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Biomedical subjects

B M Ansell

Publications and source records attributed to B M Ansell.

At least 109 records · Page 6Linked to original sources
PubMed1983

Interferon system in patients with systemic juvenile chronic arthritis: in vivo and in vitro studies.

Eighteen patients with active systemic juvenile chronic arthritis (JCA) were studied for periods of up to 1 year to see whether any relationships existed between the interferon (IFN) response, the course of the underlying disease and intercurrent infections. The control group consisted of 23 children who were each seen on one occasion. IFN-alpha production by mononuclear cells (MNC) cultured in vitro was stimulated with Newcastle disease virus (NDV). Comparison of the mean IFN-alpha responses from all patients with control responses showed that MNC from the JCA group produced significantly more IFN-alpha. Furthermore, MNC obtained from JCA patients at times of systemic flare produced significantly higher titres of IFN-alpha than at times when the patients were clinically stable. IFN-alpha production by MNC from individual patients fluctuated considerably from occasion to occasion whereas IFN-gamma production by MNC induced with phytohaemagglutinin (PHA) remained more stable. There was no significant difference between patients and controls with respect to IFN-gamma responses and no relationship with clinical condition. Serum IFN was not detected either by sensitive bioassays for IFN-alpha and IFN-gamma or by an immunoradiometric assay for IFN-alpha.

Adolescent↗
PubMed1983

The medical management of chronic arthritis in childhood.

In the management of children suffering from chronic arthritis it is important to note the type of disease present, complications both of the disease and from previous therapy as well as the family background and location, against which treatment is undertaken. Maintenance of joint position and function by appropriate splinting and exercises are the mainstays of management. Despite many new non-steroidal anti-inflammatory drugs, aspirin still has an important role, particularly with systemic manifestations. To date Ibuprofen (Brufen), Naprosyn and Tolmetin are the three non-steroidal anti-inflammatory agents which have been shown to be effective in controlling arthritis and Tolmetin may have some effect on systemic illness. The need for careful study of drugs in children is stressed. A few, usually those with systemic illness, will need oral corticosteroid therapy while an occasional child, usually with pauciarticular arthritis involving the knee, will benefit from a local corticosteroid injection. Apart from those few children with sero-positive disease, long-acting drugs are needed infrequently.

Adolescent↗
PubMed1983

Joint complaints and food allergic disorders.

An important problem in investigating food allergic diseases is to adduce evidence that specific diseases of unknown cause may be attributable to food allergy. Polyarthritis is a good example of the difficulties involved in such studies because it is a very heterogeneous disorder and generalizations about aetiology are unlikely to prove correct. We have observed transient synovitis in both children and adults which is caused by food allergy. On the other hand we have not been able to show that food allergy demonstrably contributes to juvenile chronic arthritis or to rheumatoid arthritis in adults. The arthritis associated with inflammatory bowel disease undoubtedly responds to elemental diets and the mechanism of this remission warrants further investigation.

Arthritis, Rheumatoid↗
PubMed1982

Juvenile psoriatic arthritis--an analysis of 60 cases.

Sixty children who were considered to have juvenile psoriatic arthritis were analyzed retrospectively; the mean length of follow-up was 10.8 years. There was a female predominance of 3:2. The mean age at onset for both the psoriasis and the arthritis was between 8 and 9 years. A family history of psoriasis was present in almost half, and was a valuable clue in diagnosing the 26 of 60 who presented with arthritis first. The majority had a monarticular presentation, usually of the knee. Additional joints usually became involved sporadically in an asymmetric pattern, in both upper and lower limbs, so that 87% ultimately had polyarticular disease. This course is unlike the usual one of childhood arthritis. Although 40% were asymptomatic at follow-up, six patients required bilateral hip replacement, four within the first five years following the onset of arthritis. Sixteen patients received slow-acting drugs, usually gold; eight of these had had a polyarticular onset and seven a positive test for ANA.

Age Factors↗
PubMed1982

Bone rarefaction and crush fractures in juvenile chronic arthritis.

Seventy children with juvenile chronic arthritis have had measurements of cortical and trabecular bone density in one or both radii. In 7 children with unilateral disease of one wrist, there was a substantial reduction in growth on the affected side. Trabecular bone density in the distal radius was reduced in the main group of 63 patients compared with controls, and this deficit was appreciably worse if the wrist was clinically affected by disease or if the child was being treated with steroids. Cortical bone density in the midshaft was less affected. Crush fractures of the spine were associated with more prolonged periods of bed rest, steroid therapy, radial trabecular bone density more than 2 standard deviations below normal, and subnormal 25-hydroxycholecalciferol concentrations in the serum. Since steroid therapy is often mandatory the main therapeutic implications are that the more severely affected child often needs vitamin D supplementation in "physiological" dosage, and that early mobilisation and reduction of steroid dosage should be constant aims.

25-Hydroxyvitamin D 2↗
PubMed1982

C-reactive protein in juvenile chronic arthritis: an indicator of disease activity and possibly amyloidosis.

C-reactive protein (CRP) was found to be particularly high early in the course of those cases of juvenile chronic arthritis (JCA) with a systemic onset, the mean level being 12 mg/dl (120 mg/l). It was also raised in cases with a polyarticular onset, mean level 6 mg/dl, while in cases with a pauciarticular onset it was associated with only a modest increase up to 1.5 mg/dl (15 mg/l). At the onset of disease there was a good correlation with the erythrocyte sedimentation rate (ESR). Regression of systemic disease was associated with a steady fall in C-reactive protein, but those patients who developed amyloidosis within 5 years from onset had persistently high values until cytotoxic therapy was introduced. Patients who developed amyloidosis later tended to have high CRP levels in the months or even years before diagnosis. In a few patients with polyarthritis the CRP appeared to reflect severe disease more closely than their relatively low ESR.

Amyloidosis↗
PubMed1982

Intensive immunosuppression versus prednisolone in the treatment of connective tissue diseases.

Intensive immunosuppression (IIS) was compared with prednisolone alone over a 2-year period in the treatment of severe connective tissue diseases. IIS consisted of 15 daily infusions of 750 mg antilymphocyte globulin (ALG), azathioprine 2.5 mg/kg/day, and prednisolone reducing from 150 mg, followed by maintenance azathioprine and prednisolone. The initial dose for prednisolone by itself was 60 mg and patients not responding to this regimen over a minimum of one month were then given IIS. Forty-one patients with life-threatening or severely disabling polyarteritis nodosa (PAN), dermatomyositis/polymyositis (DM), or systemic lupus erythematosus received one or other treatment. All 11 patients who received IIS for PAN remitted. Ten of these had renal impairment which was reversed or halted with IIS, and in 6 of these renal function had been deteriorating with prednisolone alone. One patient died of pneumonia in renal failure 9 months later but with PAN in remission. Two further patients, neither having renal involvement, achieved remission with prednisolone alone. Early cytotoxic treatment would seem to be indicated in PAN when there is renal involvement. Two patients with DM entered remission or prednisolone alone. The remaining 12, of whom 5 had failed steroid therapy, received IIS. Improvement or halting of deterioration was achieved in all 12 with best results in those without marked muscle wasting consequent to disease of long duration. The results suggest that IIS may be a useful adjunct in those patients failing to respond to prednisolone. IIS seemed no more effective than prednisolone alone in the treatment of the 14 patients with SLE and in particular lupus nephritis. Flares in disease activity were common in both groups and appeared to be related to prednisolone dosage. IIS was generally well tolerated, though infection occurred in 2 patients. Vertebral collapse or osteonecrosis of the femoral head occurred in 3 patients following IIS, all of whom had been previously receiving prednisolone for long periods.

Adolescent↗
PubMed1982

A comparison of Vitrathene moulded with Tweeklon ready-made wrist work splints in juvenile chronic arthritis.

A comparatiave study of purpose-made Vitrathene with a ready-made Tweeklon splint has been undertaken in 20 children with juvenile chronic arthritis who had such severe wrist and carpal involvement that a work splint was considered desirable. In half the dominant hand was splinted with Vitrathene and the other half Tweeklon. Assessments included the presence of soft-tissue swelling, extensor tenosynovitis and pain, together with the position and range of movement of the wrist, grip strength and functional tests. Tests included: maintenance of functional position, grip strength, dexterity, wear-resistance, and weight. Although the Vitrathene splint appeared better in the study, it was made by an experienced occupational therapist. The Tweeklon was applied by a physiotherapist reading the instructions which accompanied it; this took about a quarter of the time required to make the Vitrathene splints.

Adolescent↗
PubMed1982

Lymphocyte responses in juvenile chronic arthritis and Behçet's disease--cell number requirements and effects of glucocorticosteroid therapy.

Peripheral blood mononuclear cells from patients with clinically active Behçet's disease or juvenile chronic arthritis (JCA) gave high responses to phytohaemagglutinin (PHA) in vitro prior to prednisolone therapy and low responses when taking prednisolone in comparison with cells from control individuals. Such effects were not significantly different at the six concentrations of cells or the four times in culture studied. Differences from controls were also seen with cells from clinically controlled, prednisolone treated Behçet's patients; the cells responded better than controls at low cell concentrations and early times in culture, the reverse occurring at higher concentrations and later times. This pattern of response suggests the presence of a higher than normal proportion of responsive cells in these patients. These studies suggest that not only is a still wider range of culture conditions required to assess fully the differences in lymphocyte function related to disease activity and prednisolone treatment in JCA or Behçet's, but also that the use of a narrow set of 'optimized' conditions may be misleading.

Adult↗
PubMed1981

Idiopathic protrusio acetabuli in juveniles.

Eight children, aged 9 to 15, referred to a juvenile rheumatology service on account of undiagnosed hip pain, were ultimately found to have idiopathic protrusio acetabuli (IPA). Clinical and radiographic findings were generally asymmetrical on presentation. Subsequent radiographs tended to lag behind a rapid deterioration in six patients, four of whom required bilateral total hip replacement during adolescence. Pain on full flexion and moderate adductor spasm in the contra-lateral hip proved a useful early sign for predicting bilateral disease. Six of eight patients were hypermobile. In three of five families investigated, symptom-free IPA was revealed in one or more first degree relatives. Histology early in the course in two cases showed a non-diagnostic inflammatory reaction in the sub-synovium.

Acetabulum↗
PubMed1981

Assessment of flexor tenosynovitis in rheumatoid arthritis.

Assessment of the effect of therapy-physical, surgical, or local corticosteroid injections-in the management of rheumatoid flexor tenosynotivitis has proved difficult. This paper describes a simple, accurate and reproducible method of documentation using a photocopying technique. Its application to a study of the role of hydrocortisone injections in the management of flexor tenosynovitis is presented.

Arthritis, Rheumatoid↗
PubMed1981

Gait analysis: a pilot study- a possible mode of assessment of lower limb function in juvenile chronic arthritis.

There is a need for some form of objective assessment of gait which can be used clinically. A method which measures the temporal and distance factors has been employed to assess the gait of patients. Variables have been selected which reflect the gait symmetry and others have been chosen which show the speed of walking and hos this is achieved. The method of presentation of results is discussed with particular attention to the use of these results in monitoring the progress of the patients.

Adolescent↗
PubMed1981

Synovial haemangioma presenting as monarticular arthritis of the knee.

Two children with haemangioma of the synovial membrane presenting as swelling of a knee joint are described; in one patient this was associated with epiphyseal overgrowth. This condition should be considered if blood synovial fluid is obtained and clotting studies are normal.

Arthritis↗