Serum IgE concentrations in rheumatoid arthritis: lack of correlation with gold toxicity.
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Arthritis, Rheumatoid↗
Biomedical subjects
D G Palmer
Publications and source records attributed to D G Palmer.
Vasculitis in a patient receiving naproxen.
A case is described of a 44-years-old woman who developed cutaneous vasculitis, nephritis and paralytic ileus after three years' treatment with naproxen. All these features were thought to be attributable to a naproxen induced vasculitis and all resolved spontaneously after the drug was stopped.
Adult↗
A comparative study of indomethacin and ibuprofen.
In a double blind trial with 20 patients ibuprofen 1600 mg daily and indomethacin 100 mg daily were shown to be of comparable efficacy in the short-term treatment of rheumatoid arthritis. Reported side effects were similar, but a slightly greater incidence of gastric irritation was noted with indomethacin necessitating withdrawal of one patient from the trial. The serum concentrations for indomethacin and ibuprofen were determined for four hours after the last dose. Peak concentrations of both drugs occurred within two hours. Five of the seven patients considered to have comparable serum concentrations of both drugs demonstrated a preference for indomethacin.
Adult↗
Benign rheumatoid nodules.
Nine cases in which subcutaneous rheumatoid nodules were observed in the absence of any evidence of rheumatoid arthritis are recorded. In four of these cases, the nodules appeared during adolescence or adult life, a very rare phenomenon. Synovitis occurred in only one patient, after an interval of 15 years, but it did not persist and other features of rheumatoid arthritis were not present. The siting of the nodules in the sub-cutaneous tissue, the absence of features suggestive of rheumatic fever, necrobiosis lipiodica or fungal infection, and lack of any history of trauma, together with the histological appearance, supported a diagnosis of rheumatoid nodules. In all cases, serological tests for rheumatoid factor were negative but in the only case investigated with immunofluorescent staining, IgG and IgM were demonstrated in the biopsy material. It is important to recognise the fact that these benign nodules do not necessarily indicate that the patient has rheumatoid arthritis, or will develop rheumatoid arthritis in the future. The possible relationship of such nodules to granuloma annulare is discussed.
Adolescent↗
Juvenile Reiter's syndrome.
A case of Reiter's syndrome occurring in an 11-year-old, pre-pubertal boy is described. The boy was a heterozygote for the histocompatibility antigen B27 and other arthritic members of his family included his mother with colitic arthritis and an aunt with ankylosing spondylitis. His HLA-B27 negative sibs have remained well. Shigella Salmonella and Yersinia organisms have been previously incriminated as precipitating factors in some patients with Reiter's syndrome but no evidence of recent infection with any of these agents was found in this patient. The case is reported because of the rarity of the condition at this age.
Arthritis, Reactive↗
In vitro aggregation of mouse peritoneal exudate cells.
(1) Immunological mechanisms which cause macrophage agglutination in vitro have been investigated. (2) Quantitative differences in the agglutinating properties of sero-positive rheumatoid sera and normal sera were found. (3) NZB X W mouse peritoneal macrophages differed from normal (NZCW) mouse peritoneal macrophages in susceptibility to agglutination. These quantitative differences could be explained by NZB X W macrophages carrying a surface immunoglobulin component which increased agglutination by rheumatoid sera. (4) Antimacrophage antibody was more effective in rendering macrophages susceptible to the agglutinating effect of antiglobulins than was heat-aggregated gamma globulin.
Agglutination Tests↗
Nuclei of cultured synovial fibroblasts studied by immunofluorescence and microdensitometry.
Two techniques which might be expected to detect alterations in DNA have been used in a comparison of cultured non-rheumatoid and rheumatoid synovial fibroblasts. Microdensitometry showed no alteration in staining affinity for methyl green when two pairs of cultures were compared. There was, however, a minor difference in the predominant staining pattern to a fluorescein conjugated anti-IgM serum when five rheumatoid cultures were compared with five non-rheumatoid cultures after exposure to a serum containing anti-nuclear antibodies.
Cell Nucleus↗
Doctor-patient communication in patients with arthritis.
Fifty patients with a chronic form of arthritis were given a standard interview concerned with establishing what knowledge they had of their disease and the drugs they were receiving for its treatment. Eighty-six percent of patients overall knew the name of their disease and 74 percent, the names of the drugs which they were receiving. Seventy-three percent of patients receiving non-steroidal anti-inflammatory drugs were unaware that these drugs were likely to have gastro-intestinal side effects even though about half of these patients were receiving either soluble aspirin or indomethacin. Younger patients were more likely to be aware of potential gastro-intestinal side effects (46 percent) than older patients (19 percent). Thirteen patients with rheumatoid arthritis were receiving myocrisin or penicillamine which are more likely to be associated with severe side effects than non-steroidal anti-inflammatory drugs. Four of five younger patients had some knowledge of the likely side effects of these drugs but none of the eight older patients knew this information. Written instructions should be given to older patients receiving these potentially toxic drugs.
Adult↗
Iatrogenic fluorosis.
A 69-year-old spinster presented with a history of generalised bone pains in September 1977. She was asthmatic and had been treated with 60 mg sodium fluoride and three Calcium Sandoz tablets daily for three years in an attempt to minimize steroid-induced osteoporosis. She was subsequently found to have fluorosis as shown by radiological osteosclerosis in vertebrae and pelvis with histological changes of osteomalacia on bone biopsy and a high bone fluoride content. A trial regimen for osteoporosis which is currently being assessed in various centres includes fluoride along with supplementary calcium and Vit D to prevent the production of osteomalacia which may occur with the fluoride salt alone. The case described here emphasises the potential toxicity of therapeutic dosages of fluoride when prescribed with calcium alone and emphasises the need for careful clinical and biochemical monitoring in all patients receiving therapeutic dosages of fluoride.
Aged↗
Complement in the pathogenesis of rheumatic disease.
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Antigen-Antibody Complex↗
Fenbufen compared with indomethacin in osteoarthrosis.
A double-blind, crossover clinical trial was carried out with a new propionic acid derivative, fenbufen, versus indomethacin and placebo in 20 patients with osteoarthrosis. Active drug dosages of 75 mg indomethacin daily and 600 mg fenbufen daily were used. Fenbufen scored significantly better than placebo with respect to two and indomethacin better than placebo with respect to five of the assessment indices used. Indomethacin was significantly better than fenbufen with respect to two indices and, overall, appeared more effective in the dosages tested. Biochemical abnormalities of liver function (serum alkaline phosphatase and/or SGOT) were noted in 5 patients after fenbufen therapy (in 3 patients after 4-weeks' treatment and in 2 after 6 weeks) but in none after indomethacin therapy. The significance of these findings is discussed. It is concluded that fenbufen should be withdrawn from further clinical use until the true incidence and significance of hepatotoxicity has been evaluated.
Adult↗
Lateral subluxation of the atlas in rheumatoid arthritis.
Two patients with lateral subluxation of the atlas resulting from rheumatoid disease involving the upper cervical spine have been described. The deformity can be suspected on clinical grounds and in one of our two patients spinal cord damage was a sequel. Erosion of the opposing surfaces of the odontoid and lateral masses of the atlas with detachment of the transverse ligament and deeper fibres of the posterior longitudinal ligament appear to underlie this deformity. Radiological confirmation may require AP views with the head tilted to one or other side.
Aged↗
Complement updated for the clinician.
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Complement C3↗
Drug prescribing in rheumatoid arthritis in Otago.
The drug therapy prescribed for a group of 50 patients with rheumatoid arthritis in Otago prior to specialist referral was examined. Thirty-two patients were receiving some first-line anti-inflammatory drugs and six were receiving no therapy at the time of their first hospital clinic visit. Salicylates had been prescribed first in only 16 of the 50 patients while this drug had been withdrawn because of side effects in about one-third of the patients who had been treated with it prior to specialist referral. Seven patients had received phenylbutazone and six corticosteroids as the first treatment for their rheumatoid arthritis. About one-third of the patients were receiving more than one anti-inflammatory drug at the time of their initial clinic visit.
Adult↗
Pulmonary damage associated with sodium aurothiomalate therapy.
Three patients with rheumatoid arthritis developed acute respiratory distress associated with pulmonary infiltration, during treatment with sodium aurothiomalate. This manifestation of gold toxicity has only recently been recognized. The temporal relationship to the introduction of gold therapy, an exacerbation following further gold injection in one patient, the resolution which followed gold withdrawal and the associated manifestation of gold toxicity in two patients favored a diagnosis of gold-induced pulmonary disease.
Aged↗