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Biomedical subjects

H M Høyeraal

Publications and source records attributed to H M Høyeraal.

At least 19 recordsLinked to original sources
PubMed2001

Were the patterns of treatment for rheumatoid arthritis during 1977-1992 consistent with modern clinical guidelines?

OBJECTIVE: Quality assessment of the long-term treatment of patients with rheumatoid arthritis (RA). METHODS: Treatment patterns in a cohort of 70 local and 77 distant RA patients during 1977-1992 were reviewed retrospectively and compared to modern clinical guidelines. RESULTS: In 1977 disease-modifying anti-rheumatic drugs (DMARDs) were given to 62% of the new, hospitalised patients, systemic corticosteroids to 7%, and corticosteroid joint injections to 24%. Patients with short disease duration and/or serious disease were selected for DMARD-treatment. Rheumasurgery was performed on 21%. During follow-up of local patients 54% were recorded with DMARDs for a mean duration of 29 months; approximately 1/5 of the follow-up period. Methotrexate was used infrequently. Local and systemic corticosteroids were recorded in approximately 20%. Rheumasurgery, predominantly non-prosthetic, was performed on 27%. CONCLUSIONS: Patients with early and serious disease were selected for DMARD-therapy, but the treatment duration was too short for modern requirements. Pharmaceutical and surgical treatment patterns were otherwise mainly consistent with present guidelines.

Adolescent↗
PubMed1999

Increased mortality in Dupuytren's disease.

A previous study showed a dip in the prevalence curve of Dupuytren's disease in men over 79 years of age. This may indicate increased mortality. The aim of the present investigation was to study this hypothesis. Four hundred and twenty-six men with Dupuytren's disease, born between 1900 and 1924 were followed for 26 years (1969-1996). Their mortality was compared with that of an age-matched control group of 426 men. In 1996, 361 with Dupuytren's disease and 336 in the control group had died. Overall, patients with Dupuytren's disease had a significantly increased mortality of 22%. The mortality was highest among those with onset of disease before the age of 60. In this age group men with Dupuytren's disease had 70% higher mortality than that of the control group. Disease duration did not seem to influence the mortality.

Age Distribution↗
PubMed1994

Sjögren's syndrome in inflammatory rheumatic diseases: analysis of the leukocyte protein calprotectin in plasma and saliva.

In a hospital population of 154 patients with a wide range of inflammatory rheumatic diseases, patients with sicca symptoms were subjected to objective ocular and oral tests to establish cases with Sjögren's syndrome (SS). The plasma level of the leukocyte protein calprotectin has been shown to be a good indicator of disease activity and inflammation in various rheumatic diseases. In the present study, calprotectin levels in plasma and whole saliva were analysed and evaluated as potential markers of SS and salivary gland disease activity. Plasma calprotectin levels did not differ significantly between patients with SS and patients with no sicca symptoms. However, salivary calprotectin levels correlated significantly with the plasma calprotectin levels and with several ocular variables, weakly with salivary flow and serum rheumatoid factor, but not with focal sialadenitis. In conclusion, this study shows that salivary calprotectin levels seem to be associated with several variables of SS glandular pathology, indicating the need for further and more comprehensive studies on calprotectin in various oral fluids and in lacrimal fluid in relation to SS glandular disease activity.

Blood↗
PubMed1993

Characterization of responders and nonresponders to tiaprofenic acid and naproxen in the treatment of patients with osteoarthritis.

OBJECTIVE: To characterize responders/nonresponders to 2 nonsteroidal antiinflammatory drugs by a combination of start variables in the treatment of patients with osteoarthritis (OA) of the hip(s)/knee(s). METHODS: Two hundred eight patients participated in a 3-week randomized double blind parallel group trial. RESULTS: The responder rate to tiaprofenic acid and naproxen was 52 and 59%, respectively. Correctly characterized by use of a combination of 6 baseline variables were 79% of the patients treated with tiaprofenic acid and 81% treated with naproxen. CONCLUSION: Both active drugs were found effective compared with placebo in patients with OA, but with different characteristics.

Adult↗
PubMed1992

Nutrient intake and nutritional status in children with juvenile chronic arthritis.

Nutrient intake and nutritional status were assessed in 15 children with juvenile chronic arthritis (JCA) and in 17 healthy controls. Anthropometric measurements were similar in children with pauciarticular JCA and in controls, whereas weight (p = 0.05) and upper arm muscle area (UAMA) (p less than 0.01) were reduced in children with polyarticular JCA. Compared with healthy controls the concentrations of hemoglobin, serum iron and serum zinc were reduced in the children with polyarticular JCA (p less than 0.01) and serum copper was increased (p less than 0.01). In the patients the concentrations of hemoglobin, serum iron and serum zinc correlated negatively with erythrocyte sedimentation rate (ESR), whereas serum copper correlated positively. Impaired nutritional status was found in the children with polyarticular JCA in spite of increased energy and protein intake. In this group of patients the dietary intake of calcium was also found to be reduced.

Adolescent↗
PubMed1991

Prediction of short-term prognosis by biopsychosocial variables in patients with juvenile rheumatic diseases.

We describe physical symptoms and signs, laboratory data and psychosocial assessments for 84 children (age 1-17) hospitalized for the first time with suspected or definite rheumatic disease. At 16 months (range 7-28) followup change of disease severity was assessed based on hospital records. The patients were categorized as unchanged/worse (n = 36) or improved (n = 48). A linear discriminant model applying a combined set of 6 medical and 2 psychosocial variables characterized correctly 68 of 84 patients (81%). The variables were age at onset, disease severity, months of disease duration, presence of rheumatic disease in the family, erythrocyte sedimentation rate (ESR), thrombocytes, total behavior problem score on the Child Behavior Checklist and maternal distress. By discriminant function analysis of biopsychosocial variables more homogeneous groups may be obtained. Study of such groups may improve prediction of the prognosis.

Child↗
PubMed1991

The L1 protein as a new indicator of inflammatory activity in patients with juvenile rheumatoid arthritis.

L1 is a major granulocyte and monocyte protein with Mr 36.5 kDa. It is released during leukocyte activation and detected in plasma by use of an enzyme immunoassay. In our study, L1, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), orosomucoid and haptoglobin were analyzed in 127 patients with juvenile rheumatoid arthritis (79 pauci, 33 poly and 15 systemic). L1, ESR and the acute phase proteins were all found to have positive correlations with the clinical joint assessments, with L1 having the strongest correlations. High correlation coefficients were found between L1 and orosomucoid (r = 0.83), ESR (r = 0.72), haptoglobin (r = 0.71) and CRP (r = 0.65), with p less than 0.001 for all the correlations.

Antigens, Surface↗
PubMed1990

The first stay in a pediatric rheumatology ward. Associations between parent satisfaction and disease and psychosocial factors.

To assess parent satisfaction with hospital care and needs for improvement, questionnaires were sent to parents of children participating in a study of bio-psychosocial factors at the onset of juvenile rheumatic diseases. At 16 months follow-up (range 12-22 months) 85 (82%) of 106 parents answered. Twenty-four of these were also interviewed. 95-98% of parents were satisfied with the way they had been received, the ward setup and the atmosphere, the examination of the child by the physicians and the examination and treatment by the physiotherapists, whereas 86% were satisfied with information regarding illness and treatment, and 78% were satisfied with the hospital school. Dissatisfaction was positively correlated to mental distress of the mothers at the first stay and their assessment of disease severity at follow-up. The interviewed parents seemed to prefer inpatient care to outpatient care for the initial multiprofessional assessment. This may enhance the initial process of coping with chronic childhood illness and increase compliance with treatment regimens.

Adolescent↗
PubMed1990

A three-year retrospective study of synovectomies in children.

The aim of this study was to evaluate the results of synovectomies in children with juvenile arthritis. Five hundred twenty-eight synovectomies and tenosynovectomies were performed over a period of 13 years. The patients were followed for one, two, three, five, and ten years postoperatively. The evaluation after three years was chosen as the basis for this article. One hundred twenty-five children with arthritis who were not evaluated three years postoperatively had less severe arthritis, both locally and generally, than the evaluated group of 389. The rate for good results and tolerability was high at one, two, and three years postoperatively but decreased with time; more patients went from good results to poor rather than vice versa. Global assessment, soft-tissue swelling, and limitation of movement seemed to be the best parameters for evaluating the results of synovectomies. It appears necessary to wait at least three years to evaluate the long-term effect of synovectomies.

Adolescent↗
PubMed1989

Temporomandibular joint involvement in juvenile rheumatoid arthritis. Clinical diagnostic criteria.

In 103 patients (mean age 9 years) with the pauciarticular or polyarticular type of juvenile rheumatoid arthritis, clinical aspects of mandibular growth and function and general disease variables were correlated with radiographically observed temporomandibular joint (TMJ) abnormality. Discriminant analysis of the entire group revealed that a combination of disease duration and disease activity was associated with TMJ abnormality; however, a correct classification of the TMJ condition could be made in only 63 patients (63%). Further analyses revealed three effective indicators of TMJ arthritis: reduced maximal mouth opening capacity, vertical difference between the two mandibular angular regions, and deviation of the mandible at maximal protrusion. A combination of these variables discriminated correctly between the presence or absence of TMJ abnormality in 52 of a subgroup of 56 patients (93%).

Adolescent↗
PubMed1989

Chronic family difficulties and stressful life events in recent onset juvenile arthritis.

The prevalence of chronic family difficulties, recent stressful life events and socioeconomic status were assessed in 106 families of children with juvenile arthritis, divided in 5 groups according to disease course types. Chronic family difficulties were assessed by semi-structured parent interviews and life events by questionnaires and interviews. Both chronic family difficulties and recent stressful life events appeared in about 2/3 of the families, but a correlation between these were found only for the pauci and polyarticular groups. Chronic family difficulties and recent stressful life events did not differ between groups and were not associated to severity of disease. To what extent stress influences the course of various disease types of juvenile arthritis warrants longitudinal follow-up. For this a life event questionnaire may be valuable.

Adolescent↗
PubMed1988

Agreement between parents and physicians regarding clinical evaluation of patients with juvenile rheumatoid arthritis.

The reliability of disease severity assessed by parents of children with juvenile rheumatoid arthritis was studied by a self-report questionnaire. Parents of 50 patients with a minimum disease duration of 6 months and two physicians participated. Good agreement was achieved between parents and physicians regarding global assessment of disease severity, pain, morning stiffness and activities of daily life. For joint swelling and restriction of movement, the physicians scored higher than did the parents. The findings demonstrate that, with some reservations, a parent questionnaire may be used in follow-up studies on children with juvenile rheumatoid arthritis.

Activities of Daily Living↗
PubMed1988

Tolerance of cyclosporine A in children with refractory juvenile rheumatoid arthritis.

In an open trial, tolerance and safety of cyclosporine A was studied in 14 patients with refractory juvenile rheumatoid arthritis (JRA). The doses varied from 4-15 mg/kg/day. Treatment lasted for greater than 12 months in 11 and 6 to 9 months in 3 patients. Eleven patients were withdrawn due to lack of efficacy (4) or side effects (7). A drop of greater than 2 g/l in hemoglobin and a marked rise in serum creatinine were the cause of withdrawal in 5 patients. The effect of cyclosporine on disease activity seemed to be mainly symptomatic and temporary. Probably, the dose should be kept below 5 mg/kg/day. Future controlled studies should be aware of a risk of aggravation of anemia in children treated with cyclosporine.

Administration, Oral↗
PubMed1987

Comparison of synovectomy and no synovectomy in patients with juvenile rheumatoid arthritis. A 24-month controlled study.

Thirty patients with pauciarticular or polyarticular juvenile rheumatoid arthritis entered a randomized, 24-month, parallel trial of synovectomy (n = 15) versus no synovectomy (n = 15). The joints studied were 18 wrists, 8 ankles and 4 knees. The synovectomies were performed as radically as possible. Joint motion was slightly decreased in the operated joints, especially for passive movements during the first 6 months following surgery. Swelling and disease activity of the joints studied as well as subjective evaluation of joint pain improved in the synovectomy group compared with the non-synovectomy group. This improvement seemed to continue for at least 2 years.

Adolescent↗
PubMed1987

Methodological problems--juvenile chronic arthritis.

This group of diseases comprises a heterogeneous syndrome with several characteristics different from adult rheumatoid arthritis. They are characterized by joint swelling, pain/tenderness, heat and limitation of motion with or without several extra-articular manifestations. The natural course is fluctuating. There is no uniform disease course. The prognosis is better for children than adults with rheumatic disorders. The etiology is partly known and the pathogenesis unclear. There are no uniformly accepted diagnostic criteria. Patient materials studied need therefore be described in detail. The methods used for evaluation of disease and functional activities are crucial. The statistical methods, ethical problems including consent/assent are highly relevant. The management including drug therapy, drug handling and compliance need also to be considered. Due to relative rareness of the syndrome, preferably a few investigators that think alike need to collaborate for more efficient and ethically sound investigations of such patients.

Adolescent↗
PubMed1986

Radiographic temporomandibular joint abnormalities in patients with juvenile chronic arthritis during a controlled study of sodium aurothiomalate and D-penicillamine.

Sixty-two patients with juvenile chronic arthritis (JCA) were randomized to 50-week treatment with either sodium aurothiomalate (G) or D-penicillamine (PEN) and followed with regard to radiographic changes of the temporomandibular joints (TMJ). The radiographic methods comprised panoramic radiography and oblique lateral transcranial radiography, occasionally supplemented with other methods. The radiographs were read by a single assessor who did not know the type of drug treatment. Radiographic progression was seen in one G-treated and six PEN-treated patients with polyarticular JCA, and in one G-treated patient with pauci-articular JCA. A relation between changes in radiographic TMJ findings and disease activity was demonstrated. Radiographic examination of the TMJ seems to be of value in therapeutic trials in patients with JCA.

Adolescent↗
PubMed1986

Auranofin therapy in juvenile rheumatoid arthritis: a 48-week phase II study.

A 48-week phase II open, uncontrolled study of auranofin (AF) in patients juvenile rheumatoid arthritis (JRA) was conducted to assess efficacy, tolerance and serum gold levels, and to consider the feasibility of further controlled studies (phase III) in such patients. The study group included 25 patients (20 F, 5 M) with active pauciarticular (n = 4) or polyarticular (n = 21) JRA. Median age was 100 months (range 62-176); median disease duration was 55 months (range 13-155). AF was given at 0.1 mg/kg/day divided into 2 doses, and increases to maximum of 6 mg/day were permitted if clinical improvement was insufficient. Nonsteroidal anti-inflammatory drugs and physiotherapy also were allowed. Significant improvement (p less than or equal to 0.05) was observed in the various joint counts and articular indices, as well as in the physician's global assessment of health. Some subjective functional measurements also were improved, but the differences were not statistically significant. There were no clinically important trends in the laboratory measurements. No patient was withdrawn because of adverse reactions; 1 was withdrawn because of disease exacerbation and 3 for lack of response. Mild adverse reactions were seen in 9 patients: 6 had abdominal pain, 6 diarrhea/loose stools, 1 nausea, 3 rash, 2 pruritus. Two patients had dosage reduced because of loose stools. Serum gold levels varied greatly; increased dosage usually resulted in increased serum levels. Occurrence of adverse reactions or response to therapy was not related to increases in dose or to serum gold levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗