Possible unnecessary prolongation of corticosteroid therapy in rheumatoid arthritis.
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Acute Kidney Injury↗
Biomedical subjects
M L Snaith
Publications and source records attributed to M L Snaith.
Uric acid clearance in patients with gout and normal subjects.
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Adult↗
Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. I. A descriptive analysis of 704 European lupus patients. European Consensus Study Group for Disease Activity in SLE.
Using a detailed questionnaire, the cumulative historical and current demographic, clinical and serological data on 704 SLE patients from 29 European centres and 14 countries have been assessed. Ninety-three percent of the patients were Caucasian and the female/male ratio was 10:1. Analysis of the cumulative incidence showed that arthralgia/arthritis (94%), rash (69%), Raynaud's phenomenon (49%), serositis (44%) and renal disease (38%) were the most frequent clinical manifestations. Virtually all the patients (98%) were antinuclear antibody positive, while anti-ds-DNA antibodies (76%), hypocomplementaemia (71%) and anti-Ro(SSA) antibodies (35%) were frequent serological abnormalities. Whilst much of this data is in line with previous reports, it is notable that renal, lung, and central nervous system involvement and the frequency of rheumatoid factor, anti-Sm and anti-RNP antibodies were much lower than in most comparable series in the United States. We assume that ethnic differences and the greater present awareness of lupus could explain this variations. Low dose corticosteroids, non-steroidal anti-inflammatory drugs and anti-malarials were used to treat over half of the patients, 75% of whom were between 15 and 55 years of age. This report offers a useful overview of lupus both clinically and serologically in Europe in the 1990's.
Adolescent↗
Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. II. Identification of the variables indicative of disease activity and their use in the development of an activity score. The European Consensus Study Group for Disease Activity in SLE.
A European Consensus Group study, involving 29 centres from 14 countries, was performed in order to reach agreement on the definition of disease activity in systemic lupus erythematosus (SLE) and to construct a new disease index. Data on 704 lupus patients were collected and analysed, using univariate and multivariate statistical procedures, to select those clinical and laboratory features of the disorder which best correlate with the global assessment of disease activity assigned to the patients by the physician of each participating centre. A combination of 15 clinical and laboratory variables was shown to be the best predictor of disease activity in SLE. A European Consensus Lupus Activity Measurement (ECLAM) was then formulated. This index included the 15 selected variables, weighted (with some adjustments) according to their respective regression coefficients in the multivariate model. ECLAM appears to be an effective instrument for scoring patients with different degrees of disease activity. This is the first SLE disease activity index based on data from a very large number of lupus patients followed at a large number of lupus centres in different countries. It might therefore very well serve as a standardised measure for future European clinical studies. Final assessment of the validity, reliability and sensitivity of this index is now underway.
Europe↗
Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. III. Development of a computerised clinical chart and its application to the comparison of different indices of disease activity. The European Consensus Study Group for Disease Activity in SLE.
In the first phase of this study, a data-base containing clinical and laboratory findings of 704 patients with systemic lupus erythematosus (SLE), originating from 29 centres and 14 countries, was used to assess the validity of 4 common indices of disease activity, SLAM, BILAG, SLEDAI and SIS. The physician's judgement of activity was assumed as the unique reference criterion (gold standard). Computer programmes were developed to calculate automatically the 4 activity indices; this computation appeared to correspond with manual computations in a sample of 60 appropriately selected cases. All 4 indices were closely correlated with each other (r in the range of 0.716 to 0.872), and with the physician's score (r in the range of 0.620 to 0.719). In the second phase of the study the activity index developed in part I (ECLAM) was prospectively validated, and its performance compared to that of the other scales, both as a single state index and as a transition index (i.e., its ability to assess disease activity at a single point in time and to detect variations in consecutive readings). A computer-assisted clinical chart was prepared for this purpose. This chart allowed us to calculate automatically all the indices. Two consecutive observation times (time 0, and time 1 three months later) were included in the study protocol. Data on 75 patients from 19 centres were collected, and each patient was observed twice. All the computed indices were closely correlated, both at time 0 (r ranging from 0.725 to 0.884), and at time 1 (r ranging from 0.607 to 0.833).(ABSTRACT TRUNCATED AT 250 WORDS)
Diagnosis, Computer-Assisted↗
In vitro lymph node and peripheral blood lymphocyte responses to influenza immunization in patients with systemic lupus erythematosus.
Following influenza immunization, in vitro anti-influenza antibody production by peripheral blood lymphocytes (PBM) taken from some patients with systemic lupus erythematosus is shown to be impaired despite apparently normal serum antibody responses. One explanation for this finding could be the sequestration of antibody-producing cells in the lymphoid tissue. In this study, antibody production in vitro by lymphocytes from peripheral blood and lymph nodes was measured in parallel following influenza immunization of SLE patients and normal controls. Antibody production by lymph node cells was confirmed in the presence of an impaired PBM antibody response, suggesting redistribution of antibody-producing cells to the lymphoid tissue. This finding was not however, confined to SLE patients, and the relatively low serum antibody response in these individuals suggests a more generalised impairment of the immune response.
Antibody Formation↗
The value of quantitative radioisotope scanning in the differential diagnosis of low back pain and sacroiliac disease.
The specificity of scintigraphic scanning in detecting inflammatory sacroiliitis has been investigated. The sacroiliac band profile (R[Band]) was used and a new index (R[SIJ/F]) comparing the sacroiliac joint with the ipsilateral femur is described. Using the R (Band) index the mean value (1.34) for patients with definite sacroiliac disease was no different from that found for control subjects (1.35). There were significant differences using the R(SIJ/F) (7.8 versus 6.4): this ratio alone correlated with age. We conclude that neither technique is sufficiently specific to be of diagnostic value in most instances of low back pain.
Adult↗
C-reactive protein in sera from patients with systemic lupus erythematosus.
One hundred and ninety sera from 27 patients with systemic lupus erythematosus (SLE) were tested by radial immunodiffusion for C-reactive protein (CRP). One hundred and fourteen (60%) of these samples from 22 patients had detectable CRP. There was a statistically significant association between clinical activity and serum concentration of CRP in the patients who consistently recorded elevated levels. CRP was not found to distinguish between disease activity and coincident infection in 2 patients whose SLE was complicated by tuberculosis.
Adult↗
Muscle Disease in systemic lupus erythematosus: a study of its nature, frequency and cause.
The nature, frequency and cause of clinical features suggesting muscle involvement in systemic lupus erythematosus were studied in 20 patients during "active" disease. Half of these patients experienced varying combinations of myalgia, proximal muscle weakness and muscle tenderness. This group "with muscle features" had a higher incidence of arthralgia and much of their myalgia may simply have been due to pain referred from adjacent joints. However, a greater number of abnormalities were also found in the muscle biopsies of this group and it is likely that polymyositis and steroid myopathy were important contributory factors.
Adult↗
An identical twin pair discordant for rheumatoid arthritis and ankylosing spondylitis.
Both rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have an increased familial occurrence and each disease is associated with the inheritance of specific HLA antigens. We report a pair of identical twin brothers with discordant disease phenotypes: one developed AS at the age of 26, and the other developed RA at the age of 55. The twins possessed both of the disease susceptibility antigens HLA B27 and DR4. Differences in the twins' environmental exposure are discussed.
Arthritis, Rheumatoid↗