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Biomedical subjects

N Bellamy

Publications and source records attributed to N Bellamy.

At least 127 records · Page 7Linked to original sources
PubMed1988

Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.

Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.

Aged↗
PubMed1988

A survey of current prescribing practices of antiinflammatory and urate lowering drugs in gouty arthritis in the province of Ontario.

We recently conducted a cross-sectional survey of the prescribing practices of rheumatologists and a random sample of family physicians. While in general there was agreement as to the preferred management of gout, family physicians were (a) more likely to use phenylbutazone, (b) more liberal in their use of allopurinol, (c) less likely to cover the introduction of allopurinol with antiinflammatory agents or to titrate the dose against the serum uric acid, or to adjust the dose according to the serum creatinine. A small number of physicians continued to routinely use urate lowering drugs in the treatment of entirely asymptomatic hyperuricemia.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1988

An experiment in reducing interobserver variability of the examination for joint tenderness.

This experiment was designed to test the feasibility of reducing interobserver variability of the joint examination by agreement on a standard examination. Six rheumatologists independently examined 6 patients with rheumatoid arthritis (RA) in predetermined order, before and after a standardization of examination techniques. Results of an analysis of variance showed a reduction of the percent of variability due to observers from 13.8%, before standardization, to 3.2% after standardization, and an improvement in the percent variability related to patient differences from 70.7%, before standardization, to 86.3% after standardization. Such a reduction in observer variability has a potential for allowing a reduction in sample sizes required for RA clinical trials.

Analysis of Variance↗
PubMed1987

Effects of aspirin, naloxone and placebo.

This study was designed to examine the effects of aspirin, naloxone and placebo treatment on serum beta-endorphin concentration and joint pain in patients with rheumatoid arthritis (RA). Ten patients with definite or classical RA were studied. All treatments were administered in a randomized sequence. On each study day, the following measurements were carried out at specified time intervals: serum beta-endorphin concentration, serum salicylate concentration and joint pain score on a visual analogue horizontal scale. We conclude that in patients with rheumatoid arthritis suffering from chronic joint pain, serum beta-endorphin does not appear to play a role in pain relief.

Arthritis, Rheumatoid↗
PubMed1987

Observations on spontaneous improvement in patients with podagra: implications for therapeutic trials of non-steroidal anti-inflammatory drugs.

1 The natural history of acute gouty arthritis was studied in 11 volunteers with podagra. 2 Two patients withdrew from the study on day 4 because of severe persistent pain. Of the remaining patients all showed some improvement in pain by day 5 and in swelling by day 7. Tenderness improved in seven patients by day 7 but two continued to experience the same amount of discomfort as at trial entry. In spite of these improvements only three patients noted resolution of their pain during the study period. 3 These data indicate that while the majority of patients show spontaneous improvement, resolution is unlikely over a period of 7 days without the use of effective non-steroidal anti-inflammatory medication. 4 Documentation of the natural history of the acute gouty attack may assist clinical investigators in interpreting the results of uncontrolled evaluations of non-steroidal anti-inflammatory drugs.

Adult↗
PubMed1987

The detection of psychiatric morbidity and associated factors in patients with rheumatoid arthritis.

Eighty-six patients with a confirmed diagnosis of rheumatoid arthritis were surveyed to assess the extent of psychiatric morbidity as indicated by two screening questionnaires, the General Health Questionnaire and the Hospital Anxiety and Depression Scale. In addition to an investigation of the concordance of the screening questionnaires, a description of demographic characteristics and measures of disability were taken. Disability due to arthritis was indicated by measures of years of chronicity, pain, duration of morning stiffness, functional level, active treatment involvement, and presence of coexisting medical problems. The relationship of physical symptoms to level of psychiatric distress was investigated. Psychiatric cases were identified using recommended cut off scores on results of the screening questionnaires. GHQ cut off scores of 6/7 identified as "cases" 31.8% of the sample. HADS subscale cut off scores of 8/9 identified 21.4% of subjects with "anxiety" and 19.0% with "depression" scores in the morbid range. Nineteen percent of patients were found to have scores on both tests concurrently in the pathological range.

Adult↗
PubMed1987

Low dose cyclosporine in rheumatoid arthritis: a pilot study.

A 6 month open trial of cyclosporine (CyA) was conducted in 20 patients with active rheumatoid arthritis unresponsive to second line therapy. The dosage was monitored to achieve a serum blood level of 75-150 ng/ml. A 25% reduction in ARA joint count (baseline mean 38.2; 6 month or time of CyA withdrawal mean 28.7; p less than 0.001) was observed for all patients. Fifteen completed the 6 month CyA regimen and 5 developed toxicity requiring CyA to be permanently withdrawn. For the 15 patients completing 6 months of CyA, improvement was 36% (baseline 34.7; 6 month mean 22.2; p less than 0.001). Corresponding improvements were also observed on the other main study outcomes of pain and functional ability. Improvement occurred between 12-20 weeks, somewhat later than in other studies. Toxicity included mild hypertension (4 patients) and gastrointestinal intolerance (2). Three patients were withdrawn from CyA due to nephrotoxicity. There was a clinically significant reduction in calculated creatinine clearance but this returned to baseline within 6 months after CyA was withdrawn for all except 2 patients who took 12 months to return to baseline.

Adult↗
PubMed1986

A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee.

Current methods of clinical assessment in osteoarthritis show a high degree of variability. By contrast, patients with rheumatoid arthritis may be evaluated using a number of standardised and validated indices. One hundred patients with primary osteoarthritis of the hip and knee were interviewed in order to determine the dimensionality of their discomfort and disability and to define the clinical importance of each component item. The symptomatology of osteoarthritis was captured by five pain, one stiffness, twenty-two physical, eight social and eleven emotional items. In spite of a high degree of variability in the frequency of involvement of the individual items, their clinical importance was similar both within as well as across dimensions. Further studies are indicated to determine the reliability, validity and responsiveness of each of the items identified as a prelude to developing a standardized method of assessing patients with osteoarthritis of the hip and knee.

Activities of Daily Living↗
PubMed1986

Double-blind randomized controlled trial of isoxicam vs piroxicam in elderly patients with osteoarthritis of the hip and knee.

1 Fifty-seven elderly patients with primary osteoarthritis of the hip and knee were entered into a double-blind, randomized, controlled parallel group trail to compare the efficacy and tolerability of isoxicam (maximum = 200 mg day-1) and piroxicam (maximum = 20 mg day-1). 2 Clinical assessments were made following a 1 week NSAID-free washout period and at biweekly intervals during the next 6 weeks of active treatment. 3 The majority of patients in both groups experienced a clinically important and statistically significant therapeutic response. 4 No statistically significant between-group differences were noted with respect to drug efficacy. 5 One patient was withdrawn from the piroxicam group because of lack of effect, but there were no such withdrawals from the isoxicam group. 6 Five patients were withdrawn from the piroxicam group because of adverse reactions compared to only one withdrawal from the isoxicam group. 7 This study indicates that isoxicam is an efficacious and well-tolerated once-daily NSAID for elderly patients with osteoarthritis.

Aged↗
PubMed1986

Current practice in antimalarial drug prescribing in rheumatoid arthritis.

An analytic mail survey was conducted among Canadian and Australian rheumatologists to probe current prescribing practices for antimalarial agents. Ninety-six percent of respondents prescribed antimalarial therapy for rheumatoid arthritis with a preference for the use of hydroxychloroquine. The most frequently reported risk estimates for serious retinal toxicity were 0.01 and less than or equal to 0.001. Seventy-eight percent of rheumatologists reported 1 to 50% of patients refusing antimalarial therapy, usually because of concern regarding ocular toxicity. Our study indicates the importance of presenting the relevant risk:benefit data in an accurate and comprehensible form to potential recipients.

Antimalarials↗
PubMed1985

Statistical reappraisal of the clinical significance of nail beading in rheumatoid arthritis.

Nail beading has previously been reported as an accompaniment of rheumatoid arthritis. In order to assess the clinical significance of this form of nychodystrophy the fingernails and toenails of 119 patients with rheumatoid arthritis and an equal number of control subjects were studied. Analysis of data based on 4642 nails indicates that the presence of a global pattern of beading (i.e. greater than or equal to 50% involvement of the nail area) on the surface of at least six fingernails or four toenails is highly suggestive of underlying rheumatoid disease. The positive predictive value of these configurations is in the order of 95%. Nail beading, however, is infrequent in early disease and therefore its diagnostic value is limited. Although there is a strong association between nail beading and rheumatoid arthritis, the aetiology and prognostic implications of this clinical sign remain obscure.

Adult↗
PubMed1985

Controlled, double-blind, randomized trial of amitriptyline in relieving articular pain and tenderness in patients with rheumatoid arthritis.

Thirty-six patients with definite or classical rheumatoid arthritis participated in a double-blind, randomized, placebo-controlled trial to assess the effectiveness of adding amitriptyline to the treatment regimen for the relief of pain not adequately controlled by non-steroidal anti-inflammatory drugs. Dosage of amitriptyline was increased gradually up to 25 mg 3-times daily and patients were followed up for 12 weeks. Assessments were made of joint pain and tenderness every 4 weeks. The results showed no difference between the amitriptyline and placebo-treated patients for either parameter.

Adult↗
PubMed1984

Outcome measurement in osteoarthritis clinical trials: the case for standardisation.

Outcome measures for clinical trials to be valid and reliable should also be responsive to change. There are currently no standardised methods of measuring the outcome in osteoarthritis clinical trials. A review of 63 trials of nonsteroidal anti-inflammatory drugs revealed a large degree of variability in the items, instruments and scales employed. The implications of this variability are discussed and methods proposed for rationalising outcome measurement in this area of clinical research.

Activities of Daily Living↗
PubMed1984

Clinical trials: proposal for an international coding system (ICS).

The basic design, measurement and analytical components of clinical trials are frequently difficult to extract from published reports. Precedent indicates that this type of information is amenable to codification. An alphabetical international coding system (ICS) is proposed and its advantages discussed and illustrated.

Clinical Trials as Topic↗
PubMed1984

Clinical evaluation of two strategies for improving patient recall of prior drug therapy.

The ability to recall details of current and prior drug therapy was evaluated in two studies employing a total of 94 patients with inflammatory polyarthritis. Ten per cent of patients were unable to completely recall the names of their current anti-inflammatory drugs and eighty-three per cent of patients to completely recall the details of prior anti-inflammatory drug therapy. Prompting firstly with the proprietary names of drugs and thereafter with a pill board substantially enhanced recall particularly for prior NSAID therapy. Nineteen per cent of responses obtained with verbal prompting were inaccurate. No such problems were encountered in responses obtained using the pill board. These findings indicate that a complete and accurate drug history can only be obtained in the majority of patients using recall enhancement strategies.

Adult↗