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Biomedical subjects

N J Gerber

Publications and source records attributed to N J Gerber.

At least 37 records · Page 2Linked to original sources
PubMed1992

Effect of food on the bioavailability of low-dose methotrexate in patients with rheumatoid arthritis.

OBJECTIVE: To evaluate the influence of food on the bioavailability of an oral dose of methotrexate in patients with rheumatoid arthritis. METHODS: Methotrexate (15 mg) was given intravenously and orally, with or without a meal, to 10 patients. Blood samples were drawn at specific intervals to evaluate drug levels. RESULTS: Food reduced the peak concentration, from a mean of 0.71 mumoles/liter to 0.49 mumoles/liter (P less than 0.02), and slightly increased the time to peak concentration, from a mean of 1.3 hours to 2.0 hours. Bioavailability was highly variable (range 28-94%) but was not affected by food intake. CONCLUSION: Bioavailability of oral methotrexate shows marked interindividual variation but is not affected by the presence of food.

Absorption↗
PubMed1992

Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a cause of elbow pain? A controlled study.

Elbow pain is a common complaint and elbow hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the relationship between spinal and extraspinal hyperostotic features and the clinical relevance of elbow hyperostosis we have performed the first controlled, double-blinded study of 85 hospitalized probands, 33 with and 52 without thoracospinal hyperostosis on lateral chest X-ray. Elbow and shoulder hyperostosis were graded on bilateral standard radiographs. Elbow pain was assessed by an interviewer using a standardized questionnaire and extraskeletal causes of elbow pain were recorded. The prevalence of elbow hyperostosis was increased in cases with thoracospinal hyperostosis compared to controls (82% versus 58%, chi 2 = 5.32, P less than 0.025, n = 85, olds ratio (OR) 3.30 (95% CI 1.16-9.35)). Similarly, the prevalence of elbow hyperostosis was increased in cases with shoulder hyperostosis compared to controls (83% versus 60%, chi 2 = 4.51, P less than 0.05, n = 84, OR = 3.20 (95% CI 1.06-9.66)), emphasizing the multifocal nature of hyperostotic features. Elbow pain was only slightly more prevalent in cases with elbow hyperostosis compared to controls (21% versus 13%, chi 2 = 0.75, NS, OR = 1.84 (95% CI 0.46-7.44)). We conclude that elbow hyperostosis is a radiological finding of doubtful clinical relevance.

Aged↗
PubMed1992

The prevalence of palpable finger joint nodules in diffuse idiopathic skeletal hyperostosis (DISH). A controlled study.

The presence of clinically palpable finger joint nodules (Heberden's and Bouchard's nodes) was documented in 123 consecutive cases with diffuse idiopathic skeletal hyperostosis (DISH) of the thoracic spine and 191 matched DISH negative controls. The prevalence of palpable finger joint nodules was almost twice as frequent in cases with spinal DISH compared to controls (46% versus 31%, chi 2 = 7.67, P less than 0.01; multivariate adjusted odds ratio OR = 1.84; 95% CI: 1.14-2.98). This increase was most marked at the proximal interphalangeal joint, in males and in patients up to the age of 65 years. In addition and independent of other variables such as hyperostotic features, age and sex, the prevalence of palpable finger joint nodules was about twice as high in probands with a history of physically heavy work compared to those without (43% versus 26%, chi = 9.18, P less than 0.005; multivariate adjusted odds ratio OR = 2.10; 95% CI: 1.26-3.52). From these results we conclude that DISH should be considered as an independent risk factor in the development of finger joint nodules.

Aged↗
PubMed1992

[Osteoporosis].

An exact diagnostic classification in primary or secondary osteoporosis may have therapeutic consequences. This review thus covers clinical, biochemical, radiological and bioptic diagnostic procedures. The most effective prophylactic measures, i.e. physical exercise, nutrition rich in calcium and estrogen-gestagen substitution, are spotlighted. Finally, various current therapeutic modalities are critically discussed, namely calcium supplements, the osteoclast inhibitors, calcitonin and bisphosphonates, as well as the osteoblast stimulators, anabolic steroids and fluorides.

Bone Density↗
PubMed1991

[Juvenile chronic arthritis: therapeutic strategy 1990].

Therapeutic strategies based on experience with 119 patients with juvenile chronic arthritis are reviewed. Therapeutic goals are formulated and the means of attaining them (NSAIDs, the so-called disease modifying drugs gold, chloroquine and penicillamine, the antimetabolite methotrexate, intra-articular and systemic corticosteroids, physio- and ergotherapy, technical and orthopedic measures, as well as vocational and medicosocial aspects) are discussed. As the individual prognosis normally depends less on drugs than on preventive and rehabilitative measures, the outcome is largely determined by the quality of a well-coordinated inter-disciplinary team approach.

Administration, Topical↗
PubMed1991

[Postmenopausal osteoporosis: are there alternatives to estrogen/gestagen substitution?].

This review on non-estrogen measures against postmenopausal osteoporosis first deals with primary prevention in young women, such as calcium rich nutrition and physical training in sedentary young women. For the case of acute osteoporotic vertebral fracture, analgetic, physiotherapeutic and ergonomic measures are highlighted. A more profound discussion covers those possible measures against established osteoporosis, which have been evaluated in prospective controlled trials: calcium, Vitamin-D, fluorides, bisphosphonates, calcitonin, anabolic steroids and exercise. From the currently available studies, the following against established osteoporosis are preferred: Nutrition counselling, motivation for physical exercise and back schooling are sensible in every case. All the other possible interventions, however, are not yet sufficiently substantiated for routine prescription in every case, whether due to lack of proof efficacy for possible adverse side effects, disproportionate costs or other reasons. Thus, for the time being, calcium supplements, Vitamin-D, fluorides, bisphosphonates, calcitonin and anabolic steroids should be reserved for selected, defined cases or for properly controlled prospective studies.

Adult↗
PubMed1991

Detection of flexor tenosynovitis by magnetic resonance imaging: its relationship to diurnal variation of symptoms.

Fifteen patients with noninfectious arthritis and morning stiffness were examined clinically, and with magnetic resonance imaging (MRI) at the metacarpophalangeal level of one hand in the evening and early the following morning. Our purpose was to determine the prevalence of hand flexor tenosynovitis, and to look for diurnal changes in the swelling state of the flexor tendon sheaths as a possible cause for morning stiffness. MRI showed a higher prevalence of flexor tenosynovitis than clinically suspected by using the pinch test. We could not observe an increase in soft tissue swelling in the morning compared to the evening.

Adult↗
PubMed1991

[Juvenile chronic arthritis: a rare disease with potentially serious consequences].

The term juvenile chronic arthritis covers several nosological entities with very different clinical presentation, course and prognosis. This review addresses non-rheumatologists and non-pediatricians. Diagnostic criteria, clinical presentation of the most common nosological subgroups and relevant investigations are spotlighted. Therapeutic guidelines are presented, bearing in mind, that for each child an individual interdisciplinary plan has to be elaborated. This would involve close cooperation between the pediatrician, the pediatric rheumatologist, the family doctor, parents and, if necessary, the physiotherapist, ergotherapist, social worker, ophthalmologist, orthopedic surgeon and school teachers. It is essential that each member of this therapeutic team reports regularly.

Adolescent↗
PubMed1991

[Foot problems in chronic polyarthritis: shoe advice and foot care].

Inflammatory alterations of the feet due to rheumatoid arthritis very often reduce the patient's quality of life. We present the pathogenetic mechanisms and discuss practicable and efficient prophylactic and therapeutic methods. A method recently developed by our occupational therapist for placing foot pads correctly in shoes is described.

Arthritis, Rheumatoid↗
PubMed1990

[Nuclear spin tomography in synovitis: experimental and clinical results].

We report our experimental and clinical results in the evaluation of synovitis using magnetic resonance imaging (MRI), and discuss them in the light of the literature. Using rheumatoid arthritis in the rat as a model, we have shown that MRI is more sensitive than physical examination and X-ray for the diagnosis of early soft-tissue inflammation in arthritis. On the basis of MRI findings, in patients with morning stiffness we have found an incidence of tenosynovitis higher than that reported in the literature. Because other groups have demonstrated the usefulness of MRI for the evaluation of inflammatory cartilage and bony lesions in arthritis as well, we anticipate that this method will assume increasing importance in the diagnosis and monitoring of rheumatoid arthritis and related diseases.

Animals↗
PubMed1990

[Fibromyalgia syndrome, a frequently misdiagnosed entity].

Fibromyalgia syndrome is a frequent condition. It mainly affects middle-aged women, who complain of diffuse pain in the proximal limb girdles and trunk, morning stiffness, unrefreshing sleep, tiredness, and fear, without abnormal physical findings on examination. This review considers the currently evaluated diagnostic criteria and recent research data, which suggest that fibromyalgia in fact is most probably primarily a brain disturbance involving neurohormonal abnormalities and impaired deep sleep. Effective and ineffective therapies are discussed.

Antidepressive Agents, Tricyclic↗
PubMed1990

Bacterial arthritis: are fever, rigors, leucocytosis and blood cultures of diagnostic value?

Clinical suspicion, positive gram stains and cultures of the synovial fluid are the fundamental criteria for the diagnosis of bacterial arthritis. Bacterial arthritis may, however, show an oligosymptomatic clinical course and thus lead to a delay in diagnosis. The case records of 43 patients with bacterial arthritis were reviewed retrospectively. Rigors (20.9%), fever (40.5%), blood leucocytosis (41.8%) and a shift to the left of blood leucocytes (35%) were found in less than half of all examined patients. Positive cultures of the synovial fluid (71.4%) were far more frequent than positive blood cultures (23.5%). We conclude, that the absence of fever, rigors, blood leucocytosis and positive blood cultures does not rule out the possibility of bacterial arthritis.

Arthritis, Infectious↗
PubMed1990

Diffuse idiopathic skeletal hyperostosis (DISH) of the shoulder: a cause of shoulder pain?

Shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the clinical relevance of shoulder hyperostosis we performed a controlled, blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest X-rays. The study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs, assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain. The prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls (chi 2 = 5.90, P less than 0.025, n = 99). Shoulder hyperostosis, irrespective of thoracospinal hyperostosis, predisposed to shoulder pain (40% versus 18%, chi 2 = 4.06, P less than 0.05, n = 74). Shoulder hyperostosis in combination with thoracospinal hyperostosis (shoulder DISH) predisposed to shoulder pain to an even greater extent (46% versus 12%, chi 2 = 6.64, P less than 0.01, n = 47). We conclude that shoulder hyperostosis is a radiological finding of potential clinical relevance.

Arthrography↗
PubMed1989

[Bacterial arthritis--a retrospective analysis].

Bacterial arthritis is an emergency situation in which rapid diagnosis and immediate therapy are the main factors conditioning a satisfactory functional outcome. Not infrequently, bacterial arthritis may involve only mild clinical features, thus leading to a delay in diagnosis. The case histories of 43 patients with bacterial arthritis are reviewed retrospectively. Only 20.9% mentioned a history of rigor and less than half (40.5%) of the patients had a body temperature elevation above 38 degrees C. Other signs of bacterial infection (i.e. leukocytosis, positive blood cultures, synovial fluid pleocytosis) were less frequent than expected. Functional outcome was better for patients with a short latent period between the onset of clinical symptoms and initiation of treatment.

Adolescent↗
PubMed1989

Pelvic manifestations of diffuse idiopathic skeletal hyperostosis (DISH): are they clinically relevant?

This is a cross-sectional, case-controlled study on the clinical relevance of diffuse idiopathic skeletal hyperostosis (DISH) in relation to the pelvic girdle. Thirty-two rheumatology patients with DISH were compared with 35 dermatology control subjects in respect to the clinical parameters pain and passive hip joint motion in a standardized manner. There were no significant differences between the two groups, indicating no major clinical relevance of DISH in the pelvic region. In a second study, the radiographs of 23 DISH probands were compared blindly with 23 matched controls. The only significant difference was a much higher degree of severe juxtaarticular bone formation in DISH probands. The majority of these spurs proved to be asymptomatic and did not affect the range of passive hip joint mobility. DISH is a frequently seen, often radiologically very impressive phenomenon of little clinical relevance, at least in the pelvic area.

Aged↗
PubMed1989

Diffuse idiopathic skeletal hyperostosis (DISH) of the spine: a cause of back pain? A controlled study.

This is the first controlled study of the frequency of back pain in a European caucasian population with diffuse idiopathic skeletal hyperostosis (DISH). Elderly patients admitted to hospital for reasons other than back pain were assessed for the presence of spinal DISH using the routine lateral chest radiograph films. A total of 106 probands (82 males, 24 females) with a mean age of 70 years fulfilled the criteria for DISH as defined previously. One hundred and seventy-eight patients (117 males, 61 females) not meeting these criteria were used as controls. The prevalence of back pain was assessed by a blinded interviewer using a structured questionnaire. Our primary hypothesis was that spinal DISH positive probands had not had back pain more often than controls. This controlled study showed no statistically significant difference in pain frequency between spinal DISH positive probands and controls at any spinal level. We conclude that back pain does not occur more often in radiographically defined DISH positive probands than in controls. The radiological finding of spinal DISH, as far as it does not lead to stenosis of the spinal canal or dysphagia, thus seems to be a finding without clinical relevance.

Aged↗
PubMed1988

Relapsing polychondritis mimicking rheumatoid arthritis.

A woman with relapsing polychondritis presented with progressive and deforming polyarthritis (but always negative for rheumatoid factor) 14 years before the appearance of typical clinical and histological changes of nasal and auricular cartilage destruction.

Aged↗