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C J Eastmond

Publications and source records attributed to C J Eastmond.

At least 19 recordsLinked to original sources
PubMed2003

A prospective study of early diagnostic investigations in the diagnosis of ankylosing spondylitis.

This study was designed to assess the relative values current of locally available investigations in the early diagnosis of inflammatory sacroiliitis. Consecutive patients attending routine rheumatology clinics in Aberdeen clinically considered by consultant rheumatologists to have inflammatory back disease but with insufficient criteria to firmly establish a diagnosis of ankylosing spondylitis were included. Patients were assessed using a standard questionnaire, clinical examination of spinal movements, plain radiology of the sacroiliac joints, computerised tomographic scanning of the sacroiliac joints and HLA-B27 typing. Patients were systematically followed up using repeated clinical and radiological examination for five years. Plain film evidence of grade 2 radiological sacroiliitis (bilateral or unilateral) was found to be the most reliable predictor for the development of ankylosing spondylitis satisfying the New York criteria at 5 year follow up. CT scanning and HLA-B27 typing were of no added value in this series and the clinical questionnaire lacked specificity. It is concluded that the combination of clinical history, examination and plain film radiology are currently reliable criteria for diagnosing the subsequent development of ankylosing spondylitis satisfying established criteria.

Adult↗
PubMed2001

Use of discrete choice experiments to elicit preferences.

This paper considers the application of discrete choice experiments for eliciting preferences in the delivery of health care. Drawing upon the results from a recently completed systematic review, the paper summarises the application of this technique in health care. It then presents a case study applying the technique to rheumatology outpatient clinics. 200 patients were questioned about the importance of six attributes: staff seen (junior doctor or specialist nurse); time in waiting area; continuity of contact with same staff; provision of a phone-in/advice service; length of consultation; and change in pain levels. The systematic review indicated that discrete choice experiments have been applied to a wide number of areas and a number of methodological issues have been addressed. Consistent with this literature, the case study found evidence of both rationality and theoretical validity of responses. The approach was used to establish the relative importance of different attributes, how individuals trade between these attributes, and overall benefit scores for different clinic configurations. The value of attributes was estimated in terms of time, and this was converted to a monetary measure using the value of waiting time for public transport. Discrete choice experiments represent a potentially useful instrument for eliciting preferences. Future methodological work should explore issues related to the experimental design of the study, methods of data collection and analysis, and satisfaction with the economic axioms of the instrument. Collaborative work with psychologists and qualitative researchers will prove useful in this research agenda.

Adolescent↗
PubMed1995

The effects of alcoholic beverages on urate metabolism in gout sufferers.

The purine contents of commercial, low-alcohol and alcohol-free beers were determined. Four gout sufferers were studied under controlled conditions before and after ingestion of four different beverages containing alcohol, alcohol and purine, purine and neither alcohol nor purine. The results show a significant increase in purine excretion with a fluid load alone and impairment or reversal of this response with the other three beverages. These results are difficult to interpret on the basis of the alcohol and purine contents of the beverages alone. Isohumulones are present in all beers. Their effect on urate metabolism and excretion is unknown but needs further study as a possible explanation of these results. These results suggest that the three beverages other than a fluid load alone are unsuitable for gout sufferers.

Alcohol Drinking↗
PubMed1994

Psoriatic arthritis. Genetics and HLA antigens.

There is convincing evidence of a genetic basis for both psoriasis and psoriatic arthritis (PsA). Part of this genetic predisposition is due to genes within the major histocompatibility complex (MHC). In psoriasis, the primary association is with HLA-Cw6. Further work on specific nucleotide frequencies, especially those in the alpha 1 domain helix of the HLA-C molecule, will be of interest in determining whether a specific nucleotide frequency is present in all patients. The situation in PsA is considerably more complex. It is now established that there is an association between HLA-B27 and PsA, both in its peripheral arthropathy and in spinal disease in which radiological sacroiliitis is present. Spinal disease without radiological sacroiliitis is probably not associated with HLA-B27. There is some suggestion that HLA-B16 or its splits, HLA-B38 and HLA-B39, may also be associated with PsA, but there is considerable heterogeneity between the series, which prevents a firm conclusion being made. It is possible, but again not conclusive, that there is an association between HLA-DR4 and the symmetrical seronegative pattern of peripheral PsA. It is also likely that genes outwith the MHC predispose to psoriasis and PsA. It is further likely that a role will be found for environmental factors in both psoriasis and PsA. There is a tantalizing possibility of a complex interplay between a variety of environmental factors and genetic factors, both within and outwith the MHC, determining not only susceptibility but also the individual clinical pattern of disease. Further clarification of these possibilities is likely to depend primarily on understanding the role of genes within the MHC in predisposing to comparatively more homogeneous diseases, such as psoriasis and ankylosing spondylitis, before the mechanisms operating in PsA can be analysed and better understood.

Arthritis, Psoriatic↗
PubMed1992

Management of proteinuria secondary to penicillamine therapy in rheumatoid arthritis.

To determine if a policy of continuing penicillamine therapy in successfully treated patients with rheumatoid arthritis in the presence of persistent proteinuria, was associated or not with resolution of this adverse effect, a computer record of patients receiving penicillamine for rheumatoid arthritis was searched for patients with persistent proteinuria and the case notes of these patients reviewed. Eleven patients with persistent proteinuria were identified, eight of whom did not have nephrotic syndrome and were continued on penicillamine with close monitoring. In 5 patients proteinuria resolved after 16-21 months; 3 developed peripheral oedema (2) or worsening of pre-existing hypertension and proteinuria (1). In one of these the proteinuria subsequently resolved and one died of unknown cause. Of the 3 initially nephrotic patients, two had resolved at the time of the study. Persistent proteinuria in penicillamine-treated patients with rheumatoid arthritis resolves with continued therapy in the absence of nephrotic syndrome but vigilance is required for the development of any complications.

Arthritis, Rheumatoid↗
PubMed1991

Breast vasculitis in association with breast gigantism in a pregnant patient with systemic lupus erythematosus.

A 24 year old woman with systemic lupus erythematosus (SLE) developed widespread necrotic skin ulceration and gigantism of both breasts during an exacerbation of SLE in the last trimester of her second pregnancy. Over the remainder of the pregnancy the ulceration was only controlled by high dose corticosteroids. After parturition, however, it was possible to reduce the steroid dose without recurrence of the ulceration.

Adult↗
PubMed1986

Salmonella reactive arthritis: serum and secretory antibodies in eight patients identified after a large outbreak.

Serial measurements of serum and secretory antibodies to Salmonella typhimurium were made by ELISA in eight patients with suspected reactive arthritis identified after a large outbreak of Salmonella gastroenteritis. All three patients from whom Salmonella had been isolated developed significant serum IgG, IgA and IgM antibody responses. Only one of the three possessed HLA-B27. A further three patients, two with HLA-B27, had raised antibodies, although none had experienced gastroenteritis. Salmonella infection was not confirmed in the remaining two patients. The three B27-negative patients with confirmed reactive arthritis had HLA-B locus antigens which serologically cross-react with B27. One of six patients with confirmed reactive arthritis was under the age of 25 years whereas 256 of 418 (61%) patients with uncomplicated enteritis were under this age. The development of reactive arthritis may follow subclinical Salmonella infection and is influenced by genetic and age-related factors.

Adult↗
PubMed1985

Human parvovirus-associated arthritis: a clinical and laboratory description.

An outbreak of human parvovirus-associated erythema infectiosum in the Grampian region has enabled us to study the association between this small DNA virus and arthritis. This report deals with 42 patients with joint pains, in whom serological evidence of recent human parvovirus (HPV) infection was obtained. The clinical description of the disorder is based on 17 of the patients who were seen in the clinic and a further 13 patients for whom information was obtained by questionnaire. Detailed clinical features were not available for the remaining 12 patients. A rash was present in all 3 affected children but only 13 of the 27 adults. Viral prodromata were present in only 13 adults. 7 adults had neither rash nor viral prodromata. The arthritis was more common in adults than children and affected principally the female sex. In adults the arthritis was symmetrical, affecting the small joints of the hands, wrists, and knees most commonly. In all cases it was self-limiting, usually resolving within 4 weeks, although 1 adult had more persistent disease lasting almost 6 months. The 3 children reported in detail had less symmetrical and more persistent disease, which in 1 case has lasted over 7 months.

Adolescent↗
PubMed1984

Plant-thorn synovitis occurring in a child with psoriatic arthritis.

In psoriatic arthritis, trauma to joints may be important in determining the site of joint involvement. We describe a child with a psoriatic arthritis in whom penetrating injury with a rose thorn led to a localized chronic synovitis which could not be distinguished clinically from psoriatic arthritis but which was effectively treated by synovectomy and removal of the remaining thorn.

Arthritis↗
PubMed1984

Nuclear magnetic resonance (NMR) tomographic imaging for popliteal cysts in rheumatoid arthritis.

The ability of nuclear magnetic resonance (NMR) tomographic imaging to show a change in proton spin-lattice relaxation time (T1 value) in the joints of patients with rheumatoid arthritis before and after treatment with intra-articular steroid has been assessed. Six patients with seropositive rheumatoid arthritis and clinical evidence of a popliteal cyst were examined by both NMR tomography and arthrography. In all cases the presence of active rheumatoid arthritis was shown by an increase in the T1 values of the synovium of the joints. After arthrography a consistent but small rise in T1 value was noted which fell to below the initial reading after treatment by intra-articular injection of an anti-inflammatory agent. In all cases the presence of the popliteal cyst was clearly shown by both NMR tomography and arthrography. The findings indicate that NMR tomography provides a sensitive method for the demonstration of inflammatory joint disease, popliteal cysts, and possibly for monitoring response to therapy.

Arthritis, Rheumatoid↗
PubMed1983

Hypothalamic-pituitary-adrenal (HPA) axis function in patients receiving long-term intra-articular corticosteroids.

The hypothalamic-pituitary-adrenal (HPA) axis function of eight patients with rheumatoid arthritis receiving regular intra-articular methyl prednisolone acetate was studied. Tests of the HPA axis 5-7 weeks after the last injection revealed suppression in two patients. Some patients receiving intra-articular corticosteroids may therefore have abnormal responses to stress.

Aged↗
PubMed1983

Gram-negative bacteria and B27 disease.

The role of infection in ankylosing spondylitis is speculative and different studies by several groups have yielded conflicting results. The role of infection, however, in reactive arthritis and Reiter's syndrome is well established. The Grampian region has experienced three outbreaks of gastroenteritis, two due to Campylobacter jejuni and one due to Salmonella typhimurium. These outbreaks have allowed a study of reactive arthritis in the affected population following these infections. These studies do not allow accurate estimate of the frequency of reactive arthritis, largely because of difficulties in defining the infected population accurately. They do, however, suggest that in the population milder cases occur than in a population referred to hospital rheumatology clinics. These milder cases have a lower frequency of HLA-B27 than patients seen in a rheumatology clinic and suggest that there may be an association between HLA-B27 and the severity of reactive arthritis. An association between gastroenteritis due to Campylobacter jejuni and Salmonella typhimurium and erythema nodosum both with and without arthritis was observed. No difference was detected in the immunoglobulin responses of immunoglobulins A, G and M between patients with reactive arthritis due to Salmonella typhimurium and patients with gastroenteritis alone.

Adolescent↗