Biomedical subjects

R M Bennett

Publications and source records attributed to R M Bennett.

At least 73 records · Page 4Linked to original sources

PubMed1990

Nonarticular rheumatism and spondyloarthropathies. Similarities and differences.

Nonarticular rheumatism and the early stages of the spondyloarthropathies make up a large proportion of the musculoskeletal problems seen by primary care physicians. Because of their many shared features, these conditions may be confused. Moreover, the essential concepts of their diagnosis are often poorly understood. Because the approaches to treatment are radically different for the two conditions (as well as for the various types of nonarticular rheumatism), accurate diagnosis is a prerequisite of successful management. Except for describing a very small minority of patients with bizarre pain, the term "psychogenic rheumatism" has no place in contemporary medicine.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1990

The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.

To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.

Adult↗

PubMed1990

Identification of a cell-surface DNA receptor and its association with systemic lupus erythematosus.

We have previously reported the existence of a cell-membrane-associated molecule on human PBMC, which binds DNA and has the characteristics of a receptor. Monoclonal antibodies have been made to this receptor and have been used successfully for the purification of this cell-surface molecule. Preliminary studies have indicated a receptor for DNA on murine kidney and spleen cells which is similar in molecular weight to the human DNA receptor (30 kD). The occurrence of autoantibodies to cell-surface receptors has been described in several autoimmune diseases and we have noted that the serum of patients with lupus and similar disorders inhibit the binding of labeled DNA to human leukocytes. Using a "dot-blot" assay with affinity-purified human DNA receptor, sera from patients with various CTD and from healthy volunteers were screened for anti-receptor antibodies; anti-receptor antibodies were found in many patients with CTD and some of their first-degree relatives. The prevalence of anti-receptor antibodies in normal blood donors was less than 2%. It is hypothesized that anti-receptor antibodies represent an early immune response in lupus and kindred disorders and that anti-DNA antibodies may arise from the corresponding anti-idiotypic response.

Antibodies↗

PubMed1990

Scleroderma overlap syndromes.

Overlap features with diffuse scleroderma are rare. More commonly, other connective tissue diseases have features usually seen in the systemic involvement of scleroderma. The limited form of scleroderma (CREST) has interesting associations with primary biliary cirrhosis, whereas mixed connective tissue disease evolves toward a scleroderma-like picture with advancing years.

Autoantibodies↗

PubMed1989

Aerobic fitness in patients with fibrositis. A controlled study of respiratory gas exchange and 133xenon clearance from exercising muscle.

Aerobic fitness was evaluated in 25 women with fibrositis, by having them exercise to volitional exhaustion on an electronically braked cycle ergometer. Compared with published standards, greater than 80% of the fibrositis patients were not physically fit, as assessed by maximal oxygen uptake. Compared with matched sedentary controls, fibrositis patients accurately perceived their level of exertion in relation to oxygen consumption and attained a similar level of lactic acidosis, as assessed by their respiratory quotient and ventilatory threshold. Exercising muscle blood flow was estimated by 133xenon clearance in a subgroup of 16 fibrositis patients and compared with that in 16 matched sedentary controls; the fibrositis patients exhibited reduced 133xenon clearance. These results indicate a need to include aerobic fitness as a matched variable in future controlled studies of fibrositis and suggest that the "detraining phenomenon" may be of relevance to the etiopathogenesis of the disease.

Adult↗

PubMed1989

Congenital genitourinary hemangiomas in a patient with the Klippel-Trenaunay syndrome: management with the neodymium:YAG laser.

The Klippel-Trenaunay syndrome is an unusual congenital anomaly characterized by cutaneous hemangiomas, multiple varicosities, soft tissue hypertrophy and, rarely, gastrointestinal or genitourinary hemangiomas. The large bladder as well as multiple penile hemangiomas in our patient were treated successfully with the neodymium:YAG laser with minimal morbidity.

Adult↗

PubMed1989

Physical fitness and muscle metabolism in the fibromyalgia syndrome: an overview.

Patients with the fibromyalgia syndrome are physically unfit. Two crucial questions arise. Why do these patients enter a spiral of habitual inactivity? What is the role of deconditioned muscles in causing the symptoms of pain and fatigue? The use of newer techniques, such as nuclear magnetic resonance spectroscopy, allied with studies of exercise physiology, may provide new insights into the fibromyalgia enigma.

Adaptation, Physiological↗

PubMed1989

Muscle physiology and cold reactivity in the fibromyalgia syndrome.

The contention that muscles are the "end organs" responsible for fibromyalgia symptomatology is unproven. This review presents a contemporary synopsis of muscle physiology and then describes studies in the fibromyalgia syndrome which have yielded objective data of distorted muscle physiology and cold reactivity.

Cold Temperature↗

PubMed1989

Beyond fibromyalgia: ideas on etiology and treatment.

A common syndrome of musculoskeletal pain, currently called fibrositis or fibromyalgia, accounts for 10-30% of all rheumatology consultations in North America. Lacking a distinctive pathophysiological basis the nature of the pain experienced by these patients remains elusive and treatment is not based on sound scientific principles. An hypothesis is advanced which suggests that skeletal muscle is the "end organ" responsible for the pain of fibromyalgia and that previous studies on muscle deconditioning and microtrauma may be relevant to the etiopathogenesis of fibromyalgia syndrome.

Fatigue↗

PubMed1989

Confounding features of the fibromyalgia syndrome: a current perspective of differential diagnosis.

Patients eventually diagnosed as having the fibromyalgia syndrome often have symptoms which suggest alternate diagnoses such as peripheral neuropathy, spondylitis, metabolic myopathy, polymyalgia, early rheumatoid arthritis, early systemic lupus erythematosus or a chronic fatigue syndrome. Delay in diagnosis of fibromyalgia often proves costly and frustrating to the patient and may lead to inappropriate therapy.

Diagnosis, Differential↗

PubMed1988

A comparison of cyclobenzaprine and placebo in the management of fibrositis. A double-blind controlled study.

The efficacy of cyclobenzaprine (Flexeril), as compared with placebo, was tested in a 12-week, double-blind, controlled trial of 120 patients with fibrositis. Of the patients who received placebo, 52% dropped out due to lack of efficacy of the drug, compared with 16% of patients taking cyclobenzaprine. The dropout rate due to adverse reactions was similar in the 2 groups. Patients taking cyclobenzaprine experienced a significant decrease in the severity of pain and a significant increase in the quality of sleep. There was a trend toward improvement in the symptoms of fatigue, but morning stiffness was not alleviated. These improvements in symptoms were associated with a significant reduction in the total number of tender points and in muscle tightness. Our findings indicate that cyclobenzaprine is a useful adjunct in treating patients with the fibrositis syndrome.

Adult↗

PubMed1987

Chronic anterior and posterior uveitis and primary Sjögren's syndrome.

We examined eight patients with primary Sjögren's syndrome and uveitis. In all patients, the uveitis was bilateral, chronic, anterior and posterior, and not associated with active chorioretinitis. Seven of the eight patients were women. The diagnosis of primary Sjögren's syndrome was generally based on results of a Schirmer test, minor salivary gland biopsy, and serologic studies. Frequent findings included keratic precipitates, cataract, a pars plana exudate, an increased sedimentation rate, a positive test for antinuclear antibodies in a speckled pattern, and associated systemic disease compatible with the spectrum of Sjögren's syndrome.

Adult↗

PubMed1987

DNA receptor dysfunction in systemic lupus erythematosus and kindred disorders. Induction by anti-DNA antibodies, antihistone antibodies, and antireceptor antibodies.

The ability of sera from patients with SLE and similar connective tissue diseases to induce dysfunction of the receptor for DNA was studied. All SLE and MCTD sera studied resulted in marked inhibition of DNA receptor binding. Furthermore, the sera from a subgroup of patients with other rheumatic diseases and a surprisingly high percentage of asymptomatic relatives of SLE patients exhibited a similar effect. The humoral factors causing this defect were shown to be of at least three reactivities: (a) antibodies to DNA, (b) antibodies to histones, and (c) antibodies to the DNA receptor itself. The reactivity of anti-DNA and antihistone antibodies is dependent upon intact cell-surface DNA, and reconstitution experiments suggest that antihistone antibodies are reactive with histones complexed to this DNA, which in turn is bound to the DNA receptor. Cells with an antibody-induced DNA receptor defect are unable to bind DNA; the subsequent inability to degrade DNA may have important consequences in diseases such as SLE in which DNA-anti-DNA immune complexes are of pathogenetic significance.

Antibodies, Monoclonal↗

PubMed1987

An unusual syndrome of a devastating noninflammatory vasculopathy associated with anticardiolipin antibodies: report of two cases.

We describe 2 patients with marked elevations of anticardiolipin antibodies who developed multiple-organ disease characterized by a noninflammatory vasculopathy. Their cases were remarkable for the fulminant nature of their thrombotic diathesis, which was heralded by a prominent livedo reticularis of the extremities. Both patients had a serologic profile and salivary gland biopsy findings that were consistent with a diagnosis of primary Sjögren's syndrome.

Adult↗

PubMed1987

Shoulder pain. Guidelines to diagnosis and management.

The cause of shoulder pain can usually be diagnosed after a pertinent history has been obtained and a relevant physical examination performed. To carry out such an evaluation, the examiner must understand the salient anatomic relationships of the shoulder. Causes of shoulder pain include supraspinatus tendinitis (the most common), bicipital tendinitis, impingement syndromes, supraspinatus rupture, subacromial bursitis, arthritis, frozen shoulder, and various conditions that refer pain to the shoulder. Treatment in most cases consists of rest and administration of a nonsteroidal antiinflammatory drug or injection of a corticosteroid preparation, or both.

Bursitis↗

PubMed1986

Current issues concerning management of the fibrositis/fibromyalgia syndrome.

The fibrositis/fibromyalgia syndrome is one of the commonest forms of musculoskeletal pain seen in clinical practice. It is diagnosed on the basis of widespread pain accompanied by the physical finding of multiple tender points in remarkably reproducible locations. Accompanying the pain are two symptoms commonly associated with the "systemic" rheumatic disorders, namely morning stiffness and easy fatigability. Unlike the classical rheumatic diseases, however, fibrositis is not responsive to anti-inflammatory medications, including corticosteroids. Current therapeutic strategies, which are only partly successful, are aimed at modifying those factors that seemingly influence the severity and course of the condition; such afferent features include sleep disturbance, overuse syndromes, mechanical stress, psychic stress, and other causes of chronic pain. Major unresolved issues center around the assessment of functional disability in fibrositis and the apparent relationship to trauma in some patients. Until more is known about the underlying pathogenesis of this common condition, significant progress will be thwarted.

Fibromyalgia↗

PubMed1986

Defective DNA-receptor function in systemic lupus erythematosus and related diseases: evidence for an autoantibody influencing cell physiology.

The receptor for DNA was functionally defective in the majority of patients with systemic lupus erythematosus (SLE; 91% of 35 studied) and allied rheumatic disorders. This functional defect was manifest by impaired binding of exogenous DNA to the cell surface of peripheral blood mononuclear cells and an inability of cells to internalise and degrade DNA. The receptor defect was not constitutive, since it could be reversed by overnight incubation of cells; this process was sensitive to cycloheximide, suggesting a requirement for active receptor regeneration. The DNA-receptor defect could be induced in healthy controls, by incubating their cells with the serum of patients with SLE. The humoral factor inducing the defect was an autoantibody.

Autoantibodies↗

PubMed1986

Fibrositis.

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Fibromyalgia↗