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Biomedical subjects

C J Michet

Publications and source records attributed to C J Michet.

At least 19 recordsLinked to original sources
PubMed2000

Poststreptococcal reactive arthritis in adults: a case series.

OBJECTIVE: To guide primary care physicians regarding the diagnosis and treatment of poststreptococcal reactive arthritis (PSReA) in adults. PATIENTS AND METHODS: We retrospectively reviewed an indexed database of all patients evaluated or hospitalized between 1976 and 1998 at Mayo Clinic Rochester and identified 35 patients with the diagnosis of reactive streptococcal arthritis, arthralgia, or arthritides. Twenty-nine patients with the diagnosis of acute rheumatic fever (ARF), septic streptococcal arthritis, or nonspecific reactive arthritis were excluded. RESULTS: PSReA was confirmed in 6 adults (3 women, 3 men; age range, 25-66 years). All patients were symptomatic with polyarthritis and oligoarthritis disproportionate to the objective findings on physical examination. Although all patients had negative throat cultures at the onset of arthritis, increased titers of anti-DNase B and antistreptolysin O confirmed recent streptococcal infection. Antecedent events included pharyngitis in 3 patients (who had received a minimum of a 10-day course of penicillin) and toxic shock syndrome in 1 patient. The latency of onset of arthritis ranged from 4 days to 6 weeks. The arthritic symptoms had a protracted course beyond the typical maximum of 3 weeks described for ARF. Treatment with aspirin did not provide symptomatic relief in any of the patients, whereas the response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) was at least partial in all cases. Symptomatic relief occurred in 1 patient who received indomethacin and in 1 patient treated with prednisone. Penicillin prophylaxis was recommended in 1 patient. CONCLUSION: PSReA should be included in the differential diagnosis of all adult patients presenting with arthritis. Treatment strategies include aspirin, other NSAIDs, and corticosteroids. In adult patients with PSReA, there is no evidence to support the use of penicillin prophylaxis at this time.

Adult↗
PubMed1999

Trends in the incidence and mortality of systemic lupus erythematosus, 1950-1992.

OBJECTIVE: To describe trends in systemic lupus erythematosus (SLE) incidence and mortality over the past 4 decades. METHODS: Using the Rochester Epidemiology Project resources, medical records were screened to identify all Rochester, Minnesota residents with any SLE-associated diagnoses, discoid lupus, positivity for antinuclear antibodies, and/or false-positive syphilis test results determined between January 1, 1980 and December 31, 1992. Medical records were then reviewed using a pretested data collection form in order to identify cases of SLE according to the American College of Rheumatology 1982 revised criteria for SLE. Drug-induced cases were excluded. All identified SLE patients were followed up until death, migration from the county, or October 1, 1997. These data were combined with similar data from the same community obtained between 1950 and 1979, and trends in the SLE incidence and mortality over time were calculated. RESULTS: Of the 430 medical records reviewed, 48 newly diagnosed cases of SLE (42 women and 6 men) were identified between 1980 and 1992. The average incidence rate (age- and sex-adjusted to the 1970 US white population) was 5.56 per 100,000 (95% confidence interval [95% CI] 3.93-7.19), compared with an incidence of 1.51 (95% CI 0.85-2.17) in the 1950-1979 cohort. The age- and sex-adjusted prevalence rate as of January 1, 1993 was approximately 1.22 per 1,000 (95% CI 0.97-1.47). Survival among SLE patients was significantly worse than in the general population (P = 0.017 compared with the 1980-1992 cohort, and P < 0.0001 compared with the 1950-1979 cohort, by log-rank test). Cox proportional hazards modeling demonstrated a statistically significant improvement in the survival rate over time (P = 0.035). CONCLUSION: Over the past 4 decades, the incidence of SLE has nearly tripled, and there has been a statistically significant improvement in survival. These findings are likely due to a combination of improved recognition of mild disease and better approaches to therapy.

Adolescent↗
PubMed1996

Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis.

OBJECTIVE: We conducted an open observational study to assess the short and longterm effect of single local glucocorticosteroid injection for trochanteric bursitis. METHODS: 75 patient diagnosed with trochanteric bursitis based on clinical criteria were injected; 20, 32, and 22 patients each received 6, 12, and 24 mg betamethasone, respectively, mixed with 4 cm3 of 1% lidocaine. A standardized baseline questionnaire was administered to assess the severity and functional limitation due to trochanteric pain, including the visual analog scale for pain. Patients were followed at Weeks 1, 6, and 26 to determine their response to treatment. RESULTS: 77.1, 68.8, 61.3% of responding patients reported improvement in pain at Week 1, 6, and 26, respectively. Patients receiving higher doses of betamethasone were more likely to experience pain relief (p < 0.0123). CONCLUSION: Corticosteroid and lidocaine injection for trochanteric bursitis is an effective therapy with prolonged benefit.

Aged↗
PubMed1995

Common rheumatologic diseases in elderly patients.

OBJECTIVE: To review common rheumatologic disorders that affect elderly patients and emphasize the unique diagnostic and therapeutic challenges inherent in the management of rheumatologic diseases in this age-group. DESIGN: We summarize our approach to treatment and management of specific rheumatologic problems in geriatric patients and discuss pertinent studies from the literature. RESULTS: Among the spectrum of rheumatologic disorders frequently encountered in the elderly population are polymyalgia rheumatica, fibromyalgia, giant cell arteritis, crystalline arthropathies (gout and pseudogout), and degenerative joint disease. The initial manifestations of these rheumatologic diseases in elderly patients may differ from the typical findings in younger patients. Geriatric patients may have nonspecific complaints, a decline in physical function, or even confusion. Because of physiologic changes associated with aging and a decrease in functional reserves, elderly patients are susceptible to adverse effects of pharmacologic therapy (including nonsteroidal anti-inflammatory medications, corticosteroids, narcotic analgesics, allopurinol, and colchicine). Clinicians should be alert for such problems as hepatotoxicity and occult gastrointestinal blood loss. Comorbid conditions such as cardiovascular disease and cognitive impairment may complicate management strategies and may limit the goals of both surgical intervention and rehabilitation programs in elderly patients. CONCLUSION: Rheumatologic disorders in geriatric patients pose special challenges to primary-care physicians. In the selection of optimal pharmacologic and nonpharmacologic therapeutic modalities, clinicians should focus on maintaining or improving the patient's quality of life and level of independent function.

Activities of Daily Living↗
PubMed1994

Fracture risk in patients with ankylosing spondylitis: a population based study.

OBJECTIVE: To assess the risk of fractures among patients with ankylosing spondylitis (AS). METHODS: A population based cohort study compared fracture incidence in an inception cohort of 158 Rochester, Minnesota residents newly diagnosed with AS between 1935 and 1989 with expected rates from the same community. RESULTS: In 2,398 person-years of observation, there was no increase in the risk of limb fractures, but there was a pronounced increase in the risk of thoracolumbar compression fractures (standardized morbidity ratio = 7.6; 95% CI, 4.3-12.6) among those with AS. CONCLUSION: These data point to the importance of measures aimed at maintaining axial skeletal status in patients with AS.

Adolescent↗
PubMed1993

Osteoarthritis.

Osteoarthritis is the most common form of chronic joint disease. This article provides an overview of the epidemiology and pathogenesis. Approaches to the differential diagnosis and management of multiple clinical regional osteoarthritis syndrome are reviewed.

Humans↗
PubMed1992

Ankylosing spondylitis in Rochester, Minnesota, 1935-1989. Is the epidemiology changing?

OBJECTIVE: To determine trends in the incidence and clinical presentation of ankylosing spondylitis first diagnosed between 1935 and 1989 among residents of Rochester, Minnesota, and in the survival of the patients. METHODS: Population-based descriptive study. RESULTS: The overall age- and sex-adjusted incidence rate was 7.3 per 100,000 person-years (95% confidence interval 6.1-8.4). The rate tended to decline between 1935 and 1989, but there was little change in the age at symptom onset or diagnosis over the 55-year study period. Overall survival was not decreased up to 28 years following diagnosis. CONCLUSION: These data indicate that there is a constancy in the epidemiologic characteristics of ankylosing spondylitis and suggest that previously study results indicating changes may have been due to biases in patient selection and study design.

Adolescent↗
PubMed1992

Lupus anticoagulant in systemic lupus erythematosus: a clinical and renal pathological study.

Circulating lupus anticoagulant (LA) is associated with thrombosis in large and small vessels. To determine how often the presence of LA is associated with thrombosis within the renal microcirculation, 33 patients with systemic lupus erythematosus (SLE), renal dysfunction, and LA were identified over a 25-year period (LA group) and 32 patients with renal SLE but with normal gross coagulation screen were matched for age, sex, and biopsy timing (C group). Prevalences of serositis, neuropsychiatric illness, leukopenia, thrombocytopenia, hemolysis, anti-DS-DNA elevation, and complement reduction were similar. Arthritis was less and biologic false-positive (BFP) syphilis serology more common in LA. More LA patients had thrombotic events (LA 39% v C 13%; P = 0.014); bleeding episodes, including postbiopsy, were similar. At biopsy, hypertension (LA 55%, C 41%), serum creatinine (mean +/- SD: LA 186 +/- 168 mumol/L [2.1 +/- 1.9 mg/dL] v C 150 +/- 168 mumol/L [1.7 +/- 1.9 mg/dL]) and proteinuria (LA 2.6 +/- 3.1 g/24 h v C 3.1 +/- 2.7) were similar. Lesions by World Health Organization (WHO) class, activity, and chronicity indices, as well as immunofluorescence (IF) and electron microscopy (EM) findings, were not significantly different. Occlusive glomerular, arteriolar, and arterial fibrin thrombi, along with varying degrees of renal thrombotic microangiopathy, were seen in five of 33 patients with LA, but zero of 32 C patients (P = 0.053); three of these five patients died soon after biopsy. Overall, mortality was not different between LA and C. We conclude that the majority of patients with SLE, renal dysfunction, and LA exhibit renal morphologic findings indistinguishable from patients without LA. However, a significant minority of LA patients have thrombotic microangiopathy in their biopsy, which is accompanied by a worse prognosis.

Adolescent↗
PubMed1991

Total knee arthroplasty: a population-based study.

Total knee arthroplasty (TKA) is being used increasingly for the management of chronic arthritis of the knee. In this report, we review the frequency of application of TKA in the population of Olmsted County, Minnesota, from 1971 through 1986. The utilization rate of TKA increased from 20.5 per 100,000 person-years for 1971 through 1974 to 60.8 per 100,000 for 1983 through 1986. Although rates were higher in women, they increased with advancing age in both sexes. Rates between the urban and rural populations of Olmsted County did not differ. The two most common underlying diseases that necessitated TKA were osteoarthritis and rheumatoid arthritis; they were the cause of more than 90% of all operations. By extrapolating the rates of TKA in Olmsted County to the total 1986 US population, we estimate a need for at least 143,000 TKAs annually at a direct cost of more than $2.3 billion each year.

Adult↗
PubMed1991

Incidence of psoriasis in Rochester, Minn, 1980-1983.

This population-based study was carried out using the medical records linkage data resource for the population of Rochester, Minn, at Mayo Clinic. There were 132 newly diagnosed cases of psoriasis identified during a 4-year period (1980 through 1983); 88% of the cases had been seen and diagnosed by a dermatologist. The overall crude incidence rate was 57.6 per 100,000 population; for men and women, the rates were 54.4 and 60.2, respectively. The overall sex- and age-adjusted (1980 US white population) incidence rate was 60.4 per 100,000 person-years. The highest rate of occurrence (112.6) was in the 60- to 69-year-old age group. Most of the cases of psoriasis diagnosed in this study (58%) were mild, and the patients had psoriatic lesions on less than 10% of their body. There are no other published incidence rates for this condition with which to make comparisons.

Adult↗
PubMed1990

Idiopathic symptomatic osteoarthritis of the hip and knee: a population-based incidence study.

We identified all residents of Rochester, Minnesota, who sought medical assistance for the first time in 1985 because of symptomatic osteoarthritis of the hip or knee that was unrelated to a specific disease. Of these residents, 98 (59 women and 39 men) had 122 symptomatic joints (95 knees and 27 hips), for age- and sex-adjusted incidence rates of 205 new patients and 255 newly affected joints per 100,000 person-years. The incidence of osteoarthritis of the hip was greater in women than in men, whereas the sex ratio for occurrence of osteoarthritis of the knee approached unity. Rates at both sites increased steadily with aging in men but plateaued after the menopause in women; similar patterns were seen whether or not grade 1 disease was included. Projected nationally, these first population-based data indicate that as many as approximately half a million new symptomatic cases of idiopathic osteoarthritis of the knee and hip may arise annually in the white population of the United States. With increasing longevity, osteoarthritis may exact an even greater toll in the future.

Adult↗
PubMed1990

Trigeminal sensory neuropathy associated with connective tissue diseases.

We reviewed the clinical and laboratory features of 81 patients who had trigeminal sensory neuropathy (TSN) and a connective tissue disease (CTD). The neuropathy developed before the symptoms of CTD in 6/81 patients (7%), and in 38/81 patients (47%) TSN and CTD were diagnosed concurrently. The most frequently associated CTDs were undifferentiated connective tissue disease (38/81, 47%), mixed connective tissue disease (21/81, 26%), and scleroderma (15/81, 19%). Of 66 patients followed for more than 1 year (median, 5 years; range, 1 to 26 years), 8/66 patients (12%) had mild improvement and 2/66 (3%) had marked improvement of numbness; no patient had complete return of sensation. The facial numbness was frequently associated with moderate to severe facial pain that was usually resistant to pharmacologic therapy. None of the patients developed clinical or laboratory evidence of systemic vasculitis. The etiology of this cranial sensory neuropathy remains obscure.

Adult↗
PubMed1990

Epidemiology of vasculitis.

Knowledge of the epidemiology of vasculitic syndromes in the general population is limited. With few exceptions, most of the syndromes are sufficiently infrequent that accurate population-based data are lacking.

Adolescent↗
PubMed1990

Vasculitis and relapsing polychondritis.

Relapsing polychondritis is a systemic disease of unknown etiology with predominate manifestations of multiorgan cartilaginous inflammation. Although relapsing polychondritis occurs predominantly as a separately defined clinical complex, a significant number of patients may suffer from another rheumatic disease. Vasculitic syndromes are the most commonly observed disorders associated with relapsing polychondritis.

Humans↗
PubMed1990

Polymyalgia rheumatica/giant cell arteritis and other vasculitides.

The epidemiology of vasculitic syndromes encompasses a broad spectrum of diverse clinical syndromes. Almost all lack identified etiologic agents, and their clinical characteristics are determined predominantly by the size of the involved vessel and the end organs damaged. With the exception of giant cell arteritis/polymyalgia rheumatica in the elderly, and Henoch-Schönlein purpura and Kawasaki disease in the pediatric population, the vasculitic syndromes are infrequently observed diseases.

Arteritis↗
PubMed1989

A population-based case-control study of temporal arteritis: evidence for an association between temporal arteritis and degenerative vascular disease?

The first population-based incident case-control study of temporal arteritis (TA) in the US was conducted using the unique data resources of the Rochester Epidemiology Project. During the period 1950-1985, 88 newly diagnosed cases of biopsy-proven TA were identified among residents of Olmsted County, Minnesota. Cases were each matched to four Olmsted County community controls on age, sex and duration of community medical record. Odds ratios (OR) were calculated for marital status, education, Quetelet index, pregnancy, age at menopause, thyroid disease, diabetes, smoking, hypertension, angina, myocardial infarction, peripheral vascular disease, and stroke. Multivariable conditional logistic regression analysis identified statistically significant adjusted OR for smoking (2.3, 95% CI = 1.3-4.1). Elevated ORs which were not statistically significant were noted for angina, myocardial infarction, and peripheral vascular disease. These data suggest that TA and arteriosclerosis may share a common causal pathway. Alternatively, histopathological misclassification of temporal artery biopsies may have resulted in the observed association. Due to the limited power of this population-based study, multicentre collaboration should be encouraged to more precisely define the epidemiology of TA.

Aged↗
PubMed1989

Lymphoreticular disorders masquerading as rheumatic disease syndromes.

We describe four cases, each with a distinct rheumatologic presentation. Three had lymphoma, and the fourth, though initially suggestive of lymphoma, had a tuberculous infection. Clinicians should be alert for diseases masquerading as diverse clinical syndromes. It is important to establish rheumatic, lymphoproliferative, or infectious etiology because of major differences in therapeutic and prognostic implications.

Adult↗