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Biomedical subjects

H Capell

Publications and source records attributed to H Capell.

At least 19 recordsLinked to original sources
PubMed2005

Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data.

Adverse effects of glucocorticoids have been abundantly reported. Published reports on low dose glucocorticoid treatment show that few of the commonly held beliefs about their incidence, prevalence, and impact are supported by clear scientific evidence. Safety data from recent randomised controlled clinical trials of low dose glucocorticoid treatment in RA suggest that adverse effects associated with this drug are modest, and often not statistically different from those of placebo.

Antirheumatic Agents↗
PubMed2001

Investigation of novel polymorphisms within the 3' region of the IL-6 gene in patients with rheumatoid arthritis using Genescan analysis.

A highly polymorphic AT rich repeat exists in the 3' flanking region of the IL-6 gene. Using Genescan analysis we studied this region of the IL-6 gene in 55 normals and 95 patients with rheumatoid arthritis (RA). The influence of alleles on need for early major joint surgery in RA patients was assessed. We identified nine alleles of which, G8, G7 and G4 were the most common (37% vs 36% vs 13%). RA surgery patients had an increase in the frequency of G7 compared to non-surgery and control populations (46% vs 27% vs 34%, respectively) and a decrease in G8 (22% vs 46% vs 43%, respectively). RA patients homozygous for G8 had a lower ESR than those homozygous for G7 (23 mm/h vs 36 mm/h) although this was not significant. We have determined these alleles and their distribution in a normal and RA population. Initial findings suggest G8 may be associated with lower erythrocyte sedimentation rate (ESR) and less severe RA. Although trends in allele distribution were observed, further studies in larger cohorts are required.

Alleles↗
PubMed2001

The treatment of juvenile arthritis.

Until recently, two different classification systems for juvenile arthritis (JA) were utilised, each with its own terminology and subclassification. It has been recognised that particularly within the polyarticular and pauciarticular groups, many distinct subsets exist each with a different prognosis. As a result, a new classification system for JA has been developed. It is hoped that this will allow more accurate assessment of incidence and aetiology of the various subtypes in future generations and in time will allow therapy to be targeted at those most likely to achieve benefit. Since there is a new classification system for JA, the vast majority of published clinical studies were performed using the old classification system. For the purposes of this review, unless otherwise stated, the American College of Rheumatology classification will be used. This is outlined in Table 1 with clinical features of the major subtypes described in Table 3. This review will cover current best practice and discuss future directions for research using the recent advances in the treatment of rheumatoid arthritis (RA) as a model.

Amyloidosis↗
PubMed2001

The hip or not.

Pathologies within the ileopsoas compartment can present as hip pain and as such can be mistaken for diseases of the hip joint. Radiological investigations are useful in helping to differentiate between these pathologies.

Abscess↗
PubMed2000

The long-term effects of non-steroidal anti-inflammatory drugs in osteoarthritis of the knee: a randomized placebo-controlled trial.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat osteoarthritis (OA), though their long-term efficacy is uncertain. We report a comparison of the symptomatic responses to therapy with tiaprofenic acid, indomethacin and placebo over 5 yr. METHODS: A parallel-group, randomized, single-blind trial of patients with knee OA recruited 812 patients from 20 centres; 307 patients received tiaprofenic acid (300 mg b.d.), 202 indomethacin (25 mg t.d.s.) and 303 matching placebo for up to 5 yr. At the end of the parallel-group study, patients receiving tiaprofenic acid or placebo entered a 4-week blinded cross-over study of tiaprofenic acid or placebo, both given for 2 weeks. Assessments were at baseline, 4 weeks, then at 6-month intervals for up to 5 yr in the parallel group study and at 2-week intervals in the cross-over study. They comprised pain scores, duration of morning stiffness, patients' global assessments, paracetamol consumption, adverse reactions, withdrawals and functional outcomes. RESULTS: There were significant falls in overall pain scores in patients receiving NSAIDs compared with placebo at 4 weeks in the parallel-group phase. Thereafter there were no advantages favouring active therapy. In the cross-over phase, pain scores were significantly lower in patients receiving tiaprofenic acid than placebo. Patients who had been receiving long-term tiaprofenic acid showed significant rises in their pain scores when receiving placebo therapy and vice versa. Adverse events were reported by 61% of patients receiving tiaprofenic acid, 63% on indomethacin and 51% on placebo. Potentially severe side-effects were rare; for example, there were only three cases of gastrointestinal bleeding on NSAIDs. The pattern of withdrawal was similar in patients taking NSAIDs and placebo in the parallel-group study; at 48 weeks 53% of the patients remained on tiaprofenic acid, 50% on indomethacin and 54% on placebo. CONCLUSIONS: NSAIDs significantly reduce overall pain over 4 weeks. This short-term responsiveness is retained, and even after several years of therapy with tiaprofenic acid pain scores increased over 2 weeks when it was changed to placebo. Our results do not show long-term benefits from the use of NSAIDs in OA and the majority of patients had persisting pain and disability despite therapy.

Adult↗
PubMed2000

Unmet need in osteoporosis.

OBJECTIVE: To audit the management of females presenting to Accident and Emergency department with a diagnosis of low impact Colles fracture. DESIGN: Telephone questionnaire of 50 patients who attended A & E in 1998 with diagnosis of Colles fracture SETTING: Glasgow Royal Infirmary within North Glasgow catchment area. SUBJECTS: Women between 45-79 years of age who attended Accident and Emergency Department in 1998 with a diagnosis of low impact Colles fracture. RESULTS: Mean age was 63 years (range 44-78): ninety percent were post menopausal and 40% of the total group were smokers. Twenty six percent had a positive family history of osteoporosis, 24% had undergone hysterectomy and 88% took no part in any load bearing exercise. Ten percent (n = 5) were on treatment (1 alendronate, 3 etidronate with calcium, 1 hormone replacement therapy) CONCLUSION: A significant proportion of our study population have multiple risk factors for osteoporosis which are not being addressed. Raising awareness in orthopaedic surgeons, family doctors and patients is urgently required.

Aged↗
PubMed1998

Improved functional outcome in patients with early rheumatoid arthritis treated with intramuscular gold: results of a five year prospective study.

OBJECTIVE: To determine whether there is a relation between disease duration and functional outcome in patients with rheumatoid arthritis (RA) treated with intramuscular sodium aurothiomolate (gold) for five years. METHODS: 440 patients with RA were enrolled in a prospective trial of gold treatment. Initial demographic details were recorded. Disease activity was assessed at yearly intervals using a combination of clinical (pain score, Ritchie articular index, duration of morning stiffness) and laboratory (erythrocyte sedimentation rate, C reactive protein) parameters. Change in functional status was assessed using the health status questionnaire (HAQ). Patients were stratified according to disease duration at outset (group 1 = 0-2 years n = 106, group 2 = > 2-5 years n = 93, and group 3 = > 5 years n = 235). RESULTS: There were no significant differences between the groups at outset. A total of 160 patients completed five years of treatment (group 1 n = 44 (42%), group 2 n = 37 (40%), and group 3 n = 79 (34%)). Patients in group 1 had a significantly lower HAQ from year 1 to year 5 with a mean improvement of 30% at the end of the study (p < 0.001). Neither group 2 nor group 3 had a significant change in their HAQ at study end. There were significant improvements in all other variables (p < 0.05) in each group apart from pain in group 2. CONCLUSION: Patients with early RA have a larger reversible component to their HAQ. Only patients with disease duration of up to two years have a longlasting improvement in their functional ability after starting intramuscular gold treatment.

Adult↗
PubMed1997

Prevalence of low body mass in rheumatoid arthritis: association with the acute phase response.

OBJECTIVE: To ascertain the prevalence of low body mass in a rheumatoid arthritis (RA) population and to explore a possible relation with the acute phase response. METHODS: 97 patients who fulfilled the American College of Rheumatology (ACR) criteria for RA were recruited. Change in weight from initial presentation was noted. Body mass index (BMI), upper arm fat and muscle areas were recorded together with fat free mass calculated from the waist measurement. Blood samples were taken for erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and serum albumin. RESULTS: 13% of the RA group fell into the lowest 5th centile for BMI for the general population. The loss of body mass was greater for lean tissue than fat, with over 50% of the RA group falling into the lowest 10th centile of a reference population for the upper arm muscle area. Female patients who lost greater than 15% of their initial weight had higher health assessment questionnaire (HAQ) results than the rest of the group (p = 0.020). In female patients there was a significant correlation between reduced fat free mass and the acute phase response (ESR p = 0.016 and CRP p = 0.003) CONCLUSIONS: There is an increased prevalence of low body mass, greatest for lean tissue, in the RA population. In the female group there was an inverse relation between the acute phase response and fat free mass. Female patients with RA who lose a significant amount of weight are more disabled as assessed by HAQ.

Acute-Phase Reaction↗