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Biomedical subjects

W W Buchanan

Publications and source records attributed to W W Buchanan.

At least 145 records · Page 8Linked to original sources
PubMed1985

Statistical reappraisal of the clinical significance of nail beading in rheumatoid arthritis.

Nail beading has previously been reported as an accompaniment of rheumatoid arthritis. In order to assess the clinical significance of this form of nychodystrophy the fingernails and toenails of 119 patients with rheumatoid arthritis and an equal number of control subjects were studied. Analysis of data based on 4642 nails indicates that the presence of a global pattern of beading (i.e. greater than or equal to 50% involvement of the nail area) on the surface of at least six fingernails or four toenails is highly suggestive of underlying rheumatoid disease. The positive predictive value of these configurations is in the order of 95%. Nail beading, however, is infrequent in early disease and therefore its diagnostic value is limited. Although there is a strong association between nail beading and rheumatoid arthritis, the aetiology and prognostic implications of this clinical sign remain obscure.

Adult↗
PubMed1985

Controlled, double-blind, randomized trial of amitriptyline in relieving articular pain and tenderness in patients with rheumatoid arthritis.

Thirty-six patients with definite or classical rheumatoid arthritis participated in a double-blind, randomized, placebo-controlled trial to assess the effectiveness of adding amitriptyline to the treatment regimen for the relief of pain not adequately controlled by non-steroidal anti-inflammatory drugs. Dosage of amitriptyline was increased gradually up to 25 mg 3-times daily and patients were followed up for 12 weeks. Assessments were made of joint pain and tenderness every 4 weeks. The results showed no difference between the amitriptyline and placebo-treated patients for either parameter.

Adult↗
PubMed1985

Grading of tenderness as a source of interrater error in the Ritchie articular index.

To assess the effect of grading of tenderness on the interrater reliability of the Ritchie articular index (RAI), 3 physicians recorded independent joint scores on each of 18 patients, examined in random order. Our results indicate that close agreement (Intraclass Correlation Coefficient = 0.85) can be achieved on global RAI scores, and that raters can achieve reasonable agreement (kappa = 0.40-0.59) on the absolute presence or absence of tenderness of individual joints. By contrast, interrater agreement hardly exceeds the chance level (kappa = 0.008-0.148) when degree of tenderness is independently assessed. The grading system of the RAI may thus be implicated as an important source of the instrument's interrater error.

Adult↗
PubMed1985

Fibroblast growth factors in scleroderma.

Sera from patients with progressive systemic sclerosis (PSS), compared to normal sera, contained increased fibroblast growth promoting factor(s) (FGPF) for autologous and heterologous PSS skin fibroblasts and fibroblasts from normal donors. The relative stimulatory effect of FGPF was unaltered by dilution, mixing with normal serum, or media refeeding. The mean value of 42 PSS sera tested showed growth promoting activity significantly greater than the mean level of activity obtained with 42 sex matched normals (p less than 0.001). FGPF in sera from 25 patients with rheumatoid arthritis did not differ from normal controls. No correlation was seen between growth enhancement and patient age or medications. FGPF was present in serum plasma and is unlikely from platelets because serotonin and purified platelet factor produced no equivalent growth stimulation. FGPF was nondialysable, heat labile and insensitive to ribonuclease A. Disulphide bond integrity was required since 20 mM dithiothreitol destroyed activity. FGPF was excluded by an XM-50 filter after Sephadex G100 gel filtration.

Cell Division↗
PubMed1984

Outcome measurement in osteoarthritis clinical trials: the case for standardisation.

Outcome measures for clinical trials to be valid and reliable should also be responsive to change. There are currently no standardised methods of measuring the outcome in osteoarthritis clinical trials. A review of 63 trials of nonsteroidal anti-inflammatory drugs revealed a large degree of variability in the items, instruments and scales employed. The implications of this variability are discussed and methods proposed for rationalising outcome measurement in this area of clinical research.

Activities of Daily Living↗
PubMed1984

Antithrombin activity of gold sodium thiomalate.

Gold sodium thiomalate has been shown to inhibit serine esterase enzymes isolated from the lysosomes of white cells. We demonstrate for the first time to our knowledge that gold sodium thiomalate is inhibitory to the serine esterase thrombin in its interaction with washed human platelets, human platelet-rich plasma, and human platelet-poor plasma. Since thrombin is a serine esterase phylogenetically related to the serine esterases elastase and cathepsin G, the most likely mechanism of action is an interaction of the gold thiol complex with one or all of the four cysteine-cysteine disulfide bridges of the thrombin molecule.

Gold Sodium Thiomalate↗
PubMed1984

Clinical evaluation of two strategies for improving patient recall of prior drug therapy.

The ability to recall details of current and prior drug therapy was evaluated in two studies employing a total of 94 patients with inflammatory polyarthritis. Ten per cent of patients were unable to completely recall the names of their current anti-inflammatory drugs and eighty-three per cent of patients to completely recall the details of prior anti-inflammatory drug therapy. Prompting firstly with the proprietary names of drugs and thereafter with a pill board substantially enhanced recall particularly for prior NSAID therapy. Nineteen per cent of responses obtained with verbal prompting were inaccurate. No such problems were encountered in responses obtained using the pill board. These findings indicate that a complete and accurate drug history can only be obtained in the majority of patients using recall enhancement strategies.

Adult↗
PubMed1984

Problems of antiarthritic therapy in the elderly.

Rheumatic diseases are prevalent in the elderly population, resulting in high morbidity caused mainly by lack of mobility. Consequently, the use of antirheumatic drugs in older persons is extensive. This review outlines some of the hazards encountered in the use of antirheumatic drugs in the elderly. Analgesics such as propoxyphene and acetaminophen are useful adjuncts to the treatment of arthritic pain, but propoxyphene has been associated with respiratory depression, and renal clearance of acetaminophen is reduced in elderly subjects. Salicylates may cause deafness, and like the other nonsteroidal anti-inflammatory drugs, may cause salt and water retention resulting in congestive cardiac failure. Phenylbutazone should not be used because of the risk of blood dyscrasia, and indomethacin has been reported as interfering with the antihypertensive effect of beta-blockers. Chloroquine levels may be raised in patients with impaired renal function, and there is increased risk of retinal damage with the drug in elderly subjects. Injectable gold compounds and penicillamine are not contraindicated in the elderly, because they are just as efficacious as in younger persons for the treatment of rheumatoid arthritis. Toxicity due to gold compound is not increased in the elderly, but skin rashes and abnormalities of taste do occur more commonly in elderly patients treated with penicillamine. Corticosteroids do not affect disease progression and therefore should be used only in acute severe disease for short periods of time. As in the younger population, treatment of gout in the elderly is dependent on renal function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed1984

Perception--a problem in the grading of sacro-iliac joint radiographs.

Reliability in the assessment of radiographic abnormalities in the sacro-iliac joint was investigated by rheumatologists and radiologists experienced in the reading of such films. This study differs from previous ones in that films were masked to reduce cueing from the radiographic appearance of other pelvic bone and joint structures. Agreement was greatest (greater than or equal to 80%) when only the presence or absence of abnormality was considered. When corrected for chance, agreement on the individual radiographic abnormalities was frequently poor or modest. The use of reference radiographs reduced absolute disagreement and had a modest influence on absolute agreement. The scoring of films for epidemiologic purposes should preferably be delegated to senior radiologists using standard reference films. Nevertheless, there remains a considerable margin of error in the interpretation of sacroiliac joint radiographs which is of clinical and epidemiological importance considering the weight that radiographs of this joint carry in diagnostic rheumatology.

Ankylosis↗
PubMed1984

Controlled trial of clinical utility of serum salicylate monitoring in rheumatoid arthritis.

A crossover double-blind controlled trial was performed on 36 patients with rheumatoid arthritis to assess the necessity for serum salicylate monitoring in determining optimal dosage. There was no clinically or statistically significant increase in the clinical improvement of patients associated with serum monitoring but potentially toxic serum levels occurred without tinnitus when serum monitoring was not used.

Arthritis, Rheumatoid↗
PubMed1984

Clinical associations of fibroblast growth promoting factor in scleroderma.

Normal adult human dermal fibroblasts were cultured in the presence of sera from 142 subjects. Results of a fibroblast proliferation assay revealed that 16 of 42 patients with scleroderma, 1 of 25 with rheumatoid arthritis, 3 of 10 with systemic lupus erythematosus, 2 of 3 with mixed connective tissue disease and 0 of 42 normal controls had values outside the normal range. The activity of fibroblast growth promoting factor (FGPF) in the scleroderma group correlated with the skin involvement but not with involvement of any other organ system. The levels of FGPF were higher in the first 2 years of disease duration than at any other time. Our data suggest that fibroblast activation may be a key process in the pathogenesis of scleroderma.

Adult↗
PubMed1984

The relationship among platelet-associated IgG, platelet lifespan, and reticuloendothelial cell function.

Platelet-associated IgG (PAIgG) has been reported to be elevated in nonthrombocytopenic patients who have a normal platelet lifespan. This has been interpreted as indicating that PAIgG is a nonspecific finding in these patients and not a determinant of platelet survival. It is important to recognize that the reticuloendothelial (RE) system plays an important role in the clearance of antibody-sensitized cells. In this study, we related the level of PAIgG and the platelet lifespan to the RE function in patients with: (A) idiopathic thrombocytopenic purpura (ITP), and (B) five patients with elevated levels of PAIgG yet normal or near-normal platelet counts. RE function was assessed by measuring the clearance of autologous chromium-labeled red cells sensitized with a precise amount of alloantibody (2,000-3,600 molecules of IgG/cell). Eight patients with immune thrombocytopenia had significantly shortened platelet survivals (less than 2-113 hr). In contrast, the five patients with elevated PAIgG, yet normal or near-normal platelet counts, all had normal autologous platelet survivals (186-222 hr). These patients also had significantly impaired clearance of IgG-sensitized red cells, with an average of 85% of the infused red cells remaining in the circulation at 60 min (normal 42% +/- 14%, n = 10). In this study, every patient with elevated PAIgG and normal RE function had a shortened platelet lifespan. Those patients with elevated PAIgG and impaired RE function did not invariably have a shortened platelet lifespan. The observation that the PAIgG is elevated in some patients whose platelet survival is normal does not indicate that PAIgG is not biologically relevant. It indicates that these patients may have RE blockade and do not clear IgG-sensitized cells.

Blood Platelets↗
PubMed1983

Anemia associated with rheumatoid disease. Inverse correlation between erythropoiesis and both IgM and rheumatoid factor levels.

Cell culture techniques were used to evaluate the number of erythroid colonies formed by circulating progenitor cells from 24 patients with rheumatoid disease and controls. A highly significant inverse correlation was demonstrated between erythroid colony counts and serum IgM and rheumatoid factor concentrations in the rheumatoid patients. The potential role of these factors in the pathogenesis of the anemia of rheumatoid disease is discussed.

Adolescent↗