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Biomedical subjects

P Halberg

Publications and source records attributed to P Halberg.

At least 19 recordsLinked to original sources
PubMed1996

Follow-up of 151 patients with high-titer U1RNP antibodies.

We performed a longitudinal follow-up study of clinical findings in 151 patients with high-titer antibodies against U1 ribonucleoprotein (U1RNP) as measured by haemagglutination. Formal connective tissue disease (CTD) diagnoses were assigned and diagnostic transitions analysed. One-hundred eighteen females and 33 males entered the study; the mean duration of follow-up was 7.1 years. Mean age at entry was 34.7 years; 73% of the patients had early disease (duration < 2 years). Fifty-six patients (37%) presented with a definite diagnosis, most often mixed connective tissue disease (MCTD, n = 40), followed by systemic lupus erythematosus (SLE, n = 11) and systemic sclerosis (SSc, n = 5). Of 84 patients (56%) presenting with nonspecific symptoms of possible, "undifferentiated" CTD, 58 developed MCTD, 4 SSc and 2 SLE. By the end of the follow-up period. 127 patients had developed a well-defined CTD; final diagnoses were: MCTD (n = 97), SLE (n = 18), SSc (n = 12). We conclude that CTD in the context of high-titer anti-U1RNP antibodies may be transitive and sequential in nature, although the diagnostic criteria for MCTD previously proposed by our group seem to delimit a clinically stable condition in most patients in this subgroup.

Adolescent↗
PubMed1996

Randomized, placebo controlled trial of withdrawal of slow-acting antirheumatic drugs and of observer bias in rheumatoid arthritis.

Patients with rheumatoid arthritis, in stable treatment with methotrexate, penicillamine, or sulfasalazine, were randomized in a double-blind fashion either to continuation of their usual treatment or to placebo. 112 patients were included; 52 patients who refused participation had no more severe disease than the others. The patients felt worse on placebo than on active drug (p = 0.002). The mean differences in number of tender, painful and swollen joints after one month were 2.4 (p = 0.08), 3.0 (p = 0.12) and 2.2 (p = 0.03), respectively. Treatment failure occurred for 42 patients of whom 33 received placebo (p = 0.000,001). There was no difference in the severity of side effects (p = 0.91). The patients guessed their treatment correctly more often than expected (p = 0.02) because of the perceived effect. None of the two observers guessed better than chance, and there were no differences between the observers' evaluations of the joints. The effect of slow-acting antirheumatic drugs was unequivocal and no observer bias occurred.

Aged↗
PubMed1994

[Arthritis urica. Clinical picture, diagnosis and treatment].

Gout is an acute episodic monarthritis or chronic pauci- or polyarticular arthritis. The symptoms of gout are induced by monosodium-urate crystals that are liberated from accumulations in connective tissue structures, primarily cartilage. Deposition of monosodium-urate crystals is caused by hyperuricaemia, which is dealt with in a previous paper. Only a minority of persons with hyperuricaemia develop gout, however. The diagnosis is based on detection of urate crystals in synovial fluid or tophi. Acute gout is treated with antiinflammatory agents, primarily NSAIDs or colchicine. Predisposing diseases and associated conditions such as hypertension, diuretic drugs, overweight and nephropathy should be controlled as well as possible. In patients with recurrent attacks of acute gout or chronic gout, treatment with urate lowering drugs, principally allopurinol, should be given. Treatment with allopurinol should be adjusted according to levels of serum urate and renal function. Serious complications to allopurinol treatment have been described.

Anti-Inflammatory Agents↗
PubMed1994

Screening for autoantibodies to the nucleolar U3- and Th(7-2) ribonucleoproteins in patients' sera using antisense riboprobes.

In this study we report the detection of autoantibodies to the nucleolar U3- and Th(7-2) ribonucleoprotein (RNP) particles in sera from patients with connective tissue diseases. The method described employs radioactively labelled antisense U3- and Th RNA which are hybridized to immunoprecipitated U3- or Th RNA from a HeLa cell extract. Of the 66 sera that were screened with this method seven sera (11%) precipitated only Th RNP, 16 sera (24%) precipitated only U3 RNP and 4 sera (6%) precipitated both U3- and Th RNP. Both anti-U3 RNP and anti-Th RNP activity appeared to be mostly associated with scleroderma or scleroderma-associated diseases. Using this method we also showed that some of the Th RNP particles in a cell extract are associated with the La autoantigen. We conclude that for the identification of immunoprecipitated RNAs this method is very sensitive and provides unambiguous data.

Antibodies, Antinuclear↗
PubMed1994

DNA polymorphism of HLA class II genes in systemic lupus erythematosus.

We investigated the DNA restriction fragment length polymorphism (RFLP) of the major histocompatibility complex (MHC) genes: HLA-DRB, -DQA, -DQB, -DPB in 24 Danish patients with systemic lupus erythematosus (SLE) and in 102 healthy Danes. A highly significant increase of the frequency of the DR3- and DRw6-associated 7.00 kb DRB TaqI DNA fragment was found in SLE patients compared to normal controls (83.3% vs 35.5%; RR = 9.1, p < 10(-4). The frequencies of the DQA1*0501-associated 4.56 kb DQA TaqI fragment and the DRB3*01/03-associated 9.79 kb TaqI fragment were also found to be significantly increased in SLE patients (70.8% vs 29.7%; RR = 5.8, p < 10(-2) for the DQA fragment and 70.8% vs 36.1%; RR = 4.3, p < 0.05 for the DRB3 fragment). Less extensive and insignificant increases of the frequencies of the DR3-associated DQB and DPB fragments were observed. The frequencies of the DR2-associated DRB, DQA, and DQB fragments were comparable to those found in normal controls.

DNA↗
PubMed1993

[Drug therapy of rheumatoid arthritis].

Continuous, computer-aided registration of large numbers of patients with rheumatoid arthritis (RA) had lead to a revised concept of the prognosis. More patients than previously throught develop severe progressive, erosive, deforming, and crippling disease. Most of the permanent damage develops within the first 10 years of the course of the disease. The patients die 10-15 years before the background population, even though the cause of death is rarely a direct consequence of the disease. Because of these observations, the treatment strategy is now becoming more aggressive than previously. Treatment with slow acting anti-rheumatic drugs (SAARDs) is started within the first year. Synovitis activity is monitored continuously, and in case of primary or secondary resistance to one SAARD the drug is replaced by another one for as long as the disease is active. This procedure makes it necessary that all patients with suspected RA be evaluated early and repeatedly by rheumatologists during the whole course of the disease. The drug treatment should be conducted with close cooperation between the general practitioners and the rheumatologists.

Anti-Inflammatory Agents↗
PubMed1993

[Serology in patients with scleroderma].

In order to evaluate the practical clinical value of centromere, Scl-70, and nucleolar antibodies as demonstrated routinely by the Autoimmune Department of the Serum Institute of Copenhagen, 1293 sera from 497 patients with scleroderma (SSc) and other connective tissue diseases were tested for the three antibodies and for other nuclear antibodies. The three antibodies were found in 32, 15 and 15%, respectively, of sera from patients with SSc. Since more than one of the three antibodies was rarely demonstrated in any one serum, one of them was found in two thirds of sera from patients with SSc. The specificity of the three antibodies for SSc was 95% or more. Centromere antibody was found most frequently in patients with limited SSc. Scl-70 antibody was found almost exclusively in sera from patients with extensive SSc (involving the skin of the trunk). In such sera, centromere antibody was found in only 21%. Scl-70 antibody was overrepresented and centromere antibody was underrepresented in sera from patients with pulmonary involvement, the converse being true for sera from patients with calcinosis, esophageal involvement and telangiectasia.

Antibody Specificity↗
PubMed1992

Clinical manifestations in patients with autoantibodies specific for nuclear lamin proteins.

IgG antibodies to nuclear lamin proteins have been found in serum samples from 31 patients using immunofluorescence on HEp-2 cells, Western blotting, and enzyme-linked immunosorbent assay, performed against a nuclear lamina preparation from Ehrlich ascites tumor cells. Antilamin antibodies were most prevalent among patients with nonerosive, seronegative polyarthritis, or patients showing serum antiphospholipid reactivity as well. It is possible that anti-lamin antibodies may thus be a marker for a subgroup of polyarthritis patients who have a different prognosis from that of those with seropositive rheumatoid arthritis. The mechanism for the combined occurrence of anti-lamin and antiphospholipid autoantibodies is obscure. Future studies will answer whether these two antibodies represent a distinct antibody profile in patients with antiphospholipid antibody syndrome.

Adolescent↗
PubMed1992

Risk of kidney cancer in analgesics users.

The risk of kidney cancer was examined in a cohort of people discharged from Danish hospitals from 1977-1987 with a diagnosis of rheumatoid arthritis, osteoarthrosis or backpain. These individuals are presumably more or less regular users of mild analgesics. A total of 155,554 people were identified. The risk of cancer of the urinary tract was slightly increased [relative risk (RR) = 1.31], almost exclusively because of an increased risk of renal cell carcinoma (RR = 1.40). The relative risk was higher in individuals with rheumatoid arthritis than among individuals with osteoarthrosis or backpain, and higher among women than men. Although this study lacks information on the actual analgesics consumption of the individual, and various biases may be present, these findings offer little support to the concern that increased analgesics use raises the risk of kidney cancer.

Adult↗
PubMed1992

Meta-analysis of second-line antirheumatic drugs: sample size bias and uncertain benefit.

Placebo controlled trials of methotrexate, auranofin, penicillamine, azathioprine, sulphasalazine, gold sodium thiomalate and chloroquines were subjected to meta-analysis. The difference between drugs and placebo in the erythrocyte sedimentation rate was 8.8 mm/hr [95% confidence interval (CI), 6.4-11.3]. In multiple linear regression analyses, with the physician's global evaluation and relative change in joint tenderness count as outcome variables, a substantial sample size bias was demonstrated. The effect decreased with increasing sample size. The risk of dropping out from any cause was larger on drug than on placebo (odds ratio, 1.17; CI, 0.99-1.38). No evidence of a worthwhile effect on radiological changes was found. Of the 3439 patients, 4 went into complete remission on drug. We conclude that the benefit of second-line drugs is uncertain.

Arthritis, Rheumatoid↗
PubMed1991

[Is rheumatoid arthritis a new disease? Review of the literature].

No convincing descriptions of the lesions of rheumatoid arthritis (RA) can be found in the medical literature before 1800. The non-medical literature, the visual arts, and paleopathological observations have revealed finger abnormalities which have been considered suggestive of RA before 1800. However, many authorities remain unconvinced by such interpretations and it is felt, that RA may be a disease of recent origin. Recently, paleopathological observations of skeletons from 1000-3000 B.C. in the US have shown convincing bone erosions compatible with RA, and it has been suggested that RA may be an old disease in the New World, and, like syphilis, it may have been transferred to the Old World after the time of Columbus.

Arthritis, Rheumatoid↗
PubMed1991

[Salmonella infections in patients with systemic lupus erythematosus].

A retrospective review was undertaken of zoonotic Salmonella infections among 173 patients with systemic lupus erythematosus (SLE) who were followed by two departments of rheumatology in Copenhagen during an average period of 16 years. A total of six Salmonella infections were registered in five patients as one patient had two episodes of infection with Salmonella typhimurium with an interval of three years. All six infections were diagnosed during the years 1986-1990. During the period 1984 to 1988, the number of registered Salmonella infections increased from 900 to 3,500 in the Danish background population. All six infections were accompanied by Salmonella bacteraemia. the present investigation and studies of the literature demonstrate a considerably increased risk of Salmonella bacteraemia in SLE patients as compared with the population as a whole. This should be borne in mind when febrile SLE patients are investigated.

Adult↗