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Biomedical subjects

W C Dick

Publications and source records attributed to W C Dick.

At least 19 recordsLinked to original sources
PubMed1991

Patients with ankylosing spondylitis show individual patterns of variation in disease activity.

Disease activity was monitored sequentially over 1 year in 22 patients with ankylosing spondylitis (AS) attending regularly the local NASS group. Assessments, using standard methods, were made at monthly intervals by the same observer. There was marked heterogeneity such that each patient's profile of disease activity was virtually unique. All patients experienced at least one exacerbation and most underwent exacerbations and remissions, reminiscent of the experience of many patients with rheumatoid arthritis. In most instances no reason for changes in disease activity could be discerned clinically. These observations raise the possibility that the natural history of disease in AS may be different for each individual patient, which, if true, would have important implications for the design of studies to test the efficacy of therapy and for approaches to investigating pathogenic mechanisms in patients with AS.

Adolescent↗
PubMed1991

Primary Sjögren's syndrome in north east England--a longitudinal study.

We have documented the initial clinical features of 100 patients with primary Sjögren's syndrome (SS) together with the results of their baseline investigations. The evolution of the disease in these patients has been followed for a median of 34 months (range 3-84 months). The majority of patients were females aged 40-60 years, and common clinical features included eye symptoms (100%), xerostomia (100%), polyarthralgia (94%), Raynaud's phenomenon (81%) and salivary gland swelling (47%). Thyroid disease was relatively common (14%) while other endocrine disease was rare. Four patients died during follow-up, and three cases of lymphoma were detected. Other serious complications included pericarditis (10%), pleuroparenchymal lung disease (9%), renal tubular acidosis (3%) and cerebrovascular accidents (2%). The presence of anti-Ro antibodies identifies patients with more severe systemic disease. Spontaneous improvement occurred in 12 patients, while steroids were required for specific complications in 18. Overall, although lymphoma was found to excess in our group, the high mortality reported with primary SS elsewhere was not seen.

Adolescent↗
PubMed1990

Clinical and laboratory studies in patients with leprosy and enthesitis.

In a combined clinical, radiological, and laboratory study of 77 patients throughout the leprosy spectrum, 10 patients had an enthesitis which has not been described previously as far as is known and which was not associated with the characteristics of erythema nodosum leprosum reactions. C reactive protein and alpha 1 acid glycoprotein values were significantly lowered only in those patients with leprosy and enthesitis. No radiological abnormalities were found.

Adult↗
PubMed1989

Clinical and laboratory studies of arthritis in leprosy.

Arthritis associated with leprosy is underreported. In Egypt 66 patients from a leprosy colony were studied, 20 of whom had arthropathy. This was characterised by an inflammatory symmetrical peripheral polyarthritis. The wrist, metacarpal and proximal interphalangeal joints of the hands, the knees, and the metatarsophalangeal joints of the feet were affected with associated morning stiffness. The arthritis was erosive in 11 out of 20 patients, had no features of the arthritis associated with erythema nodosum leprosum reactions, but symptomatically responded to antileprosy treatment. This arthritis would seem to be a previously unrecognised feature of leprosy.

Acute-Phase Proteins↗
PubMed1989

A study of headaches and migraine in Sjögren's syndrome and other rheumatic disorders.

Migraine occurs with increased frequency in patients with systemic lupus erythematosus and in subjects suffering from Raynaud's phenomenon without any underlying connective tissue disorders. A possible link between migraine and Raynaud's phenomenon has been suggested. Two rheumatic conditions where Raynaud's phenomenon occurs very commonly are scleroderma and primary Sjögren's syndrome. It is possible that migraine is also common in these disorders but has been unrecognised. Therefore, the prevalence of migraine was assessed by a questionnaire in 191 subjects suffering from various connective tissue disorders and control subjects. Migraine was diagnosed in 16/35 (46%) patients with primary Sjögren's syndrome, 31/97 (32%) patients with scleroderma, 4/33 (12%) patients with rheumatoid arthritis/Sjögren's syndrome compared with 3/26 (11%) control subjects. A family history of headaches was more common in the patient groups than controls. There was a significant association between occurrence of Raynaud's phenomenon and migraine. Small vessel pathology may underlie both migraine and Raynaud's phenomenon in these connective tissue disorders--as has been suggested in systemic lupus erythematosus. The findings stress the need to ask specifically about complaints of headaches/migraines in patients with scleroderma and primary Sjögren's syndrome for the appropriate total management of these patients.

Female↗
PubMed1988

Genetic markers in Sjögren's syndrome: the question of its genetic heterogeneity.

Genetic factors may be implicated in the causation of Sjögren's syndrome (SS) as shown by familial clustering of the disease and certain HLA associations. Non-HLA genetic markers in SS have not previously been studied in detail. In this study of 122 unrelated patients with various categories of SS and 104 control subjects, 29 genetic markers were studied (11 blood groups, 5 serum proteins and 13 red-cell enzymes). Almost all systems showed a considerable range of gene frequency among the various subgroups of patients with SS but only a few attained statistical significance (C3 and GPT). Multivariate (kinship) analysis, however, showed clear distinction between the subgroups of SS, suggesting that they are genetically distinct entities.

Alleles↗
PubMed1988

Observations on the causes of rheumatoid arthritis.

Inflammatory, symmetrical peripheral polyarthritis is observed in a small proportion of patients following a variety of parasitic, viral and microbial infections. The development of such a post-infective arthritis disorder may depend on a sequence of events, which need not be confined to one extrinsic pathogenic organism.

Arthritis, Infectious↗
PubMed1987

Costs of providing a rheumatological service.

As a result of a management budgeting exercise, the costs of rheumatology services in two hospitals in the Northern Region have been calculated. These comprehensive and itemized charges were derived by an external group of accountants. The data for a 1-year period from April 1985 are presented. Differences in both mean out-patient-visit and in-patient bed-day charges between hospitals were found. Factors contributing to these differences are discussed. The major costs, particularly of in-patient care, are not directly controllable by the clinician. Mean costs per out-patient visit were 26.00 pounds and 36.90 pounds at the two hospitals. Costs for in-patient care per bed-day were 49.00 pounds and 70.71 pounds, respectively. The calculated total cost of the rheumatology service in Newcastle was approximately 1.00 pound per capita catchment population per annum.

Costs and Cost Analysis↗
PubMed1987

Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis.

The histopathological characteristic of ankylosing spondylitis (AS) is the presence of chronic enthesitis. Our aim was to develop a clinical measurement of the severity of tenderness over entheses. The scoring system was based on the patients' response to palpation over entheses easily accessible to examination. The enthesis index (EI) correlated with pain (r = 0.67, p less than 0.01) and stiffness (r = 0.46, p less than 0.05) scores. A single, blind, crossover study was conducted to determine the sensitivity of the index to change in clinical state associated with non-steroidal antirheumatic drug therapy and to record the interobserver variability. The index showed significantly lower scores after one week's drug treatment (p less than 0.05). The EI is a convenient, non-invasive measure of disease severity in patients with AS. Potential applications include the assessment of enthesitis in other polyarthritides and a means of distinguishing clinically between severity of enthesitis and synovitis in different types of polyarthritis.

Adolescent↗
PubMed1987

Clinical and laboratory studies of inflammatory polyarthritis in patients with leprosy in Papua New Guinea.

The results of a combined clinical and laboratory study in 55 patients throughout the leprosy spectrum are reported. Thirty one of these patients suffered from an inflammatory peripheral polyarthritis which has not been previously described and which was unassociated with the characteristics of erythema nodosum leprosum reactions or with Charcot's joints. alpha 2 Macroglobulin was raised significantly only in those patients with leprosy and arthritis.

Adult↗
PubMed1987

Effect of ethanol challenge on serum glycoproteins in alcoholic and non-alcoholic liver disease.

The effects of acute ethanol challenge on serum glycoprotein concentrations in man were studied. Serum levels of haptoglobin, alpha-2-macroglobulin and pre-albumin were measured fasting and 6 hr after oral ethanol 0.75 g/kg body weight in 8 healthy controls, 13 patients with alcoholic liver disease and 13 with non-alcoholic-related liver damage, both patient groups being further subdivided into those with and without cirrhosis. Basal levels of haptoglobin were significantly higher in non-cirrhotic alcoholics than controls and pre-albumin levels were lower in non-alcohol-related cirrhotic liver disease. In response to ethanol challenge, no consistent change was observed in any group, nor was there any significant difference between groups. There was, however, a significant correlation (r = 0.53, P less than 0.005) between the percentage changes in haptoglobin and alpha-2-macroglobulin. In 16 subjects (2 controls, 8 alcoholics and 6 non-alcoholics) blood levels of ethanol and acetaldehyde were measured serially: there was no relationship between the peak or mean concentration and the glycoprotein response. This study does not substantiate other reports which claimed to be able to predict the severity and reversibility of alcoholic liver disease on the basis of the serum glycoprotein response to ethanol: ethanol challenge with measurement of serum glycoproteins cannot substitute for proper histological assessment.

Acetaldehyde↗
PubMed1987

Association of limited joint mobility with Dupuytren's contracture in diabetes mellitus.

Limited joint mobility is a relatively recent addition to the list of other well known rheumatic disorders that may be associated with diabetes mellitus. In our study of 109 patients with diabetes, a higher prevalence of Dupuytren's contracture was found compared to nondiabetic subjects, but the difference was not statistically significant (p less than 0.1). An association between limited joint mobility and Dupuytren's contracture was shown. Patients with diabetes with Dupuytren's contracture showed no difference compared to those without Dupuytren's contracture with regard to sex, insulin dosage, metabolic control and presence of shoulder capsulitis. Limited joint mobility and Dupuytren's contracture may be associated with retinopathy.

Adolescent↗
PubMed1986

Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus.

Limited joint mobility and shoulder capsulitis were evaluated in 109 consecutive diabetic patients attending an out-patient diabetic clinic. Forty-nine had insulin-dependent diabetes mellitus (IDDM) and 60 had non-insulin-dependent diabetes mellitus (NIDDM). Seventy-five normal subjects were also examined. Limitation of joint mobility was detected in 24 (49%) patients with IDDM and in 31 (52%) patients with NIDDM but in only 17 (20%) normal subjects (p less than 0.001). There were no significant differences between diabetic patients with and without joint limitation with regard to age, sex, type of DM, mean daily insulin dosage and overall diabetic control as assessed by estimation of glycosylated haemoglobin concentration. However, patients with impaired joint mobility had a longer duration of diabetes (p = 0.01) and a significantly increased frequency of retinopathy compared to patients without joint limitation (p less than 0.05). Normal subjects with restricted joint mobility were older than those without restriction (p = 0.05). Shoulder capsulitis was present in 19% of patients with diabetes mellitus and 5% of normal subjects. However, there was no significant association between limited joint mobility and shoulder capsulitis in the diabetics.

Adolescent↗
PubMed1986

Schistosomiasis and inflammatory polyarthritis: a clinical, radiological and laboratory study of 96 patients infected by S. mansoni with particular reference to the diarthrodial joint.

Patients with active Schistosoma mansoni infection attending a medical clinic in an endemic area, 100 miles from Cairo, were asked to participate in this study. Ninety-six patients are reported, 72 of whom presented with musculoskeletal complaints. Nine of these presented with an enthesitis alone; 16 had an inflammatory peripheral polyarthritis alone; the remaining 47 were suffering from the combination of both an arthritis and an enthesitis. Alpha-1-acid glycoprotein was significantly lowered in those patients with musculoskeletal manifestations.

Adult↗
PubMed1985

Association of MHC antigens with susceptibility to and severity of rheumatoid arthritis in multicase families.

A study of HLA association with rheumatoid arthritis (RA) in multicase families has been performed in north east England. Two hundred and nineteen individuals from 13 families were assessed for the presence of RA, and all were HLA typed. Thirty-nine were found to have classical or definite RA by American Rheumatism Association (ARA) criteria. Thirty-five (90%) of these possess HLA-DR4, confirming the previously reported association of RA with DR4. A further 19 individuals were found to have probable RA or gave a convincing history of previous inflammatory polyarthritis. Thirteen (68%) of these possess HLA-DR4, and this is not significantly different from non-affected family members of whom 63% possess DR4. These results suggest that HLA-DR4 is associated only with the more severe forms of RA. Homozygosity for HLA-DR4 was not associated with either earlier onset or more severe disease when compared with heterozygous DR4. Possession of the haplotype most commonly inherited with the RA in individual families was not associated with earlier onset but may be associated with more severe disease. The severity of RA appears to be influenced by the major histocompatibility complex (MHC) in these families.

Adult↗
PubMed1985

A reinvestigation of the cross-reactivity between Klebsiella and HLA-B27 in the aetiology of ankylosing spondylitis.

The existence of cross-reactivity between Klebsiella antigens and cells from donors who are HLA-B27 positive and exhibit ankylosing spondylitis (AS) has been reinvestigated. Cells and antisera from different laboratories have been tested together using simultaneously microcytoxicity, chromium release and enzyme linked immunosorbent assays (ELISA). No reproducible interaction has been found. Mitogenic stimulation did not induce cross-reactivity and 'transformation' of B27+AS- cells by Klebsiella culture supernatants failed. Two transformed cell lines from B27+ AS+ donors exhibited specific cross reaction with two anti-Klebsiella antisera but only by chromium release. Immunoprecipitation with these cells and antisera showed the absence of any AS+ -specific antigen. It is concluded that the involvement of Klebsiella in ankylosing spondylitis through simple immunological cross-reactivity or through interaction with HLA-B27 is unlikely.

Antigens, Bacterial↗