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Biomedical subjects

Andrew L Wong

Publications and source records attributed to Andrew L Wong.

13 recordsLinked to original sources
PubMed2005

Selective IgA immune unresponsiveness to Proteus mirabilis fumarate reductase A-chain in rheumatoid arthritis.

OBJECTIVE: To determine if selective immune unresponsiveness to microbial antigens is associated with predisposition to rheumatoid arthritis (RA). METHODS: Proteins from Proteus mirabilis lysate were isolated by SDS-PAGE and examined by Western blotting for antibody responses in sera from patients with RA compared to healthy subjects and patients with psoriatic arthritis (PsA). RESULTS: Although RA patients had marked IgA immune responses to many P. mirabilis proteins compared to healthy subjects, selective unresponsiveness was found in RA to a 66 kDa protein identified as fumarate reductase A-chain (FRD-A) by mass spectroscopy. This was confirmed in Western blots with recombinant FRD-A from P. mirabilis. IgA unresponsiveness to FRD-A was found in 21/59 (35.6%) RA patients compared to 7/63 (11.1%) healthy individuals (p < 0.01) and 6/52 (11.5%) patients with PsA (p < 0.01). IgA unresponsiveness to FRD-A was present in 20/46 (43.5%) RA patients with IgA rheumatoid factors (RF) compared to 1/13 (7.7%) without RF (p < 0.025). CONCLUSION: Our results identify a selective hole in the IgA immune repertoire for P. mirabilis FRD-A in a subset of IgA RF-positive patients with RA.

Adult↗
PubMed2005

Lymphomatoid granulomatosis: a rare mimicker of vasculitis.

Lymphomatoid granulomatosis (LG) is a rare Epstein-Barr virus-associated lymphoproliferative disorder, with a propensity for blood vessel destruction. Although it most commonly affects the lung, it can affect multiple extrapulmonary sites (i.e., skin, nervous system, gastrointestinal tract, liver, spleen, kidney, and heart). Since LG often mimics systemic vasculitis, it presents a diagnostic clinical challenge. We describe a case of LG with no pulmonary involvement, which was thought to be systemic vasculitis on the basis of multiorgan involvement and biopsy findings.

Diagnosis, Differential↗
PubMed2004

Spanish Arthritis Empowerment Program: a dissemination and effectiveness study.

OBJECTIVE: To evaluate the effectiveness of the Spanish Arthritis Empowerment Program as presented by the Arthritis Foundation, Southern California Chapter, in Orange County, California. METHODS: Participants with arthritis (n = 141) enrolled in the program between October 1999 and May 2001. All materials were in Spanish. Written pretest, 6-week posttest, and 6-month followup tests measured pain rating, self-report joint counts, function (modified Health Assessment Questionnaire [mHAQ]), self efficacy, self-care behavior, and arthritis knowledge. RESULTS: Mean age was 51 years, 92% were female, 84% were born in Mexico, 55% had sixth grade education or less, and 60% had no medical insurance. Of the 141 participants, 118 completed 6-month followup testing. Repeated-measures analysis of variance showed significant improvement from pretest to 6-month followup in pain (6.0 versus 3.4); self efficacy (5.5 versus 8.4), self-care behavior (1.7 versus 4.9), arthritis knowledge (1.6 versus 4.5), and general health (2.1 versus 2.5), all at P < 0.001. Small improvement was reported in mHAQ (0.56 versus 0.50; P = 0.024). CONCLUSION: The Spanish Arthritis Empowerment Program was successfully disseminated. Significant improvements in self efficacy and in arthritis symptoms were maintained at the 6-month followup.

Analysis of Variance↗
PubMed2004

Case finding for population-based studies of rheumatoid arthritis: comparison of patient self-reported ACR criteria-based algorithms to physician-implicit review for diagnosis of rheumatoid arthritis.

OBJECTIVE: To evaluate the interrater reliability of rheumatologist diagnosis of rheumatoid arthritis (RA) and the concordance between rheumatologist and computer algorithms for assessing the accuracy of a diagnosis of RA. METHODS: Self-reported data regarding symptoms and signs for a diagnosis of RA were considered by a panel of rheumatologists and by computer algorithms to assess the probability of a diagnosis of RA for 90 patients. The rheumatologists' review was validated through medical record. RESULTS: The interrater reliability among rheumatologists regarding a diagnosis of RA was 84%; the chance-corrected agreement (kappa) was 0.66. Agreement between the rheumatologists' rating and the best-performing algorithm was 95%. Using rheumatologist's review as a standard, the sensitivity of the algorithm was 100%, specificity was 88%, and the positive predictive value was 91%. The validation of rheumatologist's review by medical record showed 81% sensitivity, 60% specificity, and 78% positive predictive value. CONCLUSION: Reliability of rheumatologists' assignment of a diagnosis of RA by using self-report data is good. Algorithms defining symptoms as either joint swelling or tenderness with symptom duration >or=4 weeks have a better agreement with rheumatologist's diagnosis than do ones relying on a longer symptom duration. RELEVANCE: These findings have important implications for health services research and quality improvement interventions pertinent to case finding for RA through self-report data.

Algorithms↗
PubMed2004

Development and evaluation of a patient self-report case-finding method for rheumatoid arthritis.

OBJECTIVE: To describe the development and evaluation of a patient self-report case-finding method for rheumatoid arthritis (RA) not dependent on direct contact with the treating physicians. METHODS: The American College of Rheumatology criteria for RA diagnosis were adapted for patient self-report using a questionnaire, and alternative scoring algorithms were evaluated to balance case-finding sensitivity and specificity. Positive rheumatoid factor tests were used to identify 1053 individuals in 2 large healthcare organizations; 440 agreed to receive study materials. Case-finding results were validated by medical record review (MRR) for a random sample of 90 patients. Three scoring algorithms were compared with MRR for likelihood of RA diagnosis. Cases not classifiable by algorithm were flagged and reviewed by 2 expert physicians for likelihood of RA diagnosis. RESULTS: Pilot testing demonstrated that patients comprehended the questionnaire and were willing to answer the questions. Completed questionnaires were returned by 265 (60%) of the 440 patients contacted. Following expert physician review of 16 flagged cases in the 90-patient MRR subsample, the most accurate scoring algorithm demonstrated 80% sensitivity, 67% specificity, 74% accuracy, and 77% positive predictive value for detecting early RA. CONCLUSION: The case-finding method represents a promising tool for identifying RA patients, with potential application in research and quality-assurance activities. RELEVANCE: This case-finding method should be useful in research and quality-assurance efforts requiring identification of RA patients treated by all types of providers in healthcare organizations in which centralized laboratory data are available.

Arthritis, Rheumatoid↗
PubMed2003

Duplication of the testis with contralateral anorchism.

We describe the case of a newborn infant with duplication of the testis and absence of the contralateral testis. The patient also had bilateral indirect inguinal hernias and an ipsilateral undescended testicle.

Abnormalities, Multiple↗
PubMed2003

Antiguanosine antibodies in murine and human lupus have the internal image of G-binding proteins.

OBJECTIVE: To examine the binding specificities of serum IgG antibodies of mouse and human origin directed against guanosine. The immunodominance of guanosine compared with the other nucleosides was established in the MRL/lpr murine model of systemic lupus erythematosus (SLE). Serum antiguanosine autoantibodies in human lupus correlate with nephritis and polyserositis in acute disease as well as in exacerbations of disease symptoms. METHODS: Antiguanosine autoantibodies obtained from humans with SLE were compared to a murine monoclonal antiguanosine antibody, 4H2. The fine specificity of the antiguanosine-binding site was determined by methylation of specific positions on the guanosine molecule and using defined analogs in competitive ELISA. RESULTS: Competitive inhibition assays revealed that serum antiguanosine antibodies bind across the 1 and 7 positions of the guanosine molecule (p < 0.01) and that an oxygen is necessary at position 6 in the molecule. 4H2 exhibited the same binding specificity for guanosine as human polyclonal antiguanosine antibodies, showing a conserved epitope across species. When the fine specificity was compared with known epitopes, the antiguanosine antibodies were found to have the internal image of a G-binding protein, identical to that of the Ha-ras oncogene product p21. CONCLUSION: The finding that antiguanosine autoantibodies vary directly with specific features of SLE, especially nephritis and polyserositis, suggests that they may contribute to the pathology of SLE. Our findings that antiguanosine antibodies have G-binding protein active site homology support the possibility that this species of antibody might interfere with cell signal transduction.

Adolescent↗
PubMed2002

Arthritis beliefs and self-care in an urban American Indian population.

OBJECTIVE: To describe beliefs and self-care strategies of American Indians with chronic arthritis joint pain. METHOD: In-depth interviews were conducted with a convenience sample of urban-dwelling American Indians (n = 56) concerning self-care and beliefs about arthritis; objective measures of arthritis disease activity were obtained through standardized interview protocols. RESULTS: Joint pain was not generally assumed to be arthritis nor directly related to aging. Belief that chronic pain affecting multiple joints was a serious and unexpected condition oriented American Indians' decisions to seek medical attention. However, verbal communications about pain may be subtle or under emphasized. Few coping strategies were used to control either chronic or episodic pain. CONCLUSIONS: Chronic arthritis pain may not be optimally managed in this population. Cultural assessment should recognize that American Indian patients may understate serious symptoms. Community educational interventions should target this population to enhance self-care, pain management, and communication of arthritis symptoms to physicians.

Adaptation, Psychological↗
PubMed2002

Descriptions of joint pain by American Indians: comparison of inflammatory and noninflammatory arthritis.

OBJECTIVE: To improve assessment of arthritis joint pain in American Indians by describing how symptoms are communicated. METHOD: In-depth interviews were conducted with American Indians who experience chronic joint pain (n = 56), to elicit descriptions and self-reported ratings of pain, disability, and beliefs associated with the pain for affected joints (n = 326). RESULTS: Discrete sets of specific verbal descriptions distinguished inflammatory arthritis (n = 20 terms) from noninflammatory arthritis (n = 22 terms), and indicated levels of pain intensity. An additional set of 14 vague but commonly used verbal descriptors did not distinguish the type of joint disease or pain intensity. CONCLUSIONS: Subtle pain complaints and vague verbal descriptions, such as "ache," "hurt," and "discomfort," may reflect severe pain symptoms, disability, and more serious joint disease in American Indian patients. In addition, certain specific sensory descriptions used by American Indians suggest inflammatory arthritis and may warrant further evaluation.

Adult↗
PubMed2002

Lower gastrointestinal bleeding in children.

Lower gastrointestinal bleeding is a common problem in the practice of general pediatrics. The differential diagnosis can be extensive and varies according to the age of the child. A specific diagnosis can usually be made with a thorough history, physical examination, simple laboratory investigations, and appropriate diagnostic studies. Treatment should be directed at the underlying cause. In most children, bleeding ceases spontaneously, and only supportive therapy is necessary. If there is evidence of hypovolemia, the patient must be hemodynamically stabilized, active bleeding stopped, and recurrent bleeding prevented.

Child↗
PubMed2002

New onset systemic lupus erythematosus with pheochromocytoma.

We describe a patient with positive antinuclear and anti-Smith antibodies, proteinuria, and thrombocytopenia suggesting systemic lupus erythematosus (SLE). During hospitalization, the patient developed labile hypertension, tachycardia, and intermittent fever. A computer tomography scan of the abdomen showed an extraadrenal mass, which was confirmed as a pheochromocytoma. After removal of the pheochromocytoma, the patient's symptoms resolved and her serology normalized. Previous case reports describe SLE patients with adrenal pheochromocytomas that presented many years after the diagnosis of lupus. This is a novel case of pheochromocytoma discovered at the onset of SLE, with resolution of SLE manifestations shortly after its removal.

Adrenal Cortex Hormones↗