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Biomedical subjects

M S Knapp

Publications and source records attributed to M S Knapp.

At least 37 records · Page 2Linked to original sources
PubMed1982

Time of day of prednisolone administration in rheumatoid arthritis.

Twelve patients with rheumatoid arthritis took low dosage prednisolone, mean 5.6 mg daily, at either 0800 h, 1300 h or 2300 h in a double-blind within-patient controlled trial. Each patient was studied on each of the 3 regimens to assess control of symptoms and side effects and also to examine circadian rhythms in signs and symptoms. For several days during each drug regimen patients collected urine at each micturition and self-assessed their signs and symptoms. Circadian rhythms of finger joint swelling and of grip strength were determined, and were similar on all regimens, with morning peaks of symptoms and signs. Subjective and objective assessments showed no differences in effectiveness between the 3 times of administration of prednisolone. Urinary excretion patterns were similar to those observed in untreated people. The quantity and circadian pattern of 11-hydroxycorticosteroids excreted were similar to those in healthy patients, providing no evidence of adrenal cortical suppression at the dose levels studied, even when this dose was taken in the evening. A single morning dose of prednisolone appears in many patients to be as effective as a single evening dose or divided doses. It is therefore reasonable to initiate therapy with a morning-only regimen, because adrenopituitary suppression should be minimised.

11-Hydroxycorticosteroids↗
PubMed1982

Domiciliary self-measurement in the rheumatoid arthritis and the demonstration of circadian rhythmicity.

Symptoms and signs of rheumatoid arthritis vary within the day and from day to day. Interesting and possibly important observations can be missed when evaluations are based only on outpatient measurements, which are likely to be made at only one time and at infrequent intervals. We have found that patients can measure their own grip strength and finger joint sizes at home, and simultaneously assess overall pain and stiffness on numerical scales. Measurements made by patients were reproducible when made at the same time of day if on the same treatment. The patient's subjective assessment of pain and stiffness is a useful measure of the severity of rheumatoid arthritis. These pain and stiffness ratings were found to be well correlated with the patient's objective measurements of finger joint size and grip strength. Information not otherwise available can be collected by studying patients at home with these self-measurement techniques. These have allowed the demonstration of circadian variations in the signs and symptoms of rheumatoid arthritis and improved the evaluation of drugs studied in clinical trials.

Arthritis, Rheumatoid↗
PubMed1981

Circadian variations in the signs and symptoms of rheumatoid arthritis and in the therapeutic effectiveness of flurbiprofen at different times of day.

1 Seventeen patients with rheumatoid arthritis were studied in a double-blind crossover trial contrasting three different times of administration of twice-daily flurbiprofen. 2 Twelve of these patients were also studied when taking the same dose of flurbiprofen as a split dose four times a day. 3 Symptoms and signs of the disease were self-assessed throughout the day for several days on each regimen and the information was analysed for rhythmicity. 4 Twice a day flurbiprofen may be more effective than four times daily flurbiprofen, and the regimen without an evening dose was the least effective of three twice-daily treatments tested. 5 Circadian rhythms of grip strength and finger joint size were demonstrated, and were similar on all treatment regimens. 6 These rhythms have a similar pattern to those detected during studies of immune responses, and it is suggested that morning stiffness in rheumatoid arthritis is not only the result of nocturnal inactivity, and may respond to appropriately timed medication given to decrease inflammation or to suppress other aspects of the immune response.

Arthritis, Rheumatoid↗
PubMed1980

Kidney biopsy.

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Biopsy↗
PubMed1980

Time of day of taking immunosuppressive agents after renal transplantation: a possible influence on graft survival.

Large-amplitude circadian rhythms in immune responses and the known variations in the effects of glucocorticoids with the time of day of administration suggest that immunosuppressive regimens may need to take this variable into account. In two similar groups of patients with renal transplants functioning satisfactorily after three months subsequent graft failure developed in 66% of those taking all immunosuppressives in the evening, compared with only 22% of those taking immunosuppressives twice daily (p < 0.05). A survey of other transplant units showed that one unit with outstanding results--graft survival at three years 82%--had a unique policy of morning-only administration of immunosuppressives. Doctors need to consider more carefully the time of drug administration when prescribing, as it may be possible to obtain better results with less toxicity.

Adult↗
PubMed1980

Kidney biopsy.

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Biopsy↗
PubMed1980

Circadian variations in urine excretion in chronic renal failure.

The pattern of urine excretion over 24 hours has been studied in nineteen patients with stable chronic renal failure of varying severity and due to a variety of renal disorders. The patterns were compared with those in eighteen health control subjects of similar age. The 24 hour urine volume was not significantly greater in the patients (1608 +/- 112 compared with 1710 ml +/- 169). A lower urine concentration (341 +/- 79 mOsm compared with 430 +/- 160 mOsm/kg) was associated with a lower total 24 hour solute excretion (596 +/- 224 compared with 699 +/- 169 mOsm/24 hours). Frequency of micturition, expressed in relation to periods of 24 hours, was similar (6.8 +/- 0.6 compared with (6.4 +/- 0.5). There was an alteration in the normal pattern of urine flow, with more urine at night and less in the day. Nocturia, a consistent feature of the patients with renal failure is due to reversal of the normal pattern and not to an increased volume of urine or increased frequency of micturition. The time of onset of decreased urine excretion during the day was associated with the change from recumbency to activity. The morning antidiuresis, and the nocturnal diuresis, are associated with, and probably the result of, changes in sodium and total solute excretion. The circadian rhythm of potassium excretion remained normal in chronic renal failure, except in very severe renal failure when it was reversed. Alterations in sodium, total solute and water excretion were associated with changes in creatinine excretion and were observed even in mild renal failure. In some patients, studied just before commencing regular dialysis, renal function would have been adequate for reasonable health had the rates of excretion observed at night persisted throughout the 24 hours. Nocturia, in nineteen patients with chronic renal failure, was due to a change in the circadian pattern of urine flow; it is suggested that this results, at least in part, from an inability to respond normally to changes from recumbency to activity.

Adult↗
PubMed1979

Possible effect of time on renal allograft rejection.

The change in plasma creatinine concentrations from decreasing values after successful renal transplantation to increasing values after the onset of rejection occurs as a sudden event. Twenty-two such episodes in 16 renal allograft recipients were studied by extrapolating sequential measurements of plasma creatinine concentrations to see when the change occurred. Seventeen of the episodes occurred between 2300 and 1100 and the rest at other times. This difference was significant. The results suggest that rejection is more common at night and apparently has a circadian rhythm, being likely to first influence creatinine clearance at around 0600.

Circadian Rhythm↗