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Biomedical subjects

V Wright

Publications and source records attributed to V Wright.

At least 145 records · Page 8Linked to original sources
PubMed1986

Heberden oration 1985. The rheology of joints.

The value of rheological studies of joint tissues has been illustrated by studies from our department. These have included studies of the stiffness of joints which suggest that subjective stiffness is more likely to be related to limitation of movement of a joint than to increased physical stiffness (either elastic or dissipative torques). A review of goniometry suggests that the diminution of joint movement with advancing age varies with the frequency of use of the joint. A simple goniometer for the hip has been described, and in contrast a sophisticated telemeterized system has been devised. Instruments to measure passive movement of joints, and their application for hypermobility, have been discussed. A knee analyser has been constructed to measure ligamentous and meniscal damage. Ligament replacement has been successfully achieved in the pig and in man by using a woven polyester tube. The load-bearing function of the menisci has been clearly demonstrated, explaining the relationship found in studies of parachutists and physical-education teachers between meniscectomy and osteoarthrosis of the knee. Support for the Leeds biomechanical hypothesis for the development of osteoarthrosis has been described from rheological studies of cartilage at the patellofemoral joint and at the ankle. The intervertebral joint does not appear to be a shock absorber in compression. The spine must bend to function in this way. The relevance to rigid segments of the spondylitic spine and surgical fusion of vertebrae is discussed.

Arthritis, Rheumatoid↗
PubMed1986

A parallel group comparison of tenoxicam and piroxicam in patients with ankylosing spondylitis.

Tenoxicam (20 mg/day) and piroxicam (20 mg/day) were compared in a double-blind, parallel group study over 4 weeks in 30 patients with ankylosing spondylitis. Both tenoxicam and piroxicam reduced spinal pain, but the improvement was greater with piroxicam. Tenoxicam and piroxicam were equally effective at improving duration of morning stiffness. Slight improvement was seen with other symptoms with both treatments. Patients were slightly more tolerant of piroxicam than tenoxicam and most patients elected to continue on their particular therapy at the end of the study.

Administration, Oral↗
PubMed1985

Microprocessor controlled arthrograph.

This new arthrograph, based on a microcomputer, provides displacements of variable amplitude, frequency and waveform. It is sufficiently small for use on a ward or in a clinic, is simple to use and is readily accepted by patients. One test and its associated analysis, together with printed and plotted results, occupies little more than two minutes.

Arthritis, Rheumatoid↗
PubMed1985

A pharmacokinetic comparison of tenoxicam in plasma and synovial fluid.

In view of the paucity of information on the synovial-fluid pharmacokinetics of nonsteroidal anti-inflammatory drugs with a long half-life, we have compared the pharmacokinetics of tenoxicam (Tilcotil, Mobiflex) in plasma and synovial fluid in six patients with polyarthritis causing knee effusion. Plasma and synovial-fluid concentrations of tenoxicam were measured up to 96 h after an oral dose of a single 40 mg tablet. A full pharmacokinetic analysis was performed. Tenoxicam passed into synovial fluid attaining a peak concentration significantly later than that for plasma. However, the mean half-life for synovial fluid (45 h) was not significantly different from that for plasma (42 h). Comparison of area under the curve (AUC) indicated the total exposure of the synovial fluid to tenoxicam was consistent in different patients, comprising 50-60% of the corresponding plasma levels in every case. In the case of tenoxicam, synovial fluid exhibits the pharmacokinetic properties of a peripheral 'tissue' compartment.

Adult↗
PubMed1985

Combination therapy with pulsed methylprednisolone in rheumatoid arthritis.

Pulsed methylprednisolone (PMP) has been shown to produce clinical improvement and reduction in the ESR and acute phase protein concentrations in patients with active rheumatoid arthritis and has been advocated for use either as an alternative to slow-acting antirheumatoid drugs (SAARDs) or in conjunction with SAARDs to accelerate the response to treatment. To test these potential roles for PMP 45 patients with active RA were randomly allocated to treatment with PMP alone, PMP + sulphasalazine (SAS - at a maintenance dose of 2.0 g/day), or PMP + D-penicillamine (DPA - at a maintenance dose of 500 mg/day). In each case three 1 g intravenous infusions were given on alternate days during the first week of the trial. Patients were monitored for 24 weeks by standard clinical and laboratory measurements. All three treatment groups showed significant clinical and laboratory improvements at two weeks. With PMP + DPA and PMP + SAS these improvements were sustained and were not significantly different in these two treatment groups. However, in the 'PMP only' group ESR and CRP rose to pretreatment values by eight weeks. Twelve patients withdrew from the study owing to a relapse of the RA. No serious adverse effects were seen in the 'PMP only' group. Both combination regimens were well tolerated; adverse effects seen were attributable to either DPA or SAS. We conclude that PMP alone is insufficient for treatment of RA but can be used successfully in combination with either DPA or SAS. A comparison between these results obtained from two previous groups of 15 patients treated with DPA alone and SAS alone (using the same study design) shows that PMP accelerated the response to therapy by at least six weeks.

Arthritis, Rheumatoid↗
PubMed1985

A double-blind controlled trial of etretinate (Tigason) and ibuprofen in psoriatic arthritis.

Etretinate (Tigason) and ibuprofen have been compared in a double-blind controlled trial in psoriatic arthritis to see if we could confirm a specific action for this vitamin A derivative suggested from earlier uncontrolled studies. Eleven out of 20 patients completed 24 weeks of therapy with etretinate (up to 0.5 mg/kg/day) whereas only 1/20 patients completed 24 weeks of therapy with ibuprofen alone. Etretinate improved skin lesions, and this may have encouraged patients to persist with it. Improvement of statistical significance was seen for articular index in both groups. In addition significant improvement in ESR, haemoglobin, C-reactive protein, and histidine occurred in the etretinate group. The main side effects of etretinate (which may preclude its use at a higher dose in this condition) included cracked and dried lips and sore mouth.

Adolescent↗
PubMed1985

Reference values for metacarpophalangeal joint stiffness in normals.

A new form of microprocessor-controlled arthrograph is described which measures stiffness parameters of the metacarpophalangeal joints of the index, middle, and ring fingers of both hands. The apparatus is simple and quick to use and gives reproducible results. The arthrograph is used to determine the reference limits for stiffness at the middle finger of the right hand in 128 normal subjects. It is found that incorporating information on the subject's finger circumference allows a much improved precision to be achieved, but the precision is not further enhanced by including details of age and sex.

Adolescent↗
PubMed1985

Measurement of outcome in rheumatic diseases.

In the assessment of outcome in rheumatic diseases a number of factors must be taken into account. It is important to make an accurate diagnosis, so that the response to treatment is not confused by heterogeneity of the population. The meaning of outcome needs to be defined. The quality of life over a prolonged period is just as important as the ultimate outcome. Subjective symptoms are important to the patient. Pain is the most important, followed by disability and then stiffness. Despite attempts to produce numerical values for pain, particularly visual analogue scales, patients' accuracy in recalling pain experienced more than an hour previously is dubious. In an attempt to quantify this aspect we have measured disturbance of sleep by changes in the EEG and in the motility of the patient. Objective clinical measures are desirable for accuracy. Arthrographs of the knees and metacarpophalangeal joints have produced useful data for physical stiffness. It is doubtful, however, whether they truly reflect the subjective stiffness of which the patient complains. That is more likely to be due to limitation of motion. Grip strength is commonly measured by a pneumatic dynomometer, but a pinch/hand grip analyser promises to give more extensive information. Active movement has been measured goniometrically. The value of electrogoniometers should be enhanced by telemeterization of the apparatus. Passive movement has been measured with a hyperextensometer in patients with hypermobility. Ligamentous laxity of the knee can be measured on the Leeds Knee Analyser and differentiates collateral ligament damage and anterior cruciate ligament damage. Laboratory variables are important in a patient model system in which potential antirheumatoid drugs can be screened and their mechanism of action investigated. Correlation matrices separate second-line agents from NSAIDs. Although mini-matrices have been produced, it would not appear that any single biochemical test will suffice to differentiate these two classes of drugs. A therapeutic index, in which the efficacy is expressed as a ratio of the toxicity of the drug, is important in determining its value. The nearest we can get to serial assessment of the pathological changes in the joint is by X-ray assessment. Changes radiologically correlate to some extent with the height of the ESR, and their progress with changes in the ESR. Functional impairment is important to the patient in the long term, and the Disability Index devised by the Stanford group commends itself for extensive long-term studies.

Arthritis, Rheumatoid↗
PubMed1985

A comparison of faecal blood loss caused by tenoxicam and piroxicam in normal healthy male volunteers.

Faecal blood loss arising from tenoxicam at a dose of 20 mg/day was compared to that arising from piroxicam at a dose of 20 mg/day in a double-blind, parallel comparative study in 12 healthy male volunteers. Faecal blood loss was measured for a 1-week run-in on placebo, during 4 weeks of treatment and for a 2-week post-treatment period in both groups. Plasma levels for tenoxicam and piroxicam confirmed good compliance in all subjects. Mean blood loss during the placebo run-in period was 0.35 ml/day. Mean blood loss during treatment with tenoxicam was 0.84 ml/day and with piroxicam 0.81 ml/day. There was no significant difference between these measurements. On cessation of treatment, faecal blood loss continued both in the tenoxicam group (mean 1.30 ml/day) and piroxicam group (mean 1.41 ml/day). The difference between these was not statistically significant. No significant haematological or biochemical abnormality resulted from either of the two trial drugs during the period of the study. Urinalysis and NAG/creatinine ratio also remained unaltered in both treatment groups.

Adult↗
PubMed1985

A double-blind, parallel study of tenoxicam and piroxicam in patients with osteoarthrosis.

A double-blind, parallel group study was carried out in 30 patients with osteoarthrosis to compare the efficacy and tolerance of tenoxicam (40 mg/day) and piroxicam (40 mg/day) given over a period of 4 weeks. All had previously been treated with a variety of non-steroidal anti-inflammatory agents and/or analgesics. Patients were allocated at random to one or other treatment group. Clinical and laboratory assessments were made on entry and after 2 and 4 weeks of treatment. The results showed that both drugs improved general pain, the improvement being somewhat greater with tenoxicam. Little change was noted in other symptoms with either treatment. Side-effects reported were mainly gastro-intestinal. Six of the 15 piroxicam-treated patients stopped treatment because of adverse reactions, 1 because of treatment failure and 1 because he preferred previous treatment. Three of the 15 tenoxicam-treated patients discontinued because of adverse reactions. The remaining patients (7 on piroxicam and 12 on tenoxicam) elected at the end of the trial period to remain on their respective treatment instead of their previous medication.

Adult↗
PubMed1985

Biochemical and clinical changes occurring during the treatment of rheumatoid arthritis with novel antirheumatoid drugs.

Groups of 15 patients with active rheumatoid arthritis have been treated with sulphasalazine, (salazosulfapyridine INN), zinc sulfate, captopril or methyl cysteine, and assessed by seven clinical measurements and six laboratory methods on eight occasions during a 24-week treatment period. The results have been compared with equivalent data derived from the use of antiinflammatory agents (e.g. aspirin) and drugs of accepted 'antirheumatoid activity' (e.g. D-penicillamine). Improvements in mean data provide the basis of a human screening system for the detection of antirheumatoid drug activity. Results suggest that sulphasalazine and captopril have this type of activity whereas zinc sulfate and methyl cysteine do not.

Adult↗
PubMed1985

A pharmacokinetic comparison of tenoxicam in plasma and synovial fluid.

In view of the paucity of information of the synovial fluid pharmacokinetics of nonsteroidal anti-inflammatory drugs with a long half-life, we have compared the pharmacokinetics of tenoxicam (TILCOTIL, MOBIFLEX) in plasma and synovial fluid in six patients with polyarthritis causing knee effusion. Plasma and synovial fluid concentrations of tenoxicam were measured up to 96 hours after an oral dose of a single 40 mg tablet. A full pharmacokinetic analysis was performed. Tenoxicam passed into synovial fluid attaining a peak concentration significantly later than that for plasma. However, the mean half-life for synovial fluid (45 hours) was not significantly different from that for plasma (42 hours). Comparison of area under the curve (AUC) indicated the total exposure of the synovial fluid to tenoxicam was consistent in different patients, comprising 50-60% of the corresponding plasma levels in every case. In the case of tenoxicam, synovial fluid exhibits the pharmacokinetic properties of a peripheral "tissue" compartment.

Adult↗