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ID PMID Title PublicationDate abstract
8921495 The Glasgow Pain Questionnaire: a new generic measure of pain; development and testing. 1996 Oct BACKGROUND: The study set out to develop and test a measure of perceived pain suitable for use in community studies and in the evaluation of clinical care. METHOD: The work had three parts; (1) generation and selection of items, (2) weighting of the items and (3) testing for reliability and validity. Potential items were obtained from 230 informal interviews conducted in a variety of settings. These were reviewed to produce a draft questionnaire, and this was used in a pilot study of 60 volunteers to determine the final item selection. Item weights were calculated using ratings of severity as judged by subjects in the pilot study and the validity testing. Weights are used so that questions referring to more severe pains have higher scores than those about milder pains. Reliability and validity testing was carried out using three groups: 100 rheumatoid arthritis outpatients; 37 attenders at an occupational health clinic and 178 chronic pain clinic patients. Scores from the three different patient groups were compared, scores were compared with a visual analogue measure of pain, and scores from the same individuals from two consecutive months were compared. DEVELOPMENT: The main product was the new measure itself, the Glasgow Pain Questionnaire (GPQ). This has a total of 24 items in five categories; pain frequency, intensity, emotional reaction, ability to cope and restrictions of daily activity. TESTING: Validity; scores were significantly different in the three groups. The GPQ scores were significantly related to the visual analogue measure of pain. Reliability; scores of the same respondents on two consecutive months were significantly associated and had a modal value of zero. CONCLUSIONS: The project has produced a new measure of self-rated pain suitable for use in large-scale population surveys. This instrument assesses not only pain intensity but affective dimensions of pain. It is considered that the validity and reliability testing carried out to date show the measure as acceptable for use in future studies.
7644100 Erythropoietin and the anaemia of chronic disease. 1995 The anaemia of chronic disease is the second most common anaemia in the world and is an underproduction anaemia with relatively low erythropoietin (EPO) values for the degree of the anaemia. This anaemia occurs with inflammation, infection, or malignancy and a principle question has been whether it would respond to recombinant human EPO (r-HuEPO). Several studies are now available to answer this question. In one study 12 of 16 patients with rheumatoid arthritis receiving r-HuEPO increased their haematocrits 6 percentage points or more and 11 of 12 reached normal haematocrits. Investigations of the effect of r-HuEPO on the anaemia of AIDS showed that patients with EPO levels of 500 U/L or less had an increase in the mean haematocrit of 4.6 percentage points with a decrease in red cell transfusions from 5.3 to 3.2 units per patient. Quality of life indices significantly improved in responders. When 413 patients with anaemia due to a wide variety of malignancies were randomized to r-HuEPO treatment, 58% of those receiving chemotherapy increased their haematocrits by at least 6 points over 12 weeks. Quality of life parameters of responders also significantly improved. Anaemia in three patients with inflammatory bowel disease also responded in 8-14 weeks to r-HuEPO and two of the three reached normal haemoglobin levels. It is clear that r-HuEPO can correct the anaemia of chronic disease and can improve the quality of life of responders.
8491425 Comparison of talonavicular dowel arthrodesis utilizing autogenous bone versus defatted ba 1993 Mar A simple dowel arthrodesis of the talonavicular joint in an early stage of destruction can reduce pain and prevent the development of valgus deformity in the rheumatoid hindfoot. Previously, we used autogenous dowels made from the iliac crest. In order to facilitate the operation and to get a better fitting dowel, we tried defatted cancellous allograft dowels from which marrow tissue had been removed. The dowels were prepared from femoral heads in our surgical bone bank. At operation, the dowels were embedded in fresh marrow aspirate from the iliac crest and the arthrodeses were stabilized with a staple. Results were evaluated by clinical examination and radiography. The results of four patients were compared with an earlier study of eight patients using autogenous dowels taken from the iliac crest. With both techniques, the patients were relieved of pain in the talonavicular joint, but some had pain from other hindfoot joints. With autogenous dowels, all eight patients healed with radiographic bony union, but with allogenous dowels, the four patients developed fibrotic nonunion. The results indicate that talonavicular arthrodesis should be made using only autologous dowels.
8534539 [Intestinal obstruction and sepsis caused by Torulopsis glabrata]. 1995 Nov A 27-year-old woman previously diagnosed of aplastic anemia secondary to treatment with gold salts for rheumatoid arthritis, presented with an episode of intestinal occlusion with acute renal failure. A CT scan revealed dilated intestinal loops, thickening of the ileum wall without cecal involvement, and multiple punctuate lesions (micro-abcesses) of liver, spleen and kidneys. At laparotomy, one meter of proximal jejunum was resected. The cultures of jejunal biopsy specimens yielded Torulopsis glabrata. The patient underwent multiorgan failure and died on the 8th postoperative day.
1466599 Increased concentrations of nitrite in synovial fluid and serum samples suggest increased 1992 Nov Cytokines induce nitric oxide synthesis by endothelial cells, macrophages and polymorphonuclear leucocytes, indicating a role for nitric oxide in inflammatory processes. Nitric oxide production was therefore measured indirectly as nitrite in serum and synovial fluid samples from patients with rheumatoid arthritis (RA) and osteoarthritis (OA) together with serum samples from healthy volunteers matched for age and sex. Serum nitrite concentrations in patients with RA and OA were significantly higher than in controls. In both disease groups synovial fluid nitrite was significantly higher than serum nitrite, implying nitric oxide synthesis by the synovium. Serum and synovial fluid nitrite concentrations in RA were also significantly higher than those in OA. These data show increased nitric oxide production in RA and OA and suggest a role for nitric oxide as an inflammatory mediator in rheumatic diseases.
8118197 [Sonographic criteria of omarthritis]. 1993 Dec The sonographic examination of the shoulder has established itself in the diagnostic variety of imaging methods. Especially the results of the rotator cuff have contributed to the fact that arthrosonography is now indispensable for the shoulder examination. In this paper, another scan--the examination of the fossa axillaris--is added to the standard ones to find the early changes in the shoulder capsule in order to obtain efficient results in discovering the omarthritis.
1418182 Dot-blot ELISA for the detection of IgM RF and IgA RF. 1992 Jun Dot-blot ELISA was developed for the detection of IgM RF and IgA RF. Normal rabbit IgG (NRIgG), concentration 100 micrograms/ml, was used as the antigen for dotting on the 0.45 microns pore size nitrocellulose membrane. Serum, conjugate and substrate incubation conditions were at room temperature for 1 hour, 1 hour and 3 minutes, respectively. The membrane with NRIgG dot could be sotred for 6 weeks before use in the assay. Positive results of IgM RF, at the serum dilution 1:800, were found in 31/51 patients with either classical or definite rheumatoid arthritis and 3/68 normal healthy individuals. Positive IgA RF, at the serum dilution 1:100, was found in 27/51 of the former and none of the latter. Significant concordance with high agreement index was found between the results of the dot-blot ELISA developed and those obtained from ELISA performed in microtitre plate (Kappa greater than or equal to 0.78 for IgM RF and 0.83 for IgA RF, p less than 0.001).
8243622 Maternal interaction style in affective disordered, physically ill, and normal women. 1993 Sep Affective style (AS) and communication deviance (CD) have been suggested as markers of dysfunctional family environments that may be associated with psychiatric illness. Studies have focused mainly on parental responses during family interactions when an offspring is the identified patient. The present study is unique in examining AS and CD in mothers with unipolar depression, bipolar disorder, or chronic physical illness, and in normal controls. The sample consisted of 64 mothers with children ages 8 to 16. Unipolar mothers were more likely to show negative AS than were any other maternal group. There were no group differences for CD. Chronic stress, few positive life events, and single parenting were associated with AS. CD was associated solely with lower socioeconomic status. Results suggest that dysfunctional interactions are determined not only by maternal psychopathology, but also by an array of contextual factors that are related to the quality of the family environment.
8894364 The frequency and clinical characteristics of methotrexate (MTX) oral toxicity in rheumato 1996 Sep To assess the frequency and clinical characteristics of methotrexate (MTX) oral toxicity in rheumatoid arthritis (RA) patients, 51 RA patients receiving MTX and 46 RA patients not receiving MTX were studied. A questionnaire, the credibility of which was tested on four separate patient groups including a group with Behcet's Syndrome, was used as a tool to determine the prevalence of stomatitis by a blind observer. In this first controlled study of the oral toxicity of MTX, prevalence of stomatitis was found in 37.2% in the group taking MTX and 19.5% in the group not taking MTX (P = 0.054). No statistical differences were detected with respect to number, duration, frequency, and site of stomatitis. Two of the 51 MTX taking patients temporarily reduced their MTX dosage and only one patient temporarily terminated MTX treatment. MTX and toxicity is usually of no major clinical concern in the treatment of RA.
7871999 [Effects of tripchlorolide (T4) of Tripterygium wilfordii hook on the production of prosta 1994 The effects of tripchlorolide, an active ingredient (T4) of Tripterygium wilfordii Hook on the production of prostaglandin E2(PGE2) by synovial cells of rheumatoid arthritis (RA) patients were investigated. Six cases of definite RA (female 5, male 1, mean age 45 with an average course of disease of 9 years) were selected. Surgically obtained synovium specimen were dissociated into digested synovial single cells (DSSC). The cells were incubated with various concentrations of T4 for 48 hours. Using radioimmunoassay T4 was found to significantly inhibit the production of PGE2 (control 6.10 +/- 2.30 vs T4 treated 0.58 +/- 0.47 x 10(-5) mol.L-1) by short-term cultured DSSC of RA patients. The results of this study suggests that T4 may be useful in the forthcoming treatment of RA due to its inhibition of production of PGE2 by synovial cells.
1370770 Seven different assays of hyaluronan compared for clinical utility. 1992 Jan To compare six assays of hyaluronan (hyaluronic acid; HYA) in serum, developed in different laboratories, we analyzed 10 samples from each of three groups: healthy persons, patients with primary biliary cirrhosis, and patients with rheumatoid arthritis. All the assays are based on the use of affinity proteins specific for HYA, prepared from cartilage or brain tissue, and are analogous to RIA or enzyme immunoassay techniques. The assay results were of the same magnitude. Although statistical analysis indicated that the methods in some cases deviated significantly from one another, this variation was less than the physiological variation in the healthy population. Therefore, the results of clinical investigations in which the various methods have been used are comparable. The analyses have high specificity and sensitivity for primary biliary cirrhosis but are somewhat less suitable for detecting rheumatoid arthritis. A seventh laboratory, which obtained antibodies to HYA, used these in an RIA to analyze a separate series of serum specimens. Results were in agreement with those obtained by one of the other assays.
8370160 The anti-arthritic and immunosuppressive effects of cyclosporin A on collagen-induced arth 1993 Sep The influence of cyclosporin A (CsA) on type II collagen-induced arthritis (CIA) in the rhesus monkey has been investigated. CsA was administered subcutaneously in a dose of 25 mg/kg per day during 9-18 days and additionally 12.5 mg/kg per day for 7 days. At this dosing regime no significant alterations of haematologic parameters were found, indicating that the toxicity of CsA was negligible. Administration of CsA after onset of arthritis had no beneficial effect, but when given between immunization and manifestation of clinical symptoms, CIA could be prevented completely. Moreover, these monkeys became resistant to the disease, because no arthritic activity could be observed upon a booster immunization with type II collagen (CII). The suppression of disease by CsA is reflected in reduced antibody levels to CII.
1357968 Helicobacter pylori seroprevalence in patients with rheumatoid arthritis: effect of nonste 1992 Oct PURPOSE: To investigate the relationship between Helicobacter pylori infection and nonsteroidal anti-inflammatory drug (NSAID) intolerance and the effect of gold use on the seroprevalence of H. pylori. PATIENTS AND METHODS: We examined the frequency of discontinuation of NSAIDs in 132 unselected patients with rheumatoid arthritis attending an outpatient subspecialty clinic, and the effect of gold compound use on the seroprevalence (by IgG enzyme-linked immunosorbent assay) of H. pylori infection in this population. Logistic and multivariate regression analysis was performed adjusting for age, gender, ethnic origin, history of ulcer, and duration of rheumatoid arthritis. RESULTS: Fifty-four patients had a positive serology for H. pylori (41%). Twenty-seven of the seropositive patients (50%), versus 45 of the seronegative patients (57.7%), had to discontinue NSAIDs (aspirin and/or nonaspirin) at least once since their diagnosis of rheumatoid arthritis because of gastrointestinal side effects (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.63 to 1.38). Forty-one of the seropositive patients (76%) had received gold compounds as compared with 62 of the seronegative patients (79.5%) (OR: 0.96; 95% CI: 0.61 to 1.50). CONCLUSION: We did not find any relationship between H. pylori seropositivity and NSAID intolerance in patients with rheumatoid arthritis. In addition, our results do not demonstrate a reduction in H. pylori seroprevalence in rheumatoid arthritis patients treated with gold compounds.
7895395 Antiperinuclear factor of the IgA isotype in active rheumatoid arthritis. 1994 Nov OBJECTIVE: For rheumatoid arthritis (RA), antiperinuclear factor (APF) is as efficient a marker as rheumatoid factor (RF). However, the prevalence and significance of APF of the IgA isotype in active RA, as well as its correlation with RF-IgA, have not been determined. Our goal was to obtain information on these points. METHODS: APF-IgA were screened in 80 sera from patients with active RA, prospectively and consecutively selected over an 8-month period. Sera from 22 patients with Sjögren's syndrome and 50 with lupus were also studied retrospectively for APF-IgG and IgA. RESULTS: APF-IgA were found at a 1:10 dilution or above in 31 RA sera (39%), which were all positive for APF-IgG as well at higher titers. In the 64 sera positive for APF no correlations were found between APF-IgA and IgA or immune complexes-IgA, latex, the Rose-Waaler test and RF-IgA. Conversely, an association of APF-IgA was found with both APF-IgG (p < 0.0001) and anti-stratum corneum of rat esophagus (ASC)-IgG (p < 0.0001). APF-IgA, though correlated with the presence of secondary sicca syndrome in RA (p = 0.0023), was not more frequent (5/22) in primary Sjögren's sera. CONCLUSIONS: RF-IgA and APF-IgA are not correlated. Despite its localization in the mucosae, the target antigen for APF elicit fewer IgA antibodies in RA than does the RF target.
7945495 Lack of a renal-protective effect of misoprostol in rheumatoid arthritis patients receivin 1994 Sep OBJECTIVE: To assess whether the synthetic prostaglandin misoprostol is renal protective in rheumatoid arthritis (RA) patients who are beginning cyclosporin A (CSA) therapy. METHODS: In this randomized, placebo-controlled, multicenter trial, 50 patients with active RA were randomized to receive either misoprostol (800 micrograms/day) or placebo for 16 weeks. After 2 weeks of pretreatment with misoprostol or placebo, all patients concomitantly received CSA at an initial and maximum dosage of 5 mg/kg/day for 12 weeks. RESULTS: A significant increase in the serum creatinine level was observed in both treatment groups, with no difference noted between groups. There was a high withdrawal rate in both groups, primarily due to adverse events. CONCLUSION: A renal-protective effect was not demonstrated for misoprostol compared with placebo in RA patients who are beginning CSA therapy.
7686572 [Alizarin red S staining of calcium compound crystals in synovial fluid]. 1993 Apr In order to study the clinical value of alizarin red S staining of calcium compound crystals in synovial fluid, the optimum conditions for staining and the detectable threshold of the crystals were examined. The staining of crystals was mainly affected by the concentration of the dye and pH of the solution. The best results were obtained with an alizarin red S concentration of 1.5-3.0% for hydroxyapatite (HA) and 2.0-3.0% for calcium pyrophosphate dihydrate (CPPD) crystal. The optimal pH of the solution was 4.0-6.0 for HA and 4.0-5.5 for CPPD crystal. For the detection of crystals phagocytosed by synovial fluid leukocytes, staining was enhanced by the addition of chloral hydrate to the dye solution which increased the permeability of the cell membrane. The detectable threshold levels of HA and CPPD crystal in synovial fluid by alizarin red S staining were 0.1 micrograms/ml and 0.5 micrograms/ml, respectively. These results suggest that alizarin red S staining is suitable for screening calcium compound crystals in synovial fluid, because it is more sensitive than other methods, such as polarized microscopy and X-ray diffraction. Alizarin red S staining was performed on 148 synovial fluids from patients with various joint diseases. The staining was positive in 100% of synovial fluids from patients with CPPD deposition disease, in 54% of fluids with osteoarthritis, and in 39% of fluids with rheumatoid arthritis. In osteoarthritis, the increase in the proportion of positive cases was found to be in accordance with the radiological grading of the joints.
7633613 Simple and specific reversed-phase liquid chromatographic method with diode-array detectio 1995 Apr 21 This paper describes a simple, specific, and sensitive high-performance liquid chromatographic (HPLC) method using ion-pair reversed-phase chromatography with photodiode-array detection for the simultaneous determination of hydroxychloroquine (HCQ) and chloroquine (CQ) in serum samples from rheumatoid arthritis patients receiving either HCQ sulphate or CQ diphosphate. The assay is also applicable to the simultaneous determination of corticosteroids. The method consisted of two diethyl ether extractions of 1.0 ml of serum, to which two internal standards (2,3-diaminonaphthalene and 18-hydroxy-11-deoxycorticosterone) and 1.0 ml of 0.25 M sodium hydroxide had been added. After the organic phase was evaporated to dryness at 30-40 degrees C under a stream of nitrogen, the extract was reconstituted with a 1:1 mixture of 0.1 M perchloric acid and methanol, an aliquot of which was injected on to the system. Peak-height ratios at different wavelengths (A245/343, A245/256, A245/265 and A245/275) were utilized as a method of assessing peak homogeneity. Some anti-inflammatory drugs which may be used for rheumatic disorders were shown not to interfere with the assay. The method provides selectivity by using diode-array detection at several wavelengths. The use of two internal standards not only compensates for losses during the sample manipulation but also prevents erroneous results in case of interference.
8311541 The GALS locomotor screen and disability. 1993 Dec OBJECTIVES: Examination of the locomotor system is frequently neglected. Therefore, the GALS locomotor screen (Gait, Arms, Legs, Spine) has been proposed by Doherty et al as a practical method of identifying functionally important problems. This study was designed to test whether this screen reflects functional impairment, as measured by accepted health status measures. METHODS: Two observers performed the GALS screen in a total of 83 patients with a variety of musculoskeletal conditions. The examination components of GALS were rated by a simple 0 to 3 scale. Physical ability was further assessed by Health Activity Questionnaire (HAQ), Barthel index and Steinbrocker's ARA classification. RESULTS: For the total patient group, Spearman correlations between GALS and the three functional indices were good (r = 0.62 to 0.71, p < 0.001). Correlations were equally good for rheumatoid arthritis patients alone (r = 0.65 to 0.70, p < 0.001), but less good although still significant for the other miscellaneous rheumatic conditions (r = 0.31 to 0.46, p < 0.05). Observed proportional agreement between the two observers for the individual scores was > 70%, with a kappa statistic k = 0.49 to 0.74. CONCLUSIONS: The GALS screen is a reliable and valid measure of functional ability, compared with standard accepted indices in a variety of musculoskeletal diseases. This supports the proposal for its use as a screening test by general practitioners and medical students.
8495257 Comparison of pyritinol and auranofin in the treatment of rheumatoid arthritis. The Europe 1993 May The efficacy and tolerability of pyritinol (PY) and auranofin (AU) were compared in a multicentre double-blind study. Patients with RA received 600 mg/day PY or 6 mg/day AU for 1 year. Response was rated by a defined improvement in at least four of the following: Ritchie index, joint swelling index, rating scales for pain and general well-being, functional index, morning stiffness, ESR. Of the 139 fully evaluable PY patients 61 (44%) dropped out due to adverse events or response failure compared with 44 (31%) of the 142 AU patients. In patients treated for 1 year efficacy parameters improved more in the PY than in the AU group, with significant differences for the general well-being (P = 0.022), ESR (P = 0.029) and haemoglobin (P = 0.0042). The response rate for PY (61/78 patients, 78%) was significantly superior to AU (58/98 patients, 59% P = 0.009). An intention-to-treat analysis corroborated this result (P = 0.030). Adverse events (AE) occurred in 64% of PY patients and in 58% of AU patients: main AE were mucocutaneous symptoms (PY 36%, AU 23%) and gastrointestinal complaints (PY 30% AU 37%). Single cases of proteinuria, hepatic and haematological abnormalities were noted in both groups.
7964769 Wedged tibial components for total knee arthroplasty. 1994 Aug Severe coronal deformity of the knee is frequently associated with erosion of one tibial condyle. This can cause problems with fixation and alignment during total knee arthroplasty. If the tibia is cut to the level of the more worn side, valuable bone is sacrificed; if the less worn side is chosen, the deficiency must be filled with bone--graft, cement, or a prosthesis. Tibial components with an integral polyethylene wedge on the undersurface were introduced in 1980 for use in patients with a bony deficit on one tibial condyle. The authors believe that the Denham prosthesis (Biomet, Wales, U.K.) was the first knee arthroplasty to offer such spacers. Twenty-six patients with preoperative varus deformity in whom a wedged component was used were compared with 29 historic control subjects. None of the wedged components loosened after a median follow-up period of 8 years compared with loosening in five of the control subjects (P = .01). In three of the control subjects a fractured triangle of cement was present on the radiographs. Use of the wedges was not accompanied by an improvement in postoperative alignment. The authors conclude that the wedges resulted in improved fixation that was independent of postoperative alignment.