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Biomedical subjects

I Wigler

Publications and source records attributed to I Wigler.

At least 19 recordsLinked to original sources
PubMed2005

Vaccination against influenza in rheumatoid arthritis: the effect of disease modifying drugs, including TNF alpha blockers.

OBJECTIVE: To assess the efficacy and safety of vaccination against influenza virus in patients with rheumatoid arthritis, with special emphasis on the effect of disease modifying antirheumatic drugs (DMARDs), including tumour necrosis factor alpha (TNFalpha) blockers. METHODS: 82 rheumatoid patients and 30 healthy controls were vaccinated with a split-virion inactivated vaccine containing 15 mug haemagglutinin (HA) per dose of each of B/Hong Kong/330/2001 (HK), A/Panama/2007/99 (PAN), and A/New Caledonian/20/99 (NC). Disease activity was assessed by tender and swollen joint count, morning stiffness, evaluation of pain, Health Assessment Questionnaire, ESR, and C reactive protein on the day of vaccination and six weeks later. Haemagglutination inhibiting (HI) antibodies were tested by a standard WHO procedure. Response was defined as a fourfold or more rise in HI antibodies six weeks after vaccination, or seroconversion in patients with a non-protective baseline level of antibodies (<1/40). Geometric mean titres (GMT) were calculated to assess the immunity of the whole group. RESULTS: Six weeks after vaccination, a significant increase in GMT for each antigen was observed in both groups, this being higher in the healthy group for HK (p=0.004). The percentage of responders was lower in rheumatoid patients than healthy controls (significant for HK). The percentage of responders was not affected by prednisone or any DMARD, including methotrexate, infliximab, and etanercept. Indices of disease activity remained unchanged. CONCLUSIONS: Influenza virus vaccine generated a good humoral response in rheumatoid patients, although lower than in healthy controls. The response was not affected by the use of prednisone or DMARDs.

Antibodies, Viral↗
PubMed2003

The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis.

OBJECTIVE: Evaluation of the effect of a ginger extract (Zintona EC) on patients suffering from gonarthritis. MATERIAL AND METHODS: Twenty-nine patients (6 men and 23 women) with symptomatic gonarthritis (ACR criteria), in the age range 42-85 years, were included after randomization in a double blind, placebo controlled, crossover study of 6 months' duration. The treatment group was given a ginger extract (250 mg of Zingiberis Rhizoma per capsule, qid), while the placebo group received the same number of identical looking capsules per day. The crossover occurred after 3 months of therapy. Results were evaluated by a 100mm visual analog scale (VAS) of pain on movement and of handicap. RESULTS: Eight patients dropped out because of inefficacy, three from group 1 (ginger extract first) and five from group 2 (placebo first). One patient from group 1 and one from group 2 dropped out because of heartburn (while they were on ginger extract). Twenty patients completed the study period of 24 weeks and 19 that of 48 weeks follow-up. By the end of 24 weeks there was a highly statistically significant difference between the VAS of pain and handicap of the two groups (P<0.001). However, at crossover both groups showed a statistically significant decrease in VAS of pain on movement and of handicap, but the differences between the groups did not reach statistical significance. CONCLUSIONS: Zintona EC was as effective as placebo during the first 3 months of the study, but at the end of 6 months, 3 months after crossover, the ginger extract group showed a significant superiority over the placebo group.

Adult↗
PubMed2000

Efficacy and safety of diacerein in osteoarthritis of the knee: a double-blind, placebo-controlled trial. The Diacerein Study Group.

OBJECTIVE: To evaluate the efficacy and safety of diacerein, a drug with interleukin-1beta--inhibitory activity in vitro, in patients with knee osteoarthritis (OA). METHODS: A total of 484 patients fulfilling the American College of Rheumatology criteria for knee OA were enrolled in this 16-week, randomized, double-blind, placebo-controlled, parallel study group with 3 diacerein dosages of 50 mg/day, 100 mg/day, and 150 mg/day (administered twice daily). RESULTS: In the intent-to-treat population, 100 mg/day diacerein (50 mg twice daily) was significantly superior (P < 0.05) to placebo using the primary criterion (visual analog scale [VAS] assessment of pain on movement). Significant improvement (P < 0.05) was also observed for the secondary criteria, which included the Western Ontario and McMaster Universities OA Index (WOMAC), the WOMAC subscores, and the VAS assessment of handicap. In patients treated with diacerein dosages of 50 mg/day and 150 mg/day, favorable but not significant results were observed for the primary criterion. The best daily dosage of diacerein, calculated from the effect on the VAS assessment of pain on movement, was 90.1 mg. In the per-protocol population, the analysis of the primary criterion showed significant dose-dependent differences (P < 0.05) between each of the 3 diacerein dosages and the placebo. No differences were observed among the 3 diacerein groups. A significantly higher incidence (P < 0.05) of adverse events (AEs), as well as a higher rate of dropoout due to AEs, was observed in patients treated with 150 mg/day diacerein versus those treated with placebo, 50 mg/day diacerein, or 100 mg/day diacerein. Mild-to-moderate transient changes in bowel habits were the most frequent AEs, increasing with the dosage. CONCLUSION: Diacerein, a drug for the treatment of OA, was shown to be an effective treatment for symptoms in patients with knee OA. Taking into account both efficacy and safety, the optimal daily dosage of diacerein for patients with knee OA is 100 mg/day (50 mg twice daily).

Adult↗
PubMed2000

Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis.

The purpose of this study was to evaluate the immediate and delayed effects of balneotherapy at the Dead Sea on patients with psoriatic arthritis (PsA). A total of 42 patients with PsA were treated at the Dead Sea for 4 weeks. Patients were randomly allocated into two groups: group 1 (23 patients) and group 2 (19 patients). Both groups received daily exposure to sun ultraviolet rays and regular bathing at the Dead Sea. Group 1 was also treated with mud packs and sulfur baths. Patients were assessed by a dermatologist and a rheumatologist 3 days before arrival, at the end of treatment, and at weeks 8, 16, and 28 from the start of treatment. The clinical indices assessed were morning stiffness, right and left hand grip, number of tender joints, number of swollen joints, Schober test, distance from finger to floor when bending forward, patient's self-assessment of disease severity, inflammatory neck and back pain and psoriasis area and severity index (PASI) score. Comparison between groups disclosed a similar statistically significant improvement for variables such as PASI, morning stiffness, patient self-assessment, right and left grip, Schober test and distance from finger to floor when bending forward. For variables such as tender and swollen joints, and inflammatory neck and back pain, improvement over time was statistically significant in group 1. Addition of mud packs and sulfur baths to sun ultraviolet exposure and Dead Sea baths seems to prolong beneficial effects and improves inflammatory back pain.

Arthritis, Psoriatic↗
PubMed1999

Validation study of a Hebrew version of WOMAC in patients with osteoarthritis of the knee.

The aim of the study was to validate a translated version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Hebrew speaking populations. The WOMAC was translated into Hebrew from its English version and its reliability and validity were studied. Before its use in patients, the Hebrew version was translated back into English by an independent translator and minor amendments were made to satisfy the original English versions designed by Bellamy et al. The Hebrew version of the WOMAC questionnaire was administered to 114 patients with osteoarthritis of the knee. All the subjects were asked about the presence and severity of pain during movement and handicap, using a visual analogue scale (VAS) of pain and handicap. Test-retest reliability was assessed using Pearson's and intraclass correlation coefficients. Internal consistency was evaluated by Cronbach's alpha coefficient of reliability. Construct validity was tested by correlating the WOMAC items with VAS of pain and handicap. The test-retest reliability Pearson's correlation coefficients for the WOMAC items ranged from 0.55 to 0.78 (p<0.01), and the Cronbach's alpha was 0.97 at time 1 and 0.98 at time 2. Significant correlations (p<0.01) were obtained between the WOMAC items and VAS of pain and handicap. The Hebrew version of WOMAC is a reliable and valid instrument for evaluating the severity of osteoarthritis of the knee in Israeli patients.

Adult↗
PubMed1995

Spa therapy for gonarthrosis: a prospective study.

The objective of this study was to evaluate the effect of spa therapy on clinical parameters of patients with gonarthrosis. Patients with gonarthrosis (n = 33) underwent a 2-week spa therapy using three treatment regimes and a 20-week follow-up as follows: group I (n = 11) had mineral water baths and hot native mineral mud packs, group II (n = 12) had mineral water baths and rinsed mineral-free mud packs and group III (n = 10) had tap water baths and mineral-free mud packs. The patients and the assessing rheumatologist were blinded to the difference in the treatment protocols. A significant improvement in the index of severity of the knee (ISK), as well as night pain scores, was achieved in group I. Improvement in physical findings and a reduction in pain ratings on a visual analogue scale (VAS) did not reach statistical significance. Analgesic consumption was significantly decreased in both groups I and III for up to 12 weeks. Global improvement assessed by patients and physician was observed in all three groups up to 16 weeks but persisted to the end of the follow-up period in group I only. Patients with gonarthrosis seemed to benefit from spa therapy under all three regimes. However, for two parameters (night pain and ISK) the combination of mineral water baths and mud packs (group I) appeared to be superior.

Aged↗
PubMed1992

Ulnar translation of the scaphoid: an early X-ray sign of rheumatoid arthritis.

The distance between the os trapezium and radius (which we called scaphoid distance) became shorter during the course of rheumatoid arthritis (RA). Measurement of this distance was performed in 600 hands (300 patients), using standard position of patient's hand in supination with permanent angle (15-20%) between the axis of the radius and the axis of the third metacarpal bone (scaphoid distance). This provided a stable distance between the most distal point of the radial styloid process and most proximal point of the os trapezium. The patients were divided into two groups: a control group consisting of 100 patients with no inflammatory joint disease, and a group of 200 patients suffering from RA. Patients suffering from RA with bone erosions had smaller scaphoid distance than those suffering from RA without bone erosions. The ratio between the distance from the distal radius to the most distal point of the third metacarpal bone and scaphoid index was called carpo-metacarpo-scaphoid index. It excluded the constitutional influence on the scaphoid distance. The shorter the scaphoid distance, the bigger the carpo-metacarpo-scaphoid index. The average indexes were: in the control group 7.8 (+/- 0.4), in group 2A with advanced RA 21.1 (+/- 4.1), and in group 2B with early RA without bone changes 12.0 (+/- 1.6). The results were statistically significant. The measurements are easy to perform and may be helpful in the early X-ray diagnosis of RA, when there are no bone erosions, or narrowing of articular spaces.

Adolescent↗
PubMed1991

Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis.

Forty-one patients with rheumatoid arthritis were treated for 2 weeks at a Tiberias spa hotel. Randomized into 2 groups, Group 1 received a combination of mineral baths and mud packs, and Group 2 had tap water baths only. Both groups had a significant but temporary improvement in Ritchie index. Group 1 showed a significant improvement in grip strength. No improvement was noticed in morning stiffness, 15 meter walk time and laboratory variables of disease activity in either group. Twelve patients with osteoarthritis (OA) received 2 weeks of treatment with mineral baths and mud packs. Statistically significant improvement for a period of 6 months was noticed in night pain, pain on passive motion, tenderness on palpation and in the index of severity of OA of the knee.

Arthritis, Rheumatoid↗
PubMed1990

Computed tomographic (CT) demonstration of calcification of the ligamenta flava of the lumbosacral spine associated with protrusion of the intervertebral disc.

Axial computed tomographic (CT) scan of the lumbosacral region was performed in 220 patients. The patient population was divided into three groups. The control group included 40 elderly patients without calcification of the ligamenta flava. The second group included 150 patients with posterior protrusion of the intervertebral discs. The third group included 30 patients with spinal stenosis. More than 80% of the patients of the second and the third group had calcification of the ligamenta flava. The diagnostic and practical importance of these findings is discussed.

Adult↗
PubMed1989

Short term effects of low dose methotrexate on the acute phase reaction in patients with rheumatoid arthritis.

Sequential daily measurements of erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) were performed for one week after an I.V. injection of 7.5-13 mg methotrexate (MTX) in 18 patients with rheumatoid arthritis. Early decreases of ESR and CRP were observed. Serum CRP was more sensitive than ESR, displaying more pronounced falls from baseline to both the minimal and to the 7th day levels. Patients receiving their first dose of MTX (n = 9) exhibited a more prominent reduction of CRP levels in comparison to veteran MTX users (n = 9). The prompt response of acute phase reactants to MTX may correspond to the relatively rapid clinical effect of the drug in RA. It may also support an antiinflammatory mechanism of action of low dose MTX.

Acute-Phase Reaction↗
PubMed1989

Direct coronal high resolution computed tomography of the temporomandibular joints in patients with rheumatoid arthritis.

Direct coronal high resolution computed tomography (CT) examination of the temporomandibular joints (TMJ) was performed in 40 patients with rheumatoid arthritis (RA). The patients were divided into 3 groups. Group 1 included patients with juvenile rheumatoid arthritis (JRA). Four patients of this group had disability of the TMJ associated with overgrowth of one of the mandibular condyles. This phenomenon has not yet been reported. Group 2 consisted of 10 patients with RA with clinically asymptomatic TMJ, 4 of whom had mild erosions of the condylar head seen on CT, consistent with RA. The majority of patients in Group 3, with clinically symptomatic TMJ showed CT changes of various degrees, which are discussed in this paper. Mild bone changes, not demonstrated by conventional procedures, were clearly seen by CT. Coronal view of the CT examination had advantages over other projections.

Adolescent↗
PubMed1988

Computed tomographic demonstration of calcification of the ligamenta flava of the lumbosacral spine in ankylosing spondylitis.

An axial computed tomographic (CT) scan of the lumbosacral regions was performed in 65 patients. The patient population was divided into two groups. The first (control) group included 40 elderly patients without calcification of the ligamenta flava. The second group included 25 patients with ankylosing spondylitis. More than 90% of those in the second group showed calcified lumbosacral ligamenta flava. In two patients these calcifications produced spinal stenosis. The diagnostic and practical importance of these findings are discussed.

Adult↗
PubMed1988

Methotrexate in rheumatoid arthritis: a prospective study in Israeli patients with immunogenetic correlations.

In a prospective open study 44 Israeli patients with rheumatoid arthritis were treated with weekly low dose methotrexate (MTX) for up to 36 months. Nine patients withdrew from the study: six because of side effects and three due to inefficacy. One patient died of septicaemia following septic arthritis. Significant improvement, graded by Ritchie articular index, grip strength, physician's global assessment, erythrocyte sedimentation rate (ESR), and platelet counts, was noticed in response to treatment. Seronegative patients had a better clinical response. Transient gastrointestinal symptoms were common and correlated with increases of serum aspartate transaminase (AST). HLA-DR1 and DR7 were significantly associated with increased serum AST concentrations.

Aged↗
PubMed1987

Prolonged volume depletion imitating end-stage renal failure.

Four patients with chronic renal insufficiency were erroneously diagnosed as reaching the "end stage" of their disease. All of them had had insidious salt and water depletion prolonged over a period of 5 to 8 weeks. The correct diagnosis was missed because the signs and symptoms of slowly developing volume depletion were indistinguishable from the clinical picture of terminal uremia. Correction of the salt and water depletion was followed by marked clinical improvement and return of renal function to baseline values. Postural hypotension and hyponatremia are important clues for the diagnosis of insidiously developing mild or moderate volume depletion super-imposed on chronic renal insufficiency.

Aged↗
PubMed1984

Long-term treatment of arterial hypertension with verapamil.

Based on the vasodilator properties of calcium antagonists, verapamil was recently introduced into the treatment of arterial hypertension. The present study was undertaken to examine the long-term efficacy of this drug in mild and moderate hypertension. In 82 patients with uncontrolled primary or renal hypertension, verapamil was used either alone or in combination with other drugs. In six cases verapamil was withdrawn because of side effects. In the remaining patients a normal average blood pressure was achieved within 7.8 +/- 1.2 weeks of treatment with doses not exceeding 400 mg/day. This effect was maintained for up to 4 years of treatment, although tolerance seemed to develop in about 10% of the patients. In view of this good response and minimal side effects, it is concluded that verapamil is an effective addition to the antihypertensive arsenal.

Adult↗