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Biomedical subjects

H L Currey

Publications and source records attributed to H L Currey.

At least 19 recordsLinked to original sources
PubMed1988

A comparison of the ability of 28 articular indices to detect an induced flare of joint inflammation in rheumatoid arthritis.

Comparison of the ability to detect a flare of joint inflammation provoked by withdrawal of non-steroidal anti-inflammatory drugs from 10 patients with rheumatoid arthritis was made between 28 computer generated articular indices. The results suggest that this method can be used to compare the sensitivity of articular indices. Identifying joint inflammation by the simultaneous presence of tenderness and swelling and weighting for joint size produced the most sensitive indices. Identifying inflamed joints by swelling alone, or swelling and/or tenderness, grading for the severity of the signs, or selecting a restricted range of joints provided no advantages.

Aged↗
PubMed1988

Analysis of clinical judgment helps to improve agreement in the assessment of rheumatoid arthritis.

Experienced rheumatologists differ widely in their assessments of rheumatoid arthritis even after extensive efforts to improve agreement by discussion and consensus. The use of computer feedback to provide an analysis of clinicians' judgment policies in a highly structured investigation has been shown to improve agreement, but this may not apply in normal clinical practice. Here the successful convergence of clinical agreements by three rheumatologists using computer assisted feedback over several months in a National Health Service outpatient department is reported. In the three months without feedback their pooled agreement for assessing the severity of rheumatoid arthritis was r2 = 0.62. During the three months in which feedback was provided agreement rose to r2 = 0.92. The principal component of all three judgment policies at the end of the feedback period was 'articular index'.

Arthritis, Rheumatoid↗
PubMed1988

Serum cytidine deaminase levels after withdrawal of non-steroidal anti-inflammatory treatment in rheumatoid arthritis.

Increases in joint inflammation in nine patients with rheumatoid arthritis were provoked by withdrawal of their non-steroidal anti-inflammatory drugs. Pain score, duration of morning stiffness, Ritchie articular index score, and the number of analgesic tablets consumed reached peaks after five, three, five, and five days respectively compared with values during six days of normal treatment. Changes in serum cytidine deaminase (believed to reflect polymorph turnover in inflamed joints) showed a different pattern, with a sharp peak after two days and a subsequent trough. Possible mechanisms for these differences are discussed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1987

Articular indices of joint inflammation in rheumatoid arthritis. Correlation with the acute-phase response.

The joints of 30 rheumatoid arthritis patients were assessed by one observer for signs of inflammation. Computer analysis was then used to calculate 70 different articular indices for each patient. Pearson correlation coefficients were calculated between serum C-reactive protein levels and the articular indices. The results show that: findings in a restricted set of examined joints were equivalent to those in a more complete set; the simultaneous presence of joint tenderness and swelling yielded higher correlation than did either variable alone; and joint "weighting" for size yielded higher correlation than did simple counts.

Acute-Phase Reaction↗
PubMed1987

Failure to find disease similarity in sibling pairs with rheumatoid arthritis.

Clinical and laboratory measures of disease expression were compared within and between 33 families with two or more affected siblings with rheumatoid arthritis (RA). None of the variables studied--age and calendar year of disease onset, pattern of joint involvement, the presence of rheumatoid nodules, Sjögren's syndrome, a positive latex or antinuclear antibody (ANA) titre--showed a greater concordance within the families than between them. The families were then divided into those in which the affected sibling pairs were and were not HLA identical. Such a division did not alter the conclusion, with the possible exception of a positive latex titre. These results suggest that genetic or unique environmental factors within families may have only a limited role in explaining disease heterogeneity in RA. Conversely, the absence of homogeneity within the families justifies their use in genetic linkage studies and the extrapolation of results obtained from affected siblings to the commoner sporadic disease.

Arthritis, Rheumatoid↗
PubMed1986

Cytidine deaminase activity as a measure of acute inflammation in rheumatoid arthritis.

Cytidine deaminase (CD), a cytoplasmic enzyme, is thought to leak out of damaged cells and can be measured in fluids by a simple biochemical assay. This study has shown that serum CD activity is raised in rheumatoid arthritis (RA) compared with osteoarthritis (OA). Synovial fluid (SF) CD activity was always less than the corresponding serum activity (mean SF/serum ratio = 0.6) in OA but up to 22 times greater than the corresponding serum activity in RA (mean SF/serum ratio = 13.1), suggesting CD production in inflammatory joints. Evidence to support the SF neutrophil as a cell of CD origin is provided by the CD gradient running from cells to SF to synovium. The close correlation between SF CD activity and neutrophil count (r = 0.93) indicates that SF CD activity is an accurate measure of acute synovial inflammation. Weak correlation of serum CD activity with erythrocyte sedimentation rate (ESR) (r = 0.44) and C-reactive protein (CRP) (r = 0.49) implies that CD estimations supply different though related information about rheumatoid disease activity. We suggest that CD released from damaged neutrophils diffuses from all inflamed joints into the blood, so that serum CD activity may provide an integrated measure of joint inflammation more specific than traditional measures such as the ESR.

Arthritis, Rheumatoid↗
PubMed1986

Experimental cryo-irrigation of the knee joint.

Experiments have been carried out to test the feasibility of using cryo-irrigation as a means of ablating the synovium in the rheumatoid knee joint. Cryo-irrigation was performed by a cooling machine and pump, which circulated cold 200/10 centistoke (cSt) silicone through the knee joint of rabbits anaesthetised with intravenous (IV) 'Saffan'. Fluid left the joint at -5 to -10 degrees C. Sixteen normal New Zealand rabbits received cryo-irrigation of one knee joint for 10-20 minutes and were killed at one day, and one, two, and 12 weeks thereafter. Judged by radioactive sulphate incorporation there was no impairment of chondrocyte function in the articular cartilage of irrigated joints. Histological examination showed mild synovitis and some loss of staining of superficial cartilage in 6/16 irrigated joints (v 1/16 control joints). Similar treatment of rabbit joints in which the Glynn model of synovitis had been induced showed marked reduction of synovitis 14-45 days after silicone treatment. Nine of 26 animals in which synovitis was induced in both knees and cryo-irrigation performed in one knee died either immediately postoperatively or during the next week. These deaths remain unexplained. A single dog received cryo-irrigation of one knee (-6 to -9 degrees C for 22 min) and remained perfectly well up to sacrifice at six months, when the joint appeared histologically completely normal.

Animals↗
PubMed1986

Inability of rheumatologists to describe their true policies for assessing rheumatoid arthritis.

Eighty nine British and Australian rheumatologists took part in a study to discover how accurately they could describe their procedures for measuring disease severity in rheumatoid arthritis. The relative importance they attached to different clinical and laboratory variables showed a very wide variation, and these stated policies were generally poor at predicting their actual judgments when assessing 'paper patients' (r2 = 39%). Policies based on equal weighting of all variables, while also poor predictors (r2 = 41%), were nevertheless superior to their stated policies for 49 respondents. Policies calculated by judgment (linear regression) analysis were much more successful predictors (R2 = 73%). Unhurried, detailed interviews with four experienced rheumatologists provided carefully considered statements of assessment policy, but these also were poor predictors of routine assessments of outpatients (r2 = 34%) compared with policies calculated by clinical judgment analysis, even when these were applied to new data (R2 = 88%).

Arthritis, Rheumatoid↗
PubMed1986

New HLA DNA polymorphisms associated with rheumatoid arthritis.

Studies of restriction enzyme fragment length polymorphisms (RFLP) have further clarified two DNA polymorphisms detected in DR4 positive individuals with a DQ beta probe. These patterns have been designated DQ beta omega, characterized in the Dw4 homozygous typing cell (HTC) BM14 and DQ beta phi, characterized in the Dw4 HTC MCF, and so do not correspond with different Dw types. These patterns clearly segregate in families with HLA haplotypes. We suggest that omega and phi may be polymorphisms of the DX beta gene. The previously reported DX alpha polymorphisms U and L were found with all DR types and in association with DQ beta omega (U) and DQ beta phi(L). In addition DQ beta phi was found to be strongly associated with TA10 positively (a subdivision of DQw3) although this association was not absolute. Associations between RFLP and other HLA Class II and I antigens seen in DR4 patients and DR4 controls suggest the existence of at least two preferential allelic associations (PAA), one containing omega/U and the other phi/L. PAA1: DX alpha U-DQ beta omega-TA10 negative-DQw3-Dw4-DR4----Bw62-Bw6-Cw3-A2 PAA2: DX alpha L-DQ beta phi-TA10 positive-DQw3-Dw4-DR4----B44-Bw4-Cw3-A2 The frequency of the omega pattern was higher, although not significantly in the RA patients compared with controls. However, a significantly higher frequency of omega was found in RA patients with extra-articular manifestations (EA) compared (a) with controls (p less than 0.04) and (h) with those patients without EA (p less than 0.05). In addition the frequency of phi was significantly higher in RA patients with nodules and/or erosions (N/ER) compared with patients without these features (p less than 0.008). When cumulative scores were assigned to patients after assessing the number of components fulfilled for each PAA, PAA1 appeared to be pronounced in patients with EA and PAA2 in patients with N/ER. The frequency of a previously reported DQ beta T6 band found with the enzyme Taq 1 and DQ-beta probe was found at a higher frequency in RA patients compared with controls. In addition a significantly higher frequency of this band was found in female RA patients compared to males.

Arthritis, Rheumatoid↗
PubMed1986

Pepsinogen--an immunoglobulin binding artefact in 'collagen' preparations.

It has previously been shown that extracts of human articular cartilage, many many of which contain type II collagen, react with heat-aggregated immunoglobulin and artificially prepared immune complexes. Sera from patients with rheumatoid arthritis and psoriatic arthritis, but not from patients with inflammatory bowel disease, react with these extracts. There are two distinct patterns of binding, either as low molecular weight immune complexes or as free antibody directed against collagen. Aggregate-binding activity identified in extracts of human articular cartilage following pepsin digestion was found to be distinct from collagen in its salt solubility. Further purification of this aggregate-binding factor by SDS gel electrophoresis has shown it to be an artefact resulting from the binding of small immune complexes to pepsinogen present in the pepsin preparation used to digest the cartilage.

Antigen-Antibody Complex↗
PubMed1985

Measuring physicians' judgment--the use of clinical data by Australian rheumatologists.

Most therapeutic decisions depend upon the clinical judgment of physicians assessing their patients. However the inherent and wide variation in such judgments is usually ignored. Rheumatoid arthritis typifies those diseases in which much information is available on which to base decisions, but little is known about how physicians combine the data to evaluate their patients' response to treatment. Thirty-four Australian rheumatologists recorded their assessments of the progress of 50 rheumatoid patients treated with 'second line' agents, based on data presented on previously validated written forms. Clinical judgment analysis, a form of multiple regression analysis, was then used to model the way physicians' judgments related to the available data. There were major differences of judgment in the assessments of response to therapy. This was so even when only 'clinically important' changes were identified. The variance in judgments which could be modelled by clinical judgment analysis ranged from 45% to 94%. Both individual inconsistency and differences in the underlying use of data contributed to disagreements between clinicians' assessments of identical cases. Identifying underlying differences in the way clinical data relate to clinicians' judgments is a step towards improving clinical consistency.

Arthritis, Rheumatoid↗
PubMed1979

A prospective study of low back pain.

Consecutive patients attending hospital for the first time with backache were entered into a prospective study, provided that certain defined causes (infective, neoplastic, metabolic and inflammatory etc.) were not apparent at the first visit. Amongst 188 available for analysis, 65% were discharged and 28% defaulted, together making a total of 93% who 'recovered uneventfully' (in the sense that they were no longer attending hospital) on average in about three months, 4% came to 'myelography' (radiculography using Dimer-X or Amipaque) including 2% to discectomy, 1.5% proved to have treatable underlying diseases accounting for their backache while 1.5% became 'chronic attenders'. Information available at the first visit (patient characteristics, history, examination, radiographs and psychological questionnaire) provided few pointers to what the outcome would be or how long the patient would attend hospital. In particular, routine X-ray examination did not provide clues to any important conditions not already suspected by the clinicians. A case is made for reserving routine radiography for patients who have not recovered within about three months.

Adolescent↗
PubMed1979

Palindromic rheumatism. II. Failure to detect circulating immune complexes during acute episodes.

Thirty-eight samples of blood and 2 of synovial fluid were obtained from 19 patients suffering from palindromic rheumatism. In 12 cases samples were obtained from the same patient both during and between acute attacks. The presence of immune complexes was sought by a C1q-binding test. Most patients gave negative results: moderately elevated levels were obtained in a few. Broadly the pattern of results showed that individual patients were either positive or negative irrespective of whether they were in an attack or in remission. C3 and C4 measurements showed no significant abnormalities, confirming previous studies. Patients with elevated C1q-binding tests tended to be seropositive. We speculate that these are patients more likely to develop rheumatoid arthritis.

Acute Disease↗
PubMed1979

Antibody-dependent and PHA-induced cellular cytotoxicity in rheumatoid arthritis.

One hundred and thirty nine observations of antibody-dependent cell mediated cytotoxicity (ADCC) were made on 77 with rheumatoid arthritis (RA) and 17 healthy controls. There were no differences in ADCC between these 2 groups or within the RA group with regard to disease activity, duration, seropositivity, or drug treatment. Sixty observations of phytohaemagglutinin induced cytotoxicity were made on 22 patients with RA and 10 healthy controls. Again there were no differences in cytotoxicity between the 2 groups.

Adult↗
PubMed1978

The management of inflammation in rheumatic diseases.

Drugs used to control inflammation in the rheumatic diseases are extremely diverse. Despite this, the pattern of clinical response and similarities in side-effects allow them to be subdivided into groups. These patterns also provide clues about the mode of action of the drugs. Conversely, studies of the mechanisms of action of drugs used to treat rheumatoid arthritis are beginning to throw light on the pathological process.

Adrenal Cortex Hormones↗