Biomedical subjects
Publications and source records attributed to W C Dick.
Seven young adults, six of whom were male, all suffering from dermatomyositis unassociated with malignancy are described. These patients were not adequately controlled with high doses of corticosteroids but all responded when immunosuppressive therapy was also given.
An assessment of quality of drug control of hyperuricaemia in gouty subjects is reported. Twenty seven of 40 patients were found to be hyperuricaemic. Factors influencing compliance with drug therapy included awareness of the nature of gout and excessive alcohol consumption.
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Two studies with levamisole in rheumatoid arthritis are reported. In the first study of 30 patients levamisole was superior to placebo in terms of pain relief, reduction in articular tenderness, duration of morning stiffness, erythrocyte sedimentation rate (ESR), and radioisotope uptake in knee and wrist joints. There were no consistent differences in lymphocyte function, immunoglobin or complement concentration, or polymorphonuclear granulocytic function. In the second study forty patients were commenced on treatment with either gold or levamisole. At the end of one year there were significant improvements with both regimens in pain score, joint tenderness and ESR. The patients on levamisole showed significant improvement of duration of morning stiffness, while the patients on gold showed significant improvement of rheumatoid factor titre and left hand grip, but there were no significant differences between the two regimens.
Forty-one heterozygous patients with familial hyperbetalipoproteinaemia have been studied. Twenty-two of these patients have been observed for four years'. Transient flitting inflammatory joint symptoms were noted in thirteen patients of this group. In six patients clinical, biochemical, radiological and radio-isotope studies have been carried out during the acute episode. These investigations suggest that this syndrome is due to acute inflammatory periarthritis and peritendinitis. Radio-active xenon clearance is not prolonged as occurs in inflammatory synovitis although there is elevation of the ratio-active technetium uptake over the affected joints suggesting that the blood flow to the affected area is increased. This is the largest group of patients with this complication reported to date and the recognition of this may prove to be an important aspect of case finding in this disorder. The treatment of hyperlipidaemia at an early stage may well contribute to a reduction in the morbidity and mortality from vascular disease. No further elucidation of the pathogenesis of the arthropathy has been made but a possible relationship between undue exercise and the onset of joint symptoms was again observed.
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Clinical features of Sjogren's syndrome were found in 31 percent of 32 patients with SLE. Eight patients had features of KCS while four had xerostomia. Subclinical abnormalities were found in six other patients tested with sialography and labial salivary gland biopsy and there were abnormalities in 65 percent of SLE patients in whom labial salivary gland biopsy was performed. The prevalence of Raynaud's phenomenon and renal disease in SLE patients with and without Sjogren's syndrome were similar but four of the five patients with SLE and an erosive arthritis had symptomatic Sjogren's syndrome.
The clinical features of Sjogren's syndrome were found in 24 percent of Glasgow patients with SLE without other atypical features. Sjogren's syndrome was found in one (13 percent) of a group of eight patients with features of both SLE and scleroderma, one of three patients with features of both polymyositis and scleroderma and in three of 12 (25 percent) patients with scleroderma. The highest frequency of Sjogren's syndrome was seen in six patients with features of SLE and an erosive polyarthritis, five of whom (83 percent) had Sjogren's syndrome. In patients satisfying diagnostic criteria for SLE no relationship between the presence of Sjogren's and the presence or absence of renal disease was found.
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Seven patients developed arthritis after Mycoplasma pneumoniae infection. Their joint symptoms persisted for up to one year. One patient developed an articular erosion and in another rheumatoid factor was present in serum transiently. Mycoplasma infection often causes ill-defined arthralgias and myalgias, but the migratory polyarthropathy of middle-sized joints that occurred in these patients is much less common. The prognosis seems to be good.
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Serial measurements were made over a period of three years of serum DNA-binding capacity and complement C3 and C4 levels in parallel with documentation of clinical features of disease activity in Glasgow patients with SLE. Raised DNA-binding levels were noted in 27 of the 32 patients over this time period. High levels (over 80%) were found in patients with both renal and non-renal disease. In some patients increases in DNA-binding capacity and decreases in C3 levels were associated with changes in disease activity. This pattern was commonest in patients with renal SLE. In others DNA-binding capacity was elevated without any relationship to SLE disease activity. A fall in serum C3 levels was usually significant while serum C4 levels frequently fell without any change in clinical features of disease activity. Very low serum C4 levels (below 15 mg/dl), however, were usually of clinical relevance. The uses of immunological measurements in the differential diagnosis of a major illness in a patient with SLE are discussed. The finding of such an illness in a patient with normal serum DNA-binding levels made it unlikely that the illness was due to an exacerbation of the SLE and more likely that an alternative cause such as supervening bacteraemia was responsible.
The clinical significance of antinative DNA antibodies as measured by the Farr test was investigated in 10 patients with the articular features of rheumatoid arthritis. 5 of these patients also satisfied criteria for a diagnosis of systemic lupus erythematosus (SLE) and might be classified as rheumatoid/lupus overlap syndromes or as rheumatoids with systemic complications. None had evidence of renal disease and 3 of the 5 had Sjgøren's syndrome. The sixth patient had aggressive peripheral arthritis, alopecia, and Sjøgren's syndrome and developed anti-DNA antibodies after treatment with penicillamine. All of the 4 rheumatoid patients with no clinical features typical of SLE had some special disease feature. The first had subclinical liver disease and the other 3 had Sjøgren's syndrome in addition to localized vasculitic skin ulceration (2) and pulmonary fibrosis (1).
Antibodies to the ribonucleoprotein (RNP) component of extractable nuclear antigen were measured in patients with systemic lupus erythematosus (SLE) and other connective tissue subgroups by counterimmunoelectrophoresis. Antibodies to RNP were found in the sera of 32% of patients with a primary diagnosis of SLE, 29% of patients with features of SLE and erosive joint disease, none of 9 scleroderma patients, and in 75% of 8 patients with features of SLE and scleroderma. In the SLE patients overall there was an increased frequency of sclerodactyly and severe Raynaud's phenomenon in the patients with antibodies to RNP but no association of antibodies to RNP was found with the presence of erosive joint disease, Sjögren's syndrome, or the absence of renal disease in these patients.
The clinical features of 78 patients with SLE seen in Cairo and Glasgow are reviewed. Raynaud's phenomenon was recorded more frequently here than in previous series. The value of serial measurements of anti-DNA antibodies, C3 and C4 in the management of SLE is discussed. Although antibodies to native DNA paralleled the disease course in only a minority of SLE patients anti-DNA antibodies were present during all major SLE exacerbations and could be diagnostically useful. Serious systemic infections complicating the management of SLE patients could occur and their diagnosis is discussed.
A short-term, double-blind, placebo-controlled crossover study was completed in 15 patients with classical or definite rheumatoid arthritis to compare the antirheumatic activity of salsalate (3 g/day) with placebo and indomethacin (75 mg/day). Subjective and objective assessments showed that both salsalate and indomethacin were significantly superior to placebo. Grip strength was not improved by either of the drugs. Patient preference was in favour of indomethacin, but the difference between it and salsalate was insignificant.
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