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Biomedical subjects

W J McCune

Publications and source records attributed to W J McCune.

At least 55 records · Page 3Linked to original sources
PubMed1989

Intravenous cyclophosphamide therapy of severe SLE.

Intravenous cyclophosphamide therapy of severe systemic lupus is associated with reduction in the numbers of circulating T and B lymphocytes, suppression of T11 (CD2) receptor-mediated responses, and suppression of autoantibody production. In clinical trials, intravenous cyclophosphamide plus moderate-to low-dose daily oral prednisone appears to reduce the rate of progression of irreversible renal injury in patients who have active nephritis and definite but limited chronic changes in biopsy specimens. It may also be effective in other forms of severe lupus, although controlled trials are lacking. It may be the treatment of choice in severe lupus characterized by ongoing antibody or immune-complex mediated tissue injury.

Acute Disease↗
PubMed1989

Cyclosporine in the treatment of psoriatic arthritis.

The short-term efficacy of cyclosporine in the treatment of six patients with moderately severe to severe psoriatic arthritis was evaluated in an open study. Patients received oral cyclosporine (6 mg/kg/d) for eight weeks. In all patients, significant improvement of psoriasis was noted within two to four weeks. At the end of therapy, rheumatologic assessment revealed the following trends in disease activity: a decrease in the number of tender joints, joint tenderness index, duration of morning stiffness, and an increase in grip strength. There was a decrease in the number of swollen joints, joint swelling index, and the time taken to walk 50 ft. Overall disease activity significantly improved as assessed independently by the patient and physician. For psoriasis and psoriatic arthritis, disease activity worsened toward baseline within four weeks of discontinuation of therapy. Short-term, low-dose cyclosporine therapy may be effective in treating psoriasis and psoriatic arthritis.

Adult↗
PubMed1988

Clinical and immunologic effects of monthly administration of intravenous cyclophosphamide in severe systemic lupus erythematosus.

Severe systemic lupus erythematosus affecting the kidney or central nervous system may lead to organ failure or death despite treatment with high doses of corticosteroids. To evaluate the clinical and immunologic effects of intravenous cyclophosphamide in this setting, we treated nine patients with monthly intravenous infusions of cyclophosphamide for six months. A comparison of characteristics at entry and follow-up revealed improvements (by paired t-test) in creatinine clearance (66 vs. 96 ml per minute, P less than 0.001); 24-hour urinary protein level (4.11 vs. 0.90 g, P less than 0.05), Farr anti-DNA titer (43 vs. 8.5 percent, P less than 0.01); complement components C3 (894 vs. 1150 mg per liter, P less than 0.05), C4 (154 vs. 222 mg per liter, P less than 0.05), and total complement activity (CH50) (88.7 vs. 113.4 IU, P less than 0.05); and Westergren erythrocyte sedimentation rate (60.2 vs. 34.4 mm per hour, P less than 0.0005). Other manifestations of lupus improved markedly in most cases, despite a reduction in the mean daily dose of prednisone, from 45 mg at entry to 17 mg at follow-up (P less than 0.01). The numbers of lymphocytes positive for T3, T4, T8, and B1 declined progressively during treatment. At follow-up, persistent decreases were observed in the T-lymphocyte subsets, whereas the absolute number of B lymphocytes had returned to levels near base line. T-cell proliferative responses at follow-up were not significantly different from entry values, except that the response to mitogenic anti-T11 (CD2) antibodies was decreased (P less than 0.01). Our data indicate that monthly intravenous administration of cyclophosphamide was associated with a substantial amelioration of severe systemic lupus, in conjunction with discrete changes in T-lymphocyte markers and T-cell function. This was a preliminary, uncontrolled study, but the results warrant further investigation of this form of treatment.

Adult↗
PubMed1988

Isolated small-vessel angiitis of the central nervous system.

Isolated cerebral angiitis was confirmed by brain parenchyma biopsy in a 31-year-old man with a rapidly progressive encephalopathy and normal cerebral angiography and magnetic resonance imaging. Presenting features of aphasia, hemiparesis, and lethargy resembled herpes simplex encephalitis. Severe neurologic deficits rapidly resolved with steroids plus cyclophosphamide, and he remains in remission after two years. This case illustrates potentially misleading early manifestations of isolated cerebral angiitis, diagnostic limitations of angiography, the value of biopsy that includes both brain parenchyma and leptomeninges, and the potential efficacy of steroid and cyclophosphamide therapy in small-vessel disease. Clinical features and response to treatment vary widely in reported cases, suggesting that isolated cerebral angiitis may have diverse etiologies.

Adult↗
PubMed1988

Identification of brain lesions in neuropsychiatric systemic lupus erythematosus by magnetic resonance scanning.

Cranial magnetic resonance imaging in 28 systemic lupus erythematosus patients who had experienced 30 acute neuropsychiatric events showed focal brain lesions in 16 of 30 events (53%) and low brain volume (atrophy) in 20 of 30 events (67%). Definite focal lesions were significantly more frequent in patients with clinically localized neurologic deficits (8 of 8, 100%), or seizures (5 of 6, 83%) than in patients without such localizing signs (3 of 16, 19%). Many of these lesions were occult on intravenous contrast-enhanced x-ray computed tomography. In 2 patients, lesions in gray matter resolved within 2 or 3 weeks, in association with clinical improvement. Magnetic resonance imaging is an important technique for detecting the extent of brain injury in cerebral lupus.

Adult↗
PubMed1988

Neuropsychiatric lupus.

Neuropsychiatric abnormalities in patients with systemic lupus have been recognized for more than a century. Although the prognosis of lupus has improved, involvement of the nervous system continues to be a major feature, with some abnormality recognized in 50 to 66 per cent of lupus patients. Diagnosis and therapy of neurologic disease remain the most difficult clinical challenges in the management of SLE.

Anticoagulants↗
PubMed1988

Evaluation of knee pain.

Most knee problems are seen first by the patient's primary physician who is thus in a unique position to intervene effectively. This article will emphasize the initial evaluation of patients with nontraumatic disorders of the knee, in which early recognition and therapeutic intervention is most likely to be beneficial.

Diagnosis, Differential↗
PubMed1987

Cervical spine involvement in rheumatoid arthritis: MR imaging.

Magnetic resonance (MR) imaging of the cervical spine was employed in 18 patients with rheumatoid arthritis and suspected cervical involvement. Fifteen patients had symptoms referable to the cervical spine, and seven had neurologic deficits. In three patients who were asymptomatic with regard to the neck, MR imaging was performed because of abnormal cervical radiographs. Cervical radiographs were available for all patients; bone erosion was evident in 14, subluxation in 17, and no abnormalities in one. MR imaging demonstrated indentation or abnormal signal in the caudal brain stem and/or cervical spinal cord in ten patients, including the seven with related neurologic deficits; discrete indentation or distortion of the dura without visible morphologic effect on the underlying neuraxis was observed in five other patients. In all patients with neurologic symptoms, cord or brain-stem abnormalities were seen on MR images. MR imaging therefore appears to provide valuable information regarding the status of the spinal cord and dura in patients with rheumatoid arthritis.

Adult↗
PubMed1987

Correlation of angiographic abnormalities with disease manifestations and disease severity in polyarteritis nodosa.

We evaluated angiograms of 26 patients with polyarteritis nodosa (PAN) as well as the associated clinical and laboratory features. All patients had visceral angiograms and either biopsy or angiographic proof of PAN. Severe disease was defined as central nervous system PAN, renal failure requiring dialysis, gangrene of fingers or toes, cardiomyopathy, bowel infarction, hepatic failure, or hepatic infarction. The presence of aneurysms was associated with severe hypertension, hepatitis B surface antigenemia and clinically severe disease. Angiography may therefore identify a subset of patients with more severe involvement and may be of value in management decisions.

Adolescent↗
PubMed1987

Giant cell arteritis and peripheral neuropathy: a report of 2 cases and review of the literature.

Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium sized vessels. While the disease may present with blindness or other signs of extracranial vasculitis, symptoms referable to the peripheral nervous system are uncommon. We describe 2 patients with biopsy proven GCA who simultaneously developed peripheral neurologic lesions. The first developed a mononeuritis multiplex superimposed on a diffuse, primarily sensory and distal polyneuropathy; the second, a symmetric, primarily motor and distal polyneuropathy. We review the published experience of GCA with peripheral nerve involvement and discuss a possible pathophysiologic basis for its occurrence.

Aged↗
PubMed1985

MR imaging of systemic lupus erythematosus involving the brain.

Focal lesions were demonstrated on magnetic resonance (MR) imaging in eight patients with systemic lupus erythematosus and recent onset of neuropsychiatric symptoms. Corresponding findings were visible in only two of seven patients who had computed tomographic (CT) scans. Three patterns of disease were observed on MR when it was performed with a pulse repetition rate of 2000 msec. The first pattern was that of cerebral infarction, with a relatively large area of increased intensity. The second pattern, multiple small areas of increased intensity, may have been secondary to microinfarctions. The third pattern was that of focal areas of increased intensity, predominantly in the cerebral gray matter. In two of three patients with the third pattern, partial or complete resolution was observed on follow-up MR images obtained several weeks after the initial studies.

Adult↗
PubMed1984

Sonographic evaluation of the cartilage of the knee.

Real-time ultrasound was assessed as a means of evaluating osteoarthritis of the knee. The knee was maintained in complete flexion so as to expose the weight-bearing portion of the femoral condylar cartilage. After establishing the validity of the method in an excised bovine knee, 7 asymptomatic individuals, 10 arthritic patients, and several patients with other conditions were examined. The results indicated that sonography can be used to measure the thickness of the articular cartilage in man, as well as to detect changes in its surface and internal characteristics. Early changes of arthritis may be revealed in this manner.

Adolescent↗
PubMed1982

Type II collagen-induced auricular chondritis.

Sensitization to type II collagen induced inflammatory destruction of elastic ear cartilage, as well as arthritis, in Sprague-Dawley rats. This auricular lesion morphologically resembled relapsing polychondritis in humans. Moreover, in the experimental model, as has been reported in human disease, extraarticular chondritis occurred in the context of immunologic sensitivity to native type II collagen. These similarities suggest that type II collagen-induced auricular chondritis may provide insights about the pathogenesis of relapsing polychondritis.

Adjuvants, Immunologic↗
PubMed1982

Immunosuppression by fractionated total lymphoid irradiation in collagen arthritis.

Treatments with fractionated total lymphoid irradiation (TLI) and cyclophosphamide were evaluated for rats injected with type II collagen. Preadministration of TLI and repeated injections of cyclophosphamide suppressed the severity of arthritis and lowered antibody titers to collagen significantly. TLI initiated at the onset of collagen arthritis decreased humoral and cellular responses to collagen but did not affect the severity of arthritis. These data demonstrate that both TLi and cyclophosphamide are immunosuppressive in an experimentally inducible autoimmune disease.

Animals↗