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Biomedical subjects

A Keat

Publications and source records attributed to A Keat.

At least 19 recordsLinked to original sources
PubMed2001

Work disability among people with ankylosing spondylitis.

OBJECTIVE: To investigate work disability among people with ankylosing spondylitis (AS) in terms of correlates and coping mechanisms. METHODS: The sample group (n = 133) was recruited through 2 sources: 1) consecutive patients attending outpatient clinics over a 6-month period, and 2) a random sample of members of the National Ankylosing Spondylitis Society. We used a cross-sectional survey with data collected by self-administered questionnaires and telephone interviews with a randomly selected subsample (n = 6). RESULTS: The majority of participants were men. The mean age was 49 years; the mean disease duration was 28 years. Thirty-one percent were unable to work because of AS, with an additional 15% reporting changes to their working lives attributable to AS (e.g., reduction in hours worked, change of job). Compared with being in full-time work, work disability was associated with being older, longer disease duration, lower educational standard, comorbidity, greater physical impairment, pain, fatigue, stiffness, anxious and depressed mood, and lower self-esteem. Descriptive data added further insight into the experience of work disability and coping with AS in a work environment. CONCLUSION: Work disability is worthy of further investigation to determine exact prevalence rates and psychosocial implications. Work disability could be addressed with simple interventions or adaptations in the workplace.

Adaptation, Psychological↗
PubMed2001

The prevalence of Mycoplasma fermentans in patients with inflammatory arthritides.

OBJECTIVES: To search for evidence that Mycoplasma fermentans is involved in the pathogenesis of some forms of human arthritis by testing for the presence of mycoplasmal DNA in joint material. METHODS: M. fermentans DNA was detected by the identification of a 104-base pair amplification product of the polymerase chain reaction (PCR). RESULTS: M. fermentans DNA was detected in synovial fluid samples from six (17%) of 35 patients with rheumatoid arthritis (RA) and 18 (21%) of 85 patients with seronegative arthritis. These detection rates were significantly greater than in samples from patients with osteoarthritis or crystal synovitis, none of 26 of these being positive. CONCLUSIONS: M. fermentans could be involved in the pathogenesis of some forms of inflammatory arthritis and this possibility is worthy of further study.

Acute Disease↗
PubMed1999

Reactive arthritis.

Reactive arthritis is one of the spondyloarthropathy family of clinical syndromes. The clinical features are those shared by other members of the spondyloarthritis family, though it is distinguished by a clear relationship with a precipitating infection. Susceptibility to reactive arthritis is closely linked with the class 1 HLA allele B27; it is likely that all sub-types pre-dispose to this condition. The link between HLA B27 and infection is mirrored by the development of arthritis in HLA B27-transgenic rats. In this model, arthritis does not develop in animals maintained in a germ-free environment. Infections of the gastrointestinal, genitourinary and respiratory tract appear to provoke reactive arthritis and a wide range of pathogens has now been implicated. Although mechanistic parallels may exist, reactive arthritis is distinguished from Lyme disease, rheumatic fever and Whipple's disease by virtue of the distinct clinical features and the link with HLA B27. As in these conditions both antigens and DNA of several micro-organisms have been detected in joint material from patients with reactive arthritis. The role of such disseminated microbial elements in the provocation or maintenance of arthritis remains unclear. HLA B27-restricted T-cell responses to microbial antigens have been demonstrated and these may be important in disease pathogenesis. The importance of dissemination of bacteria from sites of mucosal infection and their deposition in joints has yet to be fully understood. The role of antibiotic therapy in the treatment of reactive arthritis is being explored; in some circumstances, both the anti-inflammatory and anti-microbial effects of certain antibiotics appear to be valuable. The term reactive arthritis should be seen as a transitory one, reflecting a concept which may itself be on the verge of replacement, as our understanding of the condition develops. Nevertheless it appropriately describes arthritis that is associated with demonstrable infection at a distant site without traditional evidence of sepsis at the affected joint(s). Although several forms of disease could be described as "reactive", particularly acute rheumatic fever, post-meningococcal septicaemia arthritis and Lyme disease, in clinical practice the term is restricted to an acute spondyloarthritis, usually, but not exclusively, linked to acute genitourinary or gastrointestinal infection. A proportion of patients fulfil criteria for Reiter's Syndrome [1].

Anti-Bacterial Agents↗
PubMed1999

Preface

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Journal Article↗
PubMed1999

Septic and aseptic arthritis: a continuum?

This chapter considers the likelihood that a wide spectrum of infection-provoked arthritis exists, ranging from overt sepsis to apparently aseptic chronic arthritis in which very small numbers of causal bacteria can be detected only by using highly sensitive techniques. It asks whether joints are, as conventionally held, normally devoid of micro-organisms and how to judge the significance of bacteria detected within apparently sterile joints. Through a consideration of known septic, probably infective and apparently aseptic forms of arthritis, a set of criteria for attributing causality to putative arthritogenic micro-organisms is proposed.

Arthritis, Infectious↗
PubMed1993

Improving prescribing of non-steroidal anti-inflammatory drugs in hospital: an educational approach.

An assessment has been undertaken of the effect of an educationally-based voluntary prescribing policy on the overall prescribing of NSAIDs in two acute hospital units. The policy engendered a fall in district expenditure on these drugs of 12% over 1 year. The long term impact of the policy was studied after 3 years within one area of hospital prescribing, the Accident and Emergency (A & E) department. At the time of formal appraisal, a high degree of compliance with the agreed policy, of greater than 95%, was being maintained. The effect of regular audit sessions between prescribers, specialist clinicians and pharmacists was studied in detail over a period of 30 weeks. A reduction in total NSAID prescribing of 40% was achieved after a single session. A change in junior medical staff was associated with a fivefold increase in prescriptions for NSAIDs, which was not sustained. Total A & E prescribing remained static over the period of study. The audit process was also associated with a reduction in analgesic prescribing in general. The results of this study indicate that an educationally-based system for improving prescribing can change prescribing habits in the short term; these can be maintained in the longer term provided that the policy is continually monitored and reinforced by regular appraisal meetings with specialist clinicians and pharmacists. It is suggested that this educational approach can readily be adapted to the primary care setting, with general practitioners rather than specialists taking the leadership role. This would encourage the achievement of common prescribing strategies between hospitals and community that are not wholly financially led.

Anti-Inflammatory Agents, Non-Steroidal↗