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Biomedical subjects

A G Mowat

Publications and source records attributed to A G Mowat.

At least 19 recordsLinked to original sources
PubMed1992

Acute pneumonitis associated with low dose methotrexate treatment for rheumatoid arthritis: report of five cases and review of published reports.

BACKGROUND: Low dose methotrexate has become established in the treatment of refractory rheumatoid arthritis. Until recently it has been considered that the use of a low dose regimen (< 20 mg/week) would avoid the pulmonary toxicity associated with the higher doses prescribed in malignant disease. Although initial experience with low dose methotrexate was encouraging, an increasing number of cases of an acute, life threatening pneumonitis are being reported in patients with refractory rheumatoid arthritis. PATIENTS: Since 1984 43 patients with refractory rheumatoid arthritis have been established on low dose methotrexate in the Oxford Health District. Five of these patients have subsequently developed acute methotrexate induced pneumonitis. The clinical and radiological features of these cases are described and previous reports reviewed. RESULTS: Five patients having low dose methotrexate treatment developed acute pneumonitis. Presentation was subacute and dominated by constitutional features. Respiratory symptoms developed insidiously but progressed rapidly with increasing dyspnoea associated with severe hypoxia. Chest radiographs were non-specific, showing diffuse interstitial infiltration and alveolar shadowing. Microbiological investigation gave negative results. In all cases methotrexate was discontinued and high dose corticosteroids started, with rapid clinical and radiological improvement. After withdrawal of steroid both clinical and radiological resolution was maintained at follow up. CONCLUSION: Acute pneumonitis is an uncommon but serious adverse effect of low dose methotrexate treatment for refractory rheumatoid arthritis. The initial presentation is non-specific and a high index of suspicion is required as respiratory failure may develop rapidly. Management depends on exclusion of infection, withdrawal of methotrexate, and high dose corticosteroid treatment. Full supportive treatment is indicated as the prognosis in such patients is good.

Acute Disease↗
PubMed1987

Indications of vascular endothelial cell dysfunction in systemic lupus erythematosus.

Fibrinolytic and other factors have been measured in 73 patients with systemic lupus erythematosus or related conditions to determine whether clinical thrombosis, a common feature of these disorders, is associated with defective fibrinolysis. Twenty five of 72 (35%) patients, compared with two of 22 (9%) controls, showed a low level of plasminogen activator activity in response to venous occlusion, suggesting decreased fibrinolytic potential. In addition, mean plasma levels of von Willebrand factor antigen and fibronectin were markedly raised in the patients (mean (SD) 384.5 (277)% and 727 (436) mg/l respectively) compared with healthy controls (100 (50)% and 306 (65) mg/l). These data suggest a degree of endothelial cell dysfunction. No clear correlation was found between a history of thrombosis and any plasma factor measured, except for prolongation of clotting tests suggestive of the 'lupus anticoagulant'.

Adult↗
PubMed1987

Coexisting rheumatoid arthritis and ankylosing spondylitis.

Since the second publication by some of the present authors in which 10 patients with coexisting rheumatoid arthritis (RA) and ankylosing spondylitis (AS) were described, 7 new cases have been found. For accuracy, all cases of the original study still available were reexamined. Of the total of 17 cases, 13 were male and 4 female. All had positive tests for rheumatoid factor and 6 had subcutaneous nodules. The male predominance and the frequency of nodules are consistent with other publications. In addition, our study demonstrates the strong association of each of these 2 diseases with its genetic marker: the antigen HLA-DR4 was present in 8 of 12 cases tested and the antigen HLA-B27 was present in 16 of the 17 cases. The coexistence of these 2 classical rheumatological entities in the same patient appears to occur by chance and is probably often overlooked.

Aged↗
PubMed1986

A review of 100 patients with ankylosing spondylitis with particular reference to socio-economic effects.

One hundred patients with ankylosing spondylitis of at least 5 years' duration were interviewed and examined. In addition to musculoskeletal symptoms, 11 subjects had evidence of a variety of neurological complaints. Nine were unemployed and only nine of the remainder felt the disease had seriously affected their employment. One third of patients had been off work for more than 2 months in the course of the disease but frequently due to associated illness. Most patients did not experience disability with household activities but peripheral joint involvement or serious spinal stiffness increased this risk. Symptoms referrable to athletic pursuits may have first drawn attention to the disease in some individuals and sporting activities were curtailed at a younger age than in controls. Driving caused difficulties in up to 50% of subjects due to poor all-round vision. Cervical spine fractures occurred in two patients.

Activities of Daily Living↗
PubMed1986

Dupuytren's contracture and alcohol.

Reported alcohol consumption was quantified and scored by a validated questionnaire administered by an interviewer to 64 patients (10 female) with Dupuytren's contracture (DC) before hand surgery and to 89 controls (44 female) admitted for other hand or foot surgery. Serum urate (SUA), gamma-glutamyl transferase (GGT), and mean red cell volume (MCV) were measured on admission. Thirteen of 54 men with DC reported current daily alcohol intake of 40 g or more compared with one of 45 male controls (p = 0.0001). Two of 10 women with DC (but none of 44 controls) admitted consuming at least 40 g alcohol daily (p = 0.03). MCV was higher in men (but not women) with DC than in controls (p less than 0.0005). Current alcohol consumption score of patients with DC correlated with SUA (r = 0.308, p less than 0.05), MCV (r = 0.44, p less than 0.01), and GGT (r = 0.54, p much less than 0.001) on admission. DC among men is strongly associated with heavy drinking, reflected both in self reporting and haematological data.

Aged↗
PubMed1985

Corticosteroid prescribing in rheumatoid arthritis--the fiction and the fact.

The results of a postal questionnaire to consultant rheumatologists (80% response rate) suggest that most comply with current teaching regarding the indications for systemic corticosteroids in articular rheumatoid arthritis (RA). They are prescribed as a last resort and most frequently in the elderly. However, a review of 100 consecutive RA out-patients revealed 24 patients currently taking corticosteroids at a mean prednisolone dosage of 5.6 mg daily. Only two had been prescribed these drugs for extra-articular problems. In 11 cases the treatment was not initiated by a rheumatologist. The discrepancies between the two surveys are discussed.

Adrenal Cortex Hormones↗
PubMed1985

Comparison of reconstructive orthopaedic surgery in patients with seropositive and seronegative rheumatoid arthritis.

The longitudinal orthopaedic history of 107 unselected patients with rheumatoid arthritis undergoing reconstructive surgery was studied to define the relationship between serology and surgery. Using strict criteria 85 patients were seropositive and 22 seronegative. Age, disease duration, number of reconstructive orthopaedic operations, and second-line or corticosteroid drug treatment were similar in seropositive and seronegative patients. Users of steroids and/or second-line drugs had a similar number of operations to non-users. However, patients undergoing only hip or knee surgery used steroids more often in the pre-operative disease than those only having other operations (p less than 0.05). This may reflect more-aggressive disease or the direct effect of steroids. The expected proportions of seropositive and seronegative patients together with their similar surgical and treatment patterns do not suggest that they have different diseases.

Adrenal Cortex Hormones↗
PubMed1985

Spinal movements in ankylosing spondylitis and the effect of treatment.

Fourteen male patients with ankylosing spondylitis, admitted for a 2-week period of inpatient treatment, had their spinal mobility assessed on admission and at the end of treatment by clinical measures and a three-dimensional radiographic technique. The patients were given injections of low-dose corticotrophin (ACTH) or placebo under a double-blind protocol. Initially all the patients had restricted movements compared with normal. After treatment all showed some improvement of mobility but no additional benefit accrued from ACTH. Clinical measures of mobility must be interpreted with care as the changes in these measurements were not closely reflected in the lumbar movements measured radiographically. Changes seen in plain radiographs were of little predictive value for improvements in mobility.

Adrenocorticotropic Hormone↗
PubMed1985

MacIntosh arthroplasty for the rheumatoid knee: a 10-year follow up.

The results of 75 MacIntosh arthroplasties performed for rheumatoid arthritis of the knee in 63 patients were reviewed at least 10 years after surgery. Forty-two knees in 35 patients were available for assessment. Eleven arthroplasties had been revised to total knee replacement without difficulty because of pain or poor function. The remaining 31 knees in 25 patients gave good or excellent results in 22 cases, fair in eight, and poor in one. Seven patients could not be traced, and 21 patients representing 26 knees had died. At least half these knees had given satisfactory results immediately before death judged by review of the case notes. The difficulty of comparing functional status with the preoperative state because of progressive multiarticular disease was highlighted. Although greater angular deformities preoperatively reduced the chance of success in the medium term, late failure of the arthroplasty after five years was very rare. Approximately two-thirds of all the arthroplasties performed gave satisfactory results at 10-year follow up or until the time of death.

Adult↗
PubMed1985

Alcohol consumption in arthritic patients: clinical and laboratory studies.

In popular belief patients with chronic arthritis take alcohol for its analgesic effect. To test this we studied by validated questionnaire the past and present alcohol consumption of 103 patients with primary osteoarthritis of the hip (OA), 95 patients with rheumatoid arthritis (RA), and 90 orthopaedic non-arthritic controls. OA men were most likely and RA men least likely to have been heavy drinkers at any time of their lives. Mean red corpuscular volume (MCV), gamma-glutamyltransferase (GGT), and serum uric acid (SUA) levels did not correlate with reported alcohol consumption. Two of 93 OA femoral heads examined had avascular change; both were from heavy drinkers. The abstemiousness of RA men compared with their OA counterparts was due to a striking increase in joint pain after drinking alcohol (p = 0.004), fear of adverse drug reactions with alcohol, and a widespread belief not expressed by OA men that 'alcohol and arthritis do not mix'.

Alcohol Drinking↗
PubMed1985

Rapid development of gouty tophi after diuretic therapy.

Increasing attention has been drawn to the role played by diuretics in the pathogenesis of gout, particularly in the elderly. We describe an elderly woman presenting acutely with tophus formation mimicking infection, in whom diuretic therapy was responsible for her disease. Her presentation with acutely inflamed tophi without any history of joint involvement, only 3 months after starting treatment, was highly unusual.

Aged↗
PubMed1984

In-patient regime for the treatment of ankylosing spondylitis: an appraisal of improvement in spinal mobility and the effects of corticotrophin.

Twenty-one patients with ankylosing spondylitis were admitted for two weeks bedrest, postural and mobilizing exercises. Eleven received low-dose corticotrophin and 10 received placebo injections during their admission and all were reviewed after two months. In-patient therapy resulted in significant improvements in function, early morning stiffness, spinal pain, lumbar extension and lateral flexion, finger-floor distance and wall-tragus distance. These improvements were maintained at two months. Biplanar radiography confirmed significant improvements of lumbar spine mobility in 14 male subjects studied. Less improvement occurred in neck movements and these were not maintained. There were no differences between the two treatment groups.

Adrenocorticotropic Hormone↗