was 0.64 (95% CI 0.50, 0.70) and 0.55 (95% CI 0.42, 0.64), respectively. Reliability was assessed in a study of 6 patients seen twice, one week apart, by 9 physicians. The interrater reliability and test-retest reliability was greater for LAI (or M-LAI) than for SLEDAI. The Core Index performed better in its correlation with PGA (R = 0.78), although it contained no treatment data or serologic tests. Its interrater reliability and test-retest reliability were comparable with LAI. We conclude that (1) all indices have high validity; (2) LAI and the Core Index have higher reliability; and (3) these indices can be readily assimilated into routine clinic practice.

Adult↗
PubMed1991

Definition, incidence, and clinical description of flare in systemic lupus erythematosus. A prospective cohort study.

The course of systemic lupus erythematosus (SLE) is characterized by exacerbations (or flares) and remissions of disease activity. As part of an ongoing prospective cohort study, 3 disease activity indices, the physician's global assessment, the Lupus Activity Index, and the University of Toronto SLE Disease Activity Index, have been recorded, at least quarterly since 1987, on 185 SLE patients. We developed a definition of SLE flare and a description of its clinical epidemiology. Disease flare was defined as a change of greater than or equal to 1.0 in the physician's global assessment of disease activity (measured on a 0-3 scale) from the previous visit or from a visit within the last 93 days. Of the 185 patients, 98 (53%) had greater than or equal to 1 flare; the total number of flares was 146. The incidence of flare was 0.65 per patient-year of followup. The median time from the first study visit to a flare was 12 months. Flares were frequently characterized by constitutional symptoms, musculoskeletal involvement, cutaneous involvement, and decreasing levels of C3 and C4. At the time of flare, the mean University of Toronto SLE Disease Activity Index score increased by 3.0 and the mean Lupus Activity Index score (modified to omit the physician's global assessment) increased by 0.26. Overall, 44.8% of the flares prompted a change in treatment. Patients who experienced flares fulfilled more of the SLE criteria at entry and had been followed up for a longer duration after entry into the study, compared with those who did not have flares.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Morbidity of systemic lupus erythematosus: role of race and socioeconomic status.

OBJECTIVE: To determine if differences in morbidity of systemic lupus erythematosus (SLE) as measured by (1) important renal disease, (2) number of hospitalizations, and (3) neurologic disease can be explained by race, socioeconomic status (SES), or measures of compliance. DESIGN: The interrelationship of black race, SES, and the physician's assessment of compliance as risk factors for morbidity was examined in a cohort of 198 patients with SLE (179 female, 115 black). SES was measured with Nam-Powers scores for education (years), income, and job status, and source of insurance; compliance was assessed by physician global assessment and percent of protocol visits kept. Morbidity outcomes were important renal disease (creatinine level 1.5 mg/dL or greater, renal failure, nephrotic syndrome), neurologic involvement, and number of hospitalizations. SETTING: The Johns Hopkins Rheumatology Faculty Practice, in which both private and clinic patients are seen. RESULTS: Black patients had significantly lower SES on all measures (p less than 0.0001) and were also less compliant by physician global assessment (odds ratio [OR] = 0.39, p = 0.002). Univariate analyses showed that blacks had a higher frequency of important renal disease (OR = 2.07, 95% confidence interval [CI] 1.05 to 4.11) and hypertension (OR = 1.80, 95% CI 1.01 to 3.23). Important renal disease was associated with the physician global assessment of compliance (p = 0.009) and hypertension (p less than 0.001). Multiple regression models for important renal disease, including race, physician global assessment of compliance, hypertension, SES, age, and gender, identified significant associations with only physician global assessment of compliance (OR = 0.40, 95% CI 0.17 to 0.91) and hypertension (OR = 5.37, 95% CI 2.40 to 11.98); black race was not significant (OR = 1.60, 95% CI 0.68 to 3.76). The second morbidity measure, number of hospitalizations, was associated with renal disease, neurologic disease, mouth ulcers, duration of disease, and public insurance but not with black race, in the best log-linear model. Neither race, SES variables, nor physician assessment of compliance was significantly associated with neurologic disease, the third morbidity measure. CONCLUSIONS: These data fail to support an independent association of black race with morbidity in SLE; rather, they suggest that noncompliance (as measured by physician global assessment) and type of medical insurance are important factors in morbidity. Classical epidemiologic measures of SES (education, income, occupation) do not appear to be significant confounders of the relationship of race to morbidity in SLE.

Adult↗
PubMed1991

Erythropoietin response to anemia as a function of age.

The erythropoietin (EPO) response to anemia was assessed for 244 subjects aged 1-64 years (mean 45.2 years) and 121 subjects aged 65-94 years (mean 68.3 years). Subjects included non-anemic individuals as well as those with anemia of various etiologies, excluding renal disease and pregnancy. Significant inverse correlations between serum immunoreactive EPO and hematocrit were noted for both groups. Regression lines failed to show a significantly lower slope or y-intercept for older compared to younger subjects. EPO levels were not significantly lower for older compared to younger subjects when controlled for hematocrit level. These results suggest that the EPO response to anemia in older subjects is similar to that of younger subjects.

Adolescent↗
PubMed1991

Meralgia paresthetica after coronary bypass surgery.

Meralgia paresthetica is a neurologic disorder characterized by localized paresthesia and numbness on the anterolateral aspect of the thigh and involving the lateral femoral cutaneous nerve. It involves no motor deficits. Meralgia paresthetica, which may result from a variety of causes, has been observed as a rare complication in heart operations. Its cause when associated with such operations is uncertain but may be prolonged relaxed positioning on the operating table and recovery room stretcher. Another possible cause of meralgia paresthetica after heart operations is the "frog-leg" position of the legs during vein harvesting. Patients with this condition should be advised of its untreatable, but benign and self-limiting, nature.

Aged↗
PubMed1990

Antibodies to denatured type II collagen in rheumatoid arthritis: negative association with IgM rheumatoid factor.

Serum samples from 129 patients with definite or classic rheumatoid arthritis (RA) were assayed by ELISA for antibodies to denatured bovine type II collagen (dII). All patients had active disease at the time of serum sampling. Anti-dII antibodies were found in 18 (14%) of 129 patients (95% confidence intervals: 8-20%). The only clinical or laboratory feature associated with the presence of anti-dII antibodies was seronegativity for IgM rheumatoid factor (IgM RF): 6 (37.5%) of 16 seronegative patients had anti-dII antibodies vs 12 (10.6%) of the 113 seropositive patients (OR = 5, p less than 0.01). There were no associations of anti-dII antibodies with age, sex, race, disease activity, disease duration, functional class, or the presence of HLA-DR1, DR4, or DQw3 in these patients. Antibodies to type II collagen may have a pathophysiologic role in RA, especially in patients seronegative for RF.

Adult↗
PubMed1989

The VH gene sequences of anti-DNA antibodies in two different strains of lupus-prone mice are highly related.

The heavy and light chain V region sequences of an IgG anti-DNA autoantibody (PME77), derived from a lupus-prone (NZB x NZW)F1 mouse have been determined by mRNA sequencing. The V kappa gene segment belongs to the V kappa 1A gene sub-group and is found in several (NZB x NZW)F1 and MRL lpr/lpr anti-DNA antibodies, as well as in other antibodies of unrelated specificities. The VH gene segment appears to represent a unique gene or a subfamily of the large J558 VH gene family of the mouse, and is highly related to a germ-line sequence of a major anti-DNA idiotype (H130, IgM) of MRL mice. This anti-DNA-related VH segment has not been found, so far, to be expressed in antibodies with specificities for external or synthetic antigens; therefore, expression of such specificities may be regulated by powerful mechanisms of self tolerance in the healthy animal. In addition, both the heavy and light chain of the PME77 IgG antibody were found to contain somatic point mutations with a high ratio of replacement to silent mutations in complementarity determining regions. This IgM to IgG sequence relationship suggests an affinity maturation process, which is driven by the autoantigen.

Amino Acid Sequence↗
PubMed1989

Collagenous colitis, enteropathic arthritis, and autoimmune diseases: results of a patient survey.

We surveyed all patients with collagenous colitis seen at Johns Hopkins over a 4-year period, using a standardized, previously validated telephone questionnaire. Of 29 patients, 2(7%), including the index case, had monoarticular reactive arthritis. Five additional patients (17%) had a coexisting autoimmune illness. Collagenous colitis should be added to the list of causes of enteropathic arthritis. In addition, collagenous colitis should be considered in the differential diagnosis of diarrhea occurring in patients with known autoimmune diseases.

Aged↗
PubMed1988

Emergency operation after failed angioplasty.

A group of patients with failed angioplasty who then required emergency coronary bypass was compared with a historically matched group of patients who had had elective bypass grafting. The two groups were well matched in age, sex, ejection fraction, and New York Heart Association classification and in the incidence of diabetes and hypertension. Significant differences were found in the prevalence of mortality (12% versus 1.5%), hemorrhage (28% versus 13%), cardiac tamponade (10.5% versus 1.5%), myocardial infarction (28% versus 9%), and length of hospital stay (15.3 days versus 13.4 days). Cardiogenic shock carries the worst prognosis; four of the five patients with this condition died. Because emergency operation after failed angioplasty carries with it significant postoperative morbidity and mortality, this procedure cannot be considered equivalent to elective coronary bypass grafting.

Angioplasty, Balloon↗
PubMed1986

Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.

For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or para-articular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.

Adult↗
PubMed1985

Incidence of lung cancer in systemic sclerosis.

During a study of lung function in patients with systemic sclerosis, we followed 71 patients with this diagnosis for a mean of 5 years. During this period, 3 cases of lung cancer were observed in the group, giving a post hoc incidence of lung cancer of 8.6 cases/1000 persons/year compared to an expected incidence of 0.52 cases/1000 persons/year. The relative risk ratio for lung cancer in systemic sclerosis patients is 16.5. There was no definite association of lung cancer with cigarette smoking, but all 3 patients had either radiographic or pulmonary function evidence of interstitial pulmonary fibrosis. Although bronchoalveolar carcinoma is the most prevalent histologic type of lung cancer associated with systemic sclerosis in the reported cases in the literature, this was not present in any of our patients.

Female↗
PubMed1984

Monoclonal autoantibodies to histones from autoimmune NZB/NZW F1 mice.

Fusion of spleen cells from autoimmune NZB/NZW female mice with drug-resistant myeloma cells (clones NSI/1, X63-Ag8.653 and NSO/1) produced hybrid clones which secreted antibodies to various nuclear components. Roughly 50% of the anti-nuclear hybridomas produced antibodies reacting with DNA, 20% with RNA and 30% reacted with other nuclear antigens. Two hybridomas of the latter group were cloned and studied in detail. They secreted antibodies which produced bright fluorescence staining of nuclei and metaphase chromosomes. The specificity of the antibodies was determined by testing them in an enzyme-linked immunosorbent assay and a radioimmunoassay against individual acid- and salt-extracted histones, against histones mixed two and three at a time and against histone complexes isolated as such from chromatin. One of the monoclonal antibodies was specific for histone H2B and reacted with the histone free in solution or when present as a H2A-H2B complex. The second monoclonal antibody recognized a specific conformation in the H3-H4 complex that was present only when the complex was obtained from chromatin by salt extraction. The same conformation, however, could be induced by adding histone H2B to a mixture of acid-extracted H3 and H4. Our findings show that the autoimmune syndrome in NZB/NZW mice resembles human systemic lupus erythematosus not only in the incidence of antibodies to DNA and RNA, but also in the production of autoantibodies to histones.

Animals↗
PubMed1984

Clinical and demographic predictors of loss of pulmonary function in systemic sclerosis.

The course of functional pulmonary involvement in systemic sclerosis remains controversial; and it is not known if specific clinical or demographic features are predictive of subsequent changes in pulmonary function. To address these questions, we conducted a non-concurrent prospective study of serial pulmonary function in 24 patients with systemic sclerosis unselected for pulmonary involvement over a mean follow-up interval of 59.7 months. Initial values for the entire group demonstrated a mild restrictive defect with a mild reduction in gas exchange. Although a restrictive pattern was most common, normal and obstructed pulmonary function were seen. Mean rates of change of FVC, TLC, FEV1/FVC, and Dco for the entire group were not different from normal, but substantial variability in the course of pulmonary functional involvement was seen among individuals. Changes in gas transfer, lung volumes, and airflow can occur independent of each other. Rates of change in pulmonary function were not predicted by initial pulmonary function, race, sex, duration of disease, cardiac involvement, roentgenographic fibrosis, or regression of skin disease. Patients with severe Raynaud' phenomenon exhibited the greatest fall in Dco over time, suggesting an association between peripheral and pulmonary vascular involvement. A correlation between exertional dyspnea and rapid loss of Dco was noted. Former smokers had significantly greater rates of loss of FVC and Dco than either non-smokers or current smokers, suggesting that cessation of smoking was a response to rapidly declining function in a subgroup of susceptible smokers. We detected a wide spectrum of severity of pulmonary prognosis in systemic sclerosis, ranging from normal pulmonary function to rapidly progressive disease leading to death. This study indicates that patients with prolonged survival do not necessarily have a rapidly progressive pulmonary component, but those with severe Raynaud's phenomenon and susceptible smokers are at very high risk for rapid deterioration of pulmonary function.

Adult↗
PubMed1984

Monoclonal antibodies to DNA and RNA from NZB/NZW F1 mice: antigenic specificities and NH2 terminal amino acid sequences.

Two anti-DNA hybridoma autoantibodies ( A52 , D42 ) were prepared by fusing spleen cells from unimmunized NZB/NZW F1 female mice with BALB/c myeloma cells. The monoclonal antibodies were purified to homogeneity and were analyzed for their antigen-binding specificities. The two anti-DNA antibodies bound single-stranded, double-stranded, and supercoiled DNA, with a marked preference for the single-stranded conformation. Competition experiments performed with synthetic polynucleotides, as well as chain reconstitution experiments, indicated that both the sugar-phosphate backbone and the heterocyclic bases of the nucleic acid are essential for antibody recognition. Amino terminal sequence analysis of A52 and two RNA-binding hybridoma proteins revealed that the heavy chains from all three were members of the VHII subgroup and that the A52 light chain was homologous to the VK8 subgroup. The D42 heavy chain was found to be similar to a phosphocholine-binding hybridoma of the VHIII subgroup.

Amino Acid Sequence↗
PubMed1984

A four-year experience with preoperative noninvasive carotid evaluation of two thousand twenty-six patients undergoing cardiac surgery.

From January 1979 through December 1982, 2026 patients scheduled to undergo open heart surgery were evaluated by a preoperative battery of noninvasive carotid tests including phonoangiography, oculopneumoplethysmography, pulse-timing oculoplethysmography, periorbital Doppler examination, and during the last 12 months, continuous-wave Doppler ultrasonography with spectral analysis. The incidence of hemispheric neurologic deficit following cardiac surgery in the 47 patients with carotid disease was 14.9%; the incidence in patients with no carotid disease was 1.9% (p less than 0.001). Fourteen of the 47 patients were not candidates for carotid surgery because of unilateral occlusion in 13 and bilateral occlusion in one. Three of the 14 (21.4%) had intraoperative strokes on the appropriate side. Thirty-three of the 47 had operable carotid disease. Four with unilateral stenosis had no carotid surgery; one had a postoperative deficit on the side referable to the nonstenotic artery. Eighteen with unilateral stenosis underwent simultaneous cardiac and carotid surgery; one (5.6%) had a transient deficit. Seven patients with bilateral stenosis underwent cardiac and unilateral carotid surgery; no deficits occurred. Four patients with unilateral stenosis and contralateral occlusion underwent combined surgery; one had a transient ischemic attack and one a fatal stroke, both referable to the hemisphere ipsilateral to the occlusion. It appears that the presence of carotid disease increased the risk of stroke during heart surgery. Proof that carotid endarterectomy lowers this risk awaits a prospective randomized trial.

Angiography↗
PubMed1982

Antibodies to RNA from autoimmune NZB/NZW mice recognize a similar antigenic determinant and show a large idiotypic diversity.

We have identified two RNA-specific hybridoma autoantibodies in fusions of spleen cells from unimmunized NZB/NZW female mice with BALB/c myeloma cells. The two fusion experiments were carried out 2 years apart with different myeloma partners. Specificity analyses showed that the two monoclonal antibodies and the total RNA-binding IgG in NZB/NZW serum recognize a G,C-rich sequence of ribonucleotides. The isolated heavy and light chains of the two antibodies and their papain Fab fragments could be distinguished by NaDodSO4/polyacrylamide gel electrophoresis. Rabbit anti-idiotypic antibodies prepared against the two monoclonal proteins showed unique specificities for the antigen-binding sites of their cognate auto-antibodies. Moreover, the anti-idiotypic antisera had little effect on the RNA-binding capacity of the total IgG from NZB/NZW serum. These results suggest that a wide range of different idiotypes is involved in the autoimmune response to a similar antigenic determinant.

Animals↗