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Biomedical subjects

J G Hardin

Publications and source records attributed to J G Hardin.

At least 19 recordsLinked to original sources
PubMed1998

Systemic lupus erythematosus and dementia.

Comparison of Trail-making Parts A and B and the Shipley Conceptual Quotient of 18 index patients (M age = 29 years) and 18 controls indicated no dementia for the index patients.

Adolescent↗
PubMed1995

Cervical spine and radicular pain syndromes.

Neck pain may affect one third of the adult population from time to time and may persist for 6 months or longer in 10% to 15% of these patients. In addition, cervical spine disease or trauma may result in injury to the spinal cord or nerve roots, through a variety of mechanisms, leading to a group of syndromes that can be broadly classified as myelopathy or radiculopathy. This review addresses recent developments in the anatomy and physiology of the normal cervical spine, common ill-defined or miscellaneous neck pain problems, and cervical injuries, with emphasis on the flexion-extension injury called "whiplash." Other types of injuries, including fractures and fracture dislocations, also are discussed, as well as neurologic consequences of cervical disk and facet joint degenerative disease, with emphasis on cervical spondylitic myelopathy. The complications of inflammatory joint diseases such as ankylosing spondylitis and rheumatoid arthritis are not specifically addressed in this review.

Humans↗
PubMed1995

Rheumatic manifestations of disorders of the central and peripheral nervous system.

Many inflammatory rheumatic conditions may result, in part, from local release of sensory neuropeptides; substance P is currently the best studied of these. Various neurologic diseases that result in movement disorders continue to come to the attention of rheumatologists, primarily because of the pain and stiffness associated with them, and they are often misdiagnosed. Neuroarthropathies remain the most distinctive of the joint disorders that appear to result directly from neurologic injury, but little new information concerning these disorders has been generated in the past year.

Arthritis↗
PubMed1994

Underrecognized postdosing reactions to methotrexate in patients with rheumatoid arthritis.

OBJECTIVE: To report previously underrecognized postdosing side effects of methotrexate (MTX). METHODS: Over a one and a half year period, in 2 practices, all patients with rheumatoid arthritis (RA) receiving weekly MTX, and volunteering symptoms within a few hours of MTX dosing were carefully questioned concerning the nature of the postdosing reaction. RESULTS: Of 356 patients, 36 (10%) reported a previously underemphasized postdosing reaction consisting of arthralgias/myalgias, fatigue/malaise or both. Sixteen patients discontinued MTX primarily because of this side effect. CONCLUSION: In these patient populations, postdosing reactions were the 2nd most common side effect (after gastrointestinal) leading to MTX withdrawal.

Administration, Oral↗
PubMed1993

When the lungs are involved by connective tissue disease.

Pulmonary involvement by a connective tissue disease can result in clinically important complications. Pathogenic mechanisms vary from granulomatous reaction and interstitial inflammation to primary vasculitis and immune complex-mediated disease. Understanding the pulmonary complications of connective tissue diseases is challenging in that several distinct patterns of involvement are associated with the same disease but the same lung abnormalities are found with several different diseases. Early recognition and treatment of pulmonary involvement may offer the patient a better chance of recovery from serious conditions that often carry a grim prognosis if undetected.

Arthritis, Rheumatoid↗
PubMed1993

Undifferentiated, overlapping, and mixed connective tissue diseases.

Undifferentiated connective tissue disease (UCTD) is a term used by many rheumatologists to define a group of diffuse connective tissue disorders that lack definitive characteristics of any particular well-defined disorder. Overlapping connective tissue disease is often used interchangeably with UCTD but they both refer to diseases that are in evolution before all the characteristic clinical and laboratory symptoms are manifested. However, the clinical features of some of the overlapping connective tissue diseases appear to be better defined. The classical one is mixed connective tissue disease, where features of systemic lupus erythematosus, progressive systemic sclerosis, and polymyositis may exist together with a positive anti-extractable nuclear antibody and high titers of anti-ribonuclear protein antibody. This review attempts to clarify the confusion between these terms. The problems in the clinical and laboratory diagnosis of common connective tissue diseases that coexist are addressed and treatment options discussed. The long-term implications of making a diagnosis of a definitive connective tissue disease before all the required criteria are met should be kept in mind because the patient may never develop the disease and yet be subjected to psychological, social, and economic hardships.

Humans↗
PubMed1992

Complications of cervical arthritis.

Cervical arthritis can result in clinically important complications through a variety of mechanisms. The potentially most serious complication is spinal cord or nerve root compression, caused by either degenerative osteophytes or one or more of several subluxation patterns prevalent in inflammatory joint diseases. Disabling pain arising directly from the affected joints is more difficult to document but probably occurs often in the upper cervical spine, particularly in patients with rheumatoid arthritis. Limitation of head and neck mobility, with or without pain, commonly develops in inflammatory arthropathies, especially ankylosing spondylitis and juvenile rheumatoid arthritis. In the absence of neurologic signs or symptoms, most cases of symptomatic cervical arthritis should be diagnosed and treated conservatively.

Arthritis↗
PubMed1991

Septic arthritis of the C1-C2 lateral facet joint and torticollis: pseudo-Grisel's syndrome.

We present the case of a 76-year-old man who experienced the sudden development of fever, rightsided neck pain and stiffness, and torticollis. A soft tissue mass was noted on the right side of his neck, but his head was tilted to the left. Computed tomography scans (with reformatted sagittal and coronal images) of the patient's cervical spine revealed destructive changes of the right lateral masses of C1 and C2 and the clivus, and a well-delineated peridontoid soft tissue mass (confirmed by magnetic resonance imaging). After the second episode of right-sided hemiparesis, he underwent transoral surgical exploration, with anterior decompression and odontoidectomy. Histologic examination of the surgical material revealed granulation tissue, fibrosis, and chronic inflammation, consistent with abscess formation with invasion and compression of the spinal cord and bone. This case suggests that nonreducible rotational head tilt to the side opposite the side of lateral mass collapse should raise the suspicion of a possible infection.

Aged↗
PubMed1991

Symptomatic salicylate ototoxicity: a useful indicator of serum salicylate concentration?

A three phase study was designed to define further the sensitivity and specificity of symptomatic salicylate ototoxicity (primarily tinnitus) for serum salicylate concentrations. In phase one 260 patients with osteoarthritis and 112 with rheumatoid arthritis, none taking salicylates, were interviewed about their ear symptoms. Their responses were not significantly different from those of 134 salicylate treated patients with rheumatoid arthritis previously reported. In the second phase 56 patients who were taking salicylates, and who volunteered the complaint of tinnitus, had serum salicylate concentrations measured while symptomatic, and 30 (54%) had concentrations less than 1.3 mmol/l. Few tolerated an upward salicylate dose adjustment. For phase three, 94 patients were found to have a salicylate concentration above 2.2 mmol/l on one or more occasion, and these subjects were interviewed. Fifty two patients (55%) had no tinnitus, and tinnitus correlated with the blood salicylate concentration in only 28 (30%). Audiological evaluation of most of the symptomatic patients was carried out, and results were abnormal in the majority, even in those patients not reporting tinnitus. Symptomatic salicylate ototoxicity is too nonspecific and too insensitive to be a useful indicator of serum salicylate concentration.

Adult↗
PubMed1990

The spectrum of atlantoaxial facet joint involvement in rheumatoid arthritis.

Six hundred fifty outpatients with rheumatoid arthritis (RA) were evaluated and followed up during a 7-year period. As part of their routine evaluation or because of neck-shoulder girdle symptoms, 48% of the patients underwent routine cervical spine radiography. Sixty-one RA patients (9% of the total population) had C1-C2 involvement. Compared with the 589 patients with no evidence of C1-C2 involvement, these 61 patients were significantly more likely to be younger, female, and seropositive, and they had significantly more nodules and erosions, as well as a longer disease duration. Based on radiographic evidence of C1-C2 disease severity, 3 groups emerged. Group 1 (28 patients) had lateral mass collapse, group 2 (27 patients) had lateral facet joint sclerosis, erosion, or loss of joint space with no collapse, and group 3 (6 patients) had lateral subluxation with no bone or cartilage changes. Nine patients in group 1 had severe pain, and 25 had a nonreducible rotational tilt of the head. None of the patients in the other 2 groups had either of these signs or symptoms. Moreover, patients in group 1 were more likely to have other C1-C2 or subaxial subluxations and were more likely to have myelopathy. C1-C2 lateral facet joint involvement is common in RA, correlates with disease severity generally and specifically with that in the cervical spine, and, when severe, causes nonreducible rotational tilt of the patient's head.

Aged↗
PubMed1988

Salicylate ototoxicity in patients with rheumatoid arthritis: a controlled study.

Tinnitus or subjective hearing loss, or both, were reported by 61 of 134 (45%) patients with rheumatoid arthritis (RA) taking regular salicylates and by 73 of 182 (40%) untreated healthy subjects. In the patients with RA mean salicylate levels were not higher in those with tinnitus than in those without tinnitus, but levels were significantly higher in those with subjective hearing loss than in those with no symptoms. Twenty five per cent of the patients with RA had tinnitus or subjective hearing loss with salicylate levels less than 1.42 mmol/l. Audiometric responses in 31 patients correlated poorly with symptoms. Tinnitus and subjective hearing loss may be too non-specific to be reliable as tools for adjusting the salicylate level into the therapeutic range.

Adult↗
PubMed1988

Involvement of the craniocervical junction in Reiter's syndrome.

Although Reiter's syndrome uncommonly affects the cervical spine, involvement of the craniocervical articulations does occur and may be manifested as nonreducible rotational head tilt. Computerized axial tomography with reformatted images was helpful in assessing the anatomy of this area in our patient with significant head tilt and abnormal head position.

Adult↗
PubMed1987

Lack of association between HLA-DR2 and clinical response to methotrexate in patients with rheumatoid arthritis.

Recent studies have indicated an association between the HLA-DR2 phenotype and substantial response to methrotrexate in patients with rheumatoid arthritis (RA). To further resolve this issue, we analyzed this relationship. Our data, obtained from a multicenter, double-blind study of rigorously assessed patients with RA, demonstrated that neither HLA-DR2 nor any other HLA-DR specificity is significantly associated with a substantial clinical response to methotrexate in patients with RA.

Arthritis, Rheumatoid↗
PubMed1987

Atlantoaxial (C1-C2) facet joint osteoarthritis: a distinctive clinical syndrome.

Osteoarthritis of the atlantoaxial facet joints was identified radiologically in 27 patients, and these comprised 4% of all outpatients with osteoarthritis or degenerative disease of the spine seen during a 36-month period. These patients had a clinical syndrome which differed from those seen in patients who have subaxial degenerative disease of the spine or myofascial cervical pain. Occipital pain, occipital trigger points, crepitus in the occipital region, and a rotational head tilt deformity (in 13 patients, usually associated with collapse of 1 of the lateral masses [facets]), were the major features of this distinctive syndrome.

Atlanto-Axial Joint↗