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Andrew Keat

Publications and source records attributed to Andrew Keat.

8 recordsLinked to original sources
PubMed2007

Lupus and leg ulcers--a diagnostic quandary.

Leg ulcerations can occur in systemic lupus erythematosus (SLE) patients with antiphospholipid (aPL) antibodies and/or vasculitis, and it has been suggested that aPL antibodies may play a pathogenetic role in skin manifestations of SLE. To our knowledge, there is only one report of an aPL antibody-negative patient who developed pyoderma gangrenosum (PG) several years before the diagnosis of SLE. We describe a case of a young male affected by SLE who developed leg ulcers diagnosed as PG in the absence of aPL antibodies, where the onset of PG was associated with reactivation of SLE. Effective treatment led to significant improvement in skin lesions and SLE activity.

Adult↗
PubMed2006

A still image of a transient rash captured by a mobile phone.

The diagnosis of adult onset Still's disease (AOSD) can be difficult as the differential diagnosis is broad, it is based on clinical criteria and the signs, for example rash, can be transient. Clinical photography has an obvious role, and with modern technology, is now in the hands of physicians. We report a case of AOSD where an image of a transient rash taken with a camera phone allowed the diagnosis to be established. Further, we discuss the controversies around hospital bans on mobile phones (due to potential incompatibility with medical devices) and the reality of their widespread use. We conclude that, providing safeguards of consent and data storage are in place, the camera phone is a useful tool in rheumatology practice.

Adult↗
PubMed2006

A case of polymyalgia rheumatica, microscopic polyangiitis, and B-cell lymphoma.

BACKGROUND: A 73-year-old, previously well woman was admitted to an emergency department because of a 3-month history of severe proximal girdle pain and stiffness with loss of appetite and weight. She was referred to a rheumatologist 10 days after her initial presentation. Within 4 weeks she presented to an outpatient clinic with nausea, vomiting, shortness of breath, painful mouth ulcers, rash on her legs and a further decline in appetite; she was readmitted to hospital. Within 4 months of initial presentation she became jaundiced. INVESTIGATIONS: At initial presentation, physical examination, biochemical, hematological and autoimmune screening, radiography of the pelvis, an abdominal ultrasound, and electromyography were conducted. At referral to a rheumatologist similar tests were repeated. At presentation to the outpatient clinic, hematological and biochemical screening, and a urine dipstick test were conducted. At readmittance to hospital, infectious and autoimmune screening, radiography of the chest, electrocardiogram, ultrasound of the abdomen, and renal biopsy were conducted. At the time of development of jaundice, biochemical and hematological screening, CT of the abdomen and ultrasound-guided biopsy of a pancreatic mass were conducted. DIAGNOSIS: Polymyalgia rheumatica, antineutrophil-cytoplasmic-antibody-positive microscopic polyangiitis with renal involvement and B-cell lymphoma of the head of the pancreas. MANAGEMENT: The patient received oral prednisolone 15 mg daily for polymyalgia rheumatica along with alendronate 70 mg weekly. The patient received intravenous cyclophosphamide 500 mg and methylprednisolone 500 mg every 2 weeks for her microscopic polyangiitis with renal involvement. For B-cell lymphoma of the head of the pancreas, the patient received cyclophosphamide, doxorubicin, vincristine and prednisolone once monthly.

Aged↗
PubMed2003

Audit of the diagnosis, assessment, and treatment of osteoporosis in patients with ankylosing spondylitis.

OBJECTIVE: Osteoporosis (OP) is a well recognized complication of ankylosing spondylitis (AS), but there is no clear guidance to its appropriate management. To establish what might be considered as reasonable practice we surveyed the current practice of consultant rheumatologists in the United Kingdom. METHODS: A questionnaire comprising 14 questions relating to the management of OP in AS was sent to 449 British rheumatologists. Three hundred ten (69%) of the 449 questionnaires sent were returned. RESULTS: Only 98 respondents (31.6%) indicated that assessment of OP formed part of their routine management. Dual energy x-ray absorptiometry (DEXA) was the technique of choice for assessing bone mineral density (BMD) for 284 (91.6%). As general treatment, dietary advice was offered by 101 (32.6%) respondents, whereas 306 (98.7%) gave advice on exercise. Two case scenarios were presented and treatment choices recorded. When faced with a patient with osteopenia (-2.5 < T score < -1.0), 168 (54.2%) respondents would prescribe calcium and vitamin D supplements and 66 (21.3%) would prescribe a bisphosphonate. A second scenario featured a man with femoral neck T score of -2.80 and lumbar spine T score of -0.23. In this case 238 (76.8%) respondents would prescribe a bisphosphonate and 99 (31.9%) calcium and vitamin D, with some prescribing both. Thirty-eight (12.3%) would not prescribe calcium and vitamin D or a bisphosphonate. Two hundred twenty-seven (88.3%) rheumatologists indicated that they would repeat the BMD measurement in a patient with OP within 2 years. CONCLUSION: The majority of British rheumatologists do not routinely assess patients with AS for OP. Most would manage OP in AS in a similar way to postmenopausal OP, but many would not. It does not appear to be generally recognized that in AS, spinal BMD as measured by DEXA rises with advancing radiographic changes, so that hip BMD is the measurement of choice. A robust evidence base is required to clarify guidelines for the management of OP in AS.

Absorptiometry, Photon↗
PubMed2002

How should clinicians manage osteoporosis in ankylosing spondylitis?

Osteoporosis is a common complication of AS, with an incidence between 18.7% and 62%. The prevalence of osteoporosis is greater in males, and increases with increasing patient age and disease duration. Osteoporosis is also more common in patients with syndesmophytes, cervical fusion, and peripheral joint involvement. These variables are not all independent, as they may be indicators of disease duration. Osteoporosis in patients with AS is largely confined to the axial skeleton, in contrast to the pattern of osteoporosis seen in rheumatoid arthritis. BMD at the lumbar spine and femoral neck may be severely reduced, while most studies indicate that carpal and radial BMD remain within normal limits. The development of syndesmophytes in late AS can lead to difficulties in the use of DEXA scanning to determine lumbar BMD, as the extraspinal bone may obscure osteoporotic vertebrae. Under these circumstances more accurate assessment of lumbar BMD, and one that correlates better with femoral neck BMD, may be obtained by quantitative CT scanning or DEXA scanning of the lateral aspect of the L3 vertebra. Osteoporosis in AS significantly increases the risk of vertebral compression fractures within 5 years of the diagnosis of AS. The risk of a vertebral compression fracture occurring over a 30 year period following the diagnosis of AS is 14%, compared to 3.4% for population controls. In patients with vertebral osteoporosis relatively minor trauma, such as slipping, can lead to spinal fracture and dislocatior with subsequent damage to the spinal cord. There is a higher incidence of spinal cord injury following spinal fracture dislocations in patients with AS, and the resulting neurological deficit can range from mild sensory loss to complete paraplegia. Cytokines such as TNF-alpha and IL-6 may play an important part in the pathogenesis of osteoporosis in early AS, and IL-6 levels have been correlated with markers of disease activity and severity. In late AS, mechanical factors such as decreased mobility and the support provided by extraspinal bone may play a role in vertebral osteoporosis. Screening patients with AS for the presence of osteoporosis is an important, but contentious subject. This and subsequent monitoring needs to be considered in all patients, but longterm studies are needed to determine with confidence which patients should undergo screening, by which methods, and how often. The treatment of osteoporosis in AS is at present similar to that used for primary osteoporosis, except that due to the male predominance and a relatively young age of patients, there is a limited role for hormone replacement therapy. Exercise regimens and bisphosphonates are widely used, but a study of the relative efficacy of different bisphosphonate agents in patients with AS is required.

Absorptiometry, Photon↗
PubMed2002

Reactive arthritis or post-infective arthritis?

Infective mechanisms probably underlie a wide range of inflammatory arthropathies. There appears to be a spectrum of mechanisms ranging from the frankly septic, through low-grade infection with very small numbers of microorganisms in the joint to arthritides in which no hard evidence for an infective cause exists. In the midst of the spectrum lie 'post-infective' and 'reactive' arthritides, characterized clinically, genetically and by epidemiological links with infection. Identification of bacterial components within joint material from such patients suggested that the causes of the arthritis had been found. It is now clear that many bacteria are present in inflamed joints; establishing their significance will be of crucial importance, but not easy.

Arthritis, Infectious↗