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Biomedical subjects

F Wollheim

Publications and source records attributed to F Wollheim.

At least 19 recordsLinked to original sources
PubMed2004

A randomised placebo controlled 12 week trial of budesonide and prednisolone in rheumatoid arthritis.

OBJECTIVES: To compare budesonide, a locally acting glucocorticoid with minimal systemic exposure, with conventional glucocorticoid treatment and placebo in rheumatoid arthritis. METHODS: A double blind, randomised, controlled trial over 12 weeks in 143 patients with active rheumatoid arthritis, comparing budesonide 3 mg daily, budesonide 9 mg daily, prednisolone 7.5 mg daily, and placebo. Particular attention was paid to the pattern of clinical response and to changes in the four week period following discontinuation of treatment. RESULTS: There were improvements in tender joint count and swollen joint count on budesonide 9 mg compared with placebo (28% for tender and 34% for swollen joint counts, p<0.05). Prednisolone 7.5 mg gave similar results, while budesonide 3 mg was less effective. ACR20 response criteria were met by 25% of patients on placebo, 22% on budesonide 3 mg, 42% on budesonide 9 mg, and 56% on prednisolone 7.5 mg. A rapid and significant reduction in symptoms and signs in response to budesonide 9 mg and prednisolone 7.5 mg was evident by two weeks and maximal at eight weeks. There was no evidence that budesonide provided a different pattern of symptom control from prednisolone, or that symptoms became worse than placebo treatment levels after discontinuation of glucocorticoid treatment. Adverse effects attributable to glucocorticoids were equally common in all groups. CONCLUSIONS: The symptomatic benefits of budesonide 9 mg and prednisolone 7.5 mg are achieved within a short time of initiating treatment, are maintained for three months, and are not associated with any rebound in symptoms after stopping treatment.

Adult↗
PubMed1998

Assessment of functional ability in patients with scleroderma: a proposed new disability assessment instrument.

OBJECTIVE: To develop a simple assessment of functional ability in patients with scleroderma and to examine its reliability both as a patient self-administered instrument and when administered by a trained observer. METHODS: An 11 item, 4 grade, functional assessment questionnaire was developed after extensive consultation with patients, physiotherapists (PT), and occupational therapists (OT) with the aim of including all functional areas of relevance. The instrument was self-administered by patients after an interval of 7 days. In the interval, the patients were assessed using the same instrument by direct observation from both a PT and an OT. Forty-seven patients with scleroderma, of varying severity, were recruited from 2 centers. Results were similar for both centers and data were pooled for analysis. RESULTS: Agreement between the patients' first and 2nd assessment was good for all questions (estimated kappas 0.69 to 0.94) with no evidence of an order effect. Agreement was also good between therapists (estimated kappas 0.47 to 0.81). There was poor agreement between patients and therapists, with patients rating their disability substantially higher compared to the standardized therapist assessment. CONCLUSION: This assessment schedule has high face and content validity and has excellent reliability both between trained therapists and within patients over a short time period. Its administration either as a self-report or by a therapist depends, in part, on the type of investigation undertaken.

Disability Evaluation↗
PubMed1993

Validity and reliability of three methods used in the diagnosis of Raynaud's phenomenon. The UK Scleroderma Study Group.

Three different assessment methods for the classification of Raynaud's phenomenon (RP) were compared. These were (i) a previously validated method using colour charts supplemented with a short questionnaire, (ii) answers to a questionnaire based on criteria derived from the consensus opinion of a group of clinicians, and (iii) individual clinician's assessment using standard descriptions based upon the same consensus view. We report the results of a study involving six clinicians and 30 subjects investigating the level of repeatability between the three methods and also the reliability between the six clinicians. There did not exist any overall systematic bias between the six clinicians. Further, agreement between them, as assessed by the kappa statistic, ranged from moderate to good. However, there did exist systematic bias between the results from all three of the classification approaches with agreement between them ranging from only poor to moderate. We conclude that the previously validated colour chart assessment is too insensitive to detect RP. Further, a structured questionnaire based on perceived clinician's opinion could not reproduce clinicians' classification in practice. By contrast, supplying clinicians with standard descriptions did yield a reliable classification system for RP.

Humans↗
PubMed1992

Reliability of skin involvement measures in scleroderma. The UK Scleroderma Study Group.

Two methods have been proposed to quantify the extent of skin involvement in scleroderma. These are (1) a scoring system which quantifies and summates this severity rating in 17 areas of skin surface and (2) a method estimating the percentage of skin involvement using a shaded manikin. We report on a study comparing the inter-observer reliability of these two approaches using the ratings of six clinicians on 12 patients. Systematic bias between observers was noted with both methods, but inter-observer agreement, as-assessed by the intraclass correlation coefficient (ICC), was higher with the score method. The manikin method resulted in a greater degree of disagreement between the observers, as well as a higher amount of random error, reflecting the difficulty of defining the bounds of abnormal skin. Despite the presence of bias, the score method is the preferred method for assessing the level of skin involvement.

Analysis of Variance↗
PubMed1990

Recurrent cerebral infarction and the antiphospholipid syndrome: effect of intravenous gammaglobulin in a patient with systemic lupus erythematosus.

A 23 year old woman with systemic lupus erythematosus and antiphospholipid syndrome developed severe thrombocytopenia (5-10 X 10(9)/l) and cerebral infarction. Treatment with high doses of corticosteroids and cytostatic drugs was not effective. The condition was successfully treated only when three courses of intravenous gammaglobulin at 400 mg/kg daily was added. A clear relation was found between the immunoglobulin infusions and rising platelet counts, whereas an effect on the levels of anticardiolipin antibodies could not be recorded. The findings suggested that the mechanisms responsible may be modification and solubilisation of immune complexes or interference with anticardiolipin binding to platelet membranes, or both.

Adult↗
PubMed1989

[Favourable surgery of cervical neck instability in rheumatism].

A team project commenced 20 years ago can now present results of 150 surgical stabilising procedures for cervical neck instability in rheumatoid arthritis. The favourable results indicate widened indications. MR examination demonstrated regression of soft tissue swelling ("pannus") after surgery, which possibly contributed to the good results.

Aged↗
PubMed1988

Detection of suspected inflammatory joint disease with a new simple self-administered hand test.

A self-administered hand test was used to screen 5262 persons aged 40-70 living in a rural district in southern Sweden. It revealed evidence of hand impairment in 13%. The prevalence of RA was 1.1%. At the screening procedure a subgroup of 48 previously unrecognized individuals with inflammatory joint disease was identified. They were assessed by a rheumatologist, who established the following diagnoses: four definite RA, eight probable RA, three psoriatic arthritis, one unclassifiable arthritis, 10 osteoarthritis and 22 non-specific arthralgia. No advanced RA was detected. Two were seropositive and another was erosive. One with RA, one with psoriatic arthritis and three with arthralgic symptoms were unable to work. Most had only a minor need for further medical aid. The test was thus able to identify persons with hand impairment. Follow-up studies will address the practical implications of the screening procedure.

Activities of Daily Living↗
PubMed1988

Reduction of rheumatoid periodontoid pannus following posterior occipito-cervical fusion visualised by magnetic resonance imaging.

Nine patients (four females and five males) with chronic rheumatoid arthritis (RA) and atlanto-axial (AA) instability subjected to occipito-cervical fusion were evaluated clinically and radiologically. All of them had soft tissue formation (pannus) around the odontoid peg. The age ranged from 50 to 79 years (mean: 66). The duration of the RA disease was 3-48 years (mean: 18.5). All patients were seropositive. Both conventional radiography and magnetic resonance imaging (MR) were performed pre- and postoperatively. All fusions except one were stable. One patient was re-fused after 2 months because of wire break. With regard to pain all patients had improved and eight were pain free. Six patients who experienced signs of myelopathy prior to the fusion had improved at follow up. MR revealed reduction of pannus in all nine cases. This was obvious in one patient within 6 weeks postoperatively. The MR findings of a reduction or even disappearance of pannus following posterior fusion should decrease the need for transoral surgery.

Aged↗
PubMed1987

Esophageal dysfunction and radionuclide transit in progressive systemic sclerosis.

Sixty patients with progressive systemic sclerosis (PSS) were studied by radionuclide esophageal transit (RT) and esophageal cineradiography. Fifty-two patients (87%) had abnormal RT with prolonged transit time and 28 (47%) had stagnation of radionuclide. RT was positively correlated to duration of disease (p less than 0.01). A positive correlation between transit time and the presence of dysphagia was observed. Reduced esophageal motility evaluated by cineradiography was observed in 44 patients (73%). In patients with moderate-severe esophageal dysfunction there was a positive association between prolonged RT and hypomotility at the radiological examination (p = 0.001). RT is a safe and non-invasive method which is more sensitive than cineradiography and might be used as a screening test to evaluate esophageal involvement in patients with PSS.

Adult↗
PubMed1985

Gastrointestinal function in patients with progressive systemic sclerosis.

In 24 patients with progressive systemic sclerosis (PSS) the pentagastrin-stimulated gastric acid secretion was determined to investigate if acid hypersecretion is associated with reflux-oesophagitis--the most common complication to oesophageal involvement in PSS. Gastro-oesophageal reflux was observed in 12, reflux-oesophagitis in 9 and oesophageal mycosis in 8 patients. Gastric acid secretion was increased in 13 (54%) patients and tended to be higher in patients with oesophagitis. Patients with reflux and increased acid secretion seemed to be free from oesophageal mycosis. Bacterial overgrowth and malabsorption are known complications to intestinal scleroderma and these items were investigated using non-invasive methods. Four patients had increased bile acid deconjugation, 3 had increased (14C)xylose degradation indicating bacterial overgrowth and 7 patients had decreased fat absorption in the triolein breath test. Nutritional status with respect to selenium, folate, cobalamin and fat-soluble vitamins was essentially normal.

Adult↗
PubMed1985

Systemic lupus erythematosus in an adult population in southern Sweden: incidence, prevalence and validity of ARA revised classification criteria.

In a defined Swedish population an annual incidence of 4.8 cases, a mortality of 1.3 cases and a prevalence of 39 cases per 100 000 individuals was found for systemic lupus erythematosus. Sensitivities were comparable (94%, cf. 92%) for ARA criteria of 1982 and those of 1971. Males had more internal organ criteria and showed a tendency to fewer cutaneous criteria than females. Spontaneous abortion was rare and hospitalization infrequent among the 65 patients studied.

Adolescent↗
PubMed1985

Systemic lupus erythematosus and infection: a controlled and prospective study including an epidemiological group.

An epidemiological group of 60 SLE patients was studied; 162 infections were observed prospectively for an aggregate of 1366 months. Bacterial infection was more frequent in the SLE patients than in matched controls but only slightly more frequent than in matched rheumatoid arthritis patients. The rheumatoid arthritis patients, also matched with regard to corticosteroid dosage, showed a tendency towards an increased infection rate only. Lower urinary tract infections were comparable in all three matched groups. In a total of 102 SLE patients studied, including the epidemiological group, clinical SLE activity was accompanied by an increase in the frequency of bacterial infection. In 49 patients bacterial infections were more common after flare than before. There was a high incidence of mucocutaneous infections induced by S. aureus, where skin traumatisation was an added risk factor. No increase of opportunistic infections was found in matched groups, but 26 such infections occurred in the subjects as a whole, and they were seen to be more frequent in conjunction with steroid-treated active SLE. Admission to hospital because of suspected infection was common, and infection was the cause or a contributory factor in five of the seven deaths among SLE patients.

Adrenal Cortex Hormones↗