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Biomedical subjects

J M Esdaile

Publications and source records attributed to J M Esdaile.

At least 109 records · Page 6Linked to original sources
PubMed1990

Atypical presentations of polymyalgia rheumatica.

Seventy patients with polymyalgia rheumatica (PMR) were seen at a suburban rheumatology practice from July 1983 to December 1987. Six of these patients presented without the typical limb girdle features associated with PMR. Presenting symptoms included peripheral synovitis or unilateral shoulder pain (3 patients), lower leg pain (3 patients), carpal tunnel syndrome (1 patient), and abdominal pain (1 patient). The disease evolved into the recognizable syndrome of PMR over a period of 2-12 months. We suggest that PMR may present in a variety of guises, or have a "stuttering evolution" to the full syndrome. The presenting manifestations of these atypical cases result from peripheral synovitis and thus represent a variant of the more common subclinical proximal synovitis seen in PMR. Increased clinical awareness of atypical presentations may assist earlier diagnosis and effective treatment.

Aged↗
PubMed1990

Association of anti-DNA idiotype markers with clinical and serological manifestations in patients with systemic lupus erythematosus.

Serum levels of 6 anti-DNA antibody idiotypes were measured in 65 consecutive patients with systemic lupus erythematosus (SLE) and 45 healthy subjects. Five of the 6 idiotypes were elevated in SLE sera compared to the normal controls (p less than 0.005). Analysis of the associations of the idiotypes with clinical, hematological, and serological characteristics revealed that significantly decreased serum levels of 3 idiotypes (103.1, 100, and 1305) were associated with nephritis and that one of these idiotypes (103.1) was also associated with discoid rash. An association of lowered levels of 3 idiotype markers (604, 1305, and 1400) was also observed with the presence of lupus anticoagulant and anticardiolipin antibodies. Serial studies in individual patients with SLE nephritis failed to show a close correlation of serum idiotype levels with the degree of proteinuria, creatinine clearance, anti-DNA antibody, or complement values. The association of decreased levels of specific idiotypes with the presence of nephritis, discoid rash, and antiphospholipid antibodies suggests the participation of these antibodies in the pathogenesis of disease.

Adolescent↗
PubMed1989

Modeling percentage change: a potential linear mirage.

The percentage change over time in a variable such as serum creatinine or blood pressure is a potentially appealing outcome measure for longitudinal studies of prognosis or therapy. We demonstrate that when the baseline value of the variable used in the calculation of the percentage change outcome is included in a linear regression model as an independent predictor, a quadratic relationship between the baseline level and the predicted outcome level of this same variable is inevitably masked by the linear regression model. Misinterpretation of the percentage change model has resulted in conflicting results regarding the value of serum creatinine as a prognostic marker in lupus nephritis. We illustrate the problem and resolve the conflict using data on 87 patients with lupus nephritis. A straightforward alternative approach to the use of percentage change as an outcome is proposed: it is not subject to the problems of interpretation noted in the percentage change model.

Blood Pressure↗
PubMed1989

Exogenous female hormones and rheumatoid arthritis: a methodological view of the contradictions in the literature.

The purpose of this review is not to resolve the contradictory findings that are present in the literature. Rather, it considers a selected number of issues that may pertain to some future understanding of the current controversy. Furthermore, certain issues such as biological plausibility and the absence of a definitive dose, duration, or timing relationships are not discussed. If the association of the use of exogenous female hormones with the prevention of rheumatoid arthritis came to be accepted as likely causal, basic scientists might well unravel the biological processes involved. The dose and duration of exposure to the hormones and the timing of the exposure (current use versus past use) in relation to the preventative effect remains unclear. While clearly a point against a causal relationship the possibility exists that this may result from errors in recall or that prior hormone exposure may 'vaccinate' a woman against the disease. A number of studies have been published only in abstract or are still underway. Reanalysis of existing data sets may also provide some insight into the contradictory findings. The issues raised in this review are of relevance to investigators. They may also be used by readers interested in this topic who wish to attempt to resolve the conflicts in the hormone-rheumatoid arthritis literature for themselves.

Arthritis, Rheumatoid↗
PubMed1989

The clinical and renal biopsy predictors of long-term outcome in lupus nephritis: a study of 87 patients and review of the literature.

The prognostic markers in 87 consecutive patients with lupus nephritis who underwent renal biopsy are reported for five clinically relevant long-term outcomes--renal insufficiency, renal failure, death due to renal systemic lupus erythematosus, death due to non-renal SLE and death due to SLE, both renal and non-renal. We have demonstrated that a number of previously neglected or rarely studied predictors were important prognostic markers. These included the duration of renal disease before biopsy, overall severity of SLE, as well as the presence of vasculitis, hypertension or a comorbid ailment. Furthermore, the study confirms the predictive importance of serum creatinine, 24-h urinary excretion of protein, C3, and of the activity and chronicity indices on biopsy. However, overall a simple measure of tubulointerstitial disease was the best predictor obtained from biopsy. Prognostic models based on clinical data alone were developed for each of the five outcomes. The models amplify our clinical understanding of lupus nephritis. Markers of renal severity were most important in predicting renal outcomes such as renal insufficiency and renal failure. Prognostic factors less directly related to renal disease (comorbidity and vasculitis) were important predictors of fatality. A marker of immunologic disease activity (C3) was a valuable predictor for many of the outcomes. Thus markers of disease severity reflecting organ damage due to SLE and other comorbid conditions could be combined with markers of immunologic activity to predict a variety of outcomes of relevance to a clinician. When biopsy data obtained by light or electron microscopy were evaluated for their ability to add new predictive information to the clinical models, only a limited value for biopsy was noted. It is likely that this reflected the close correlational relationships between clinical and biopsy variables, the strong clinical models generated, and the inclusion in the clinical models of the previously neglected clinical variables, duration of renal disease before biopsy and the presence of vasculitis or comorbid disease.

Adolescent↗
PubMed1988

The relationship of socioeconomic status to subsequent health status in systemic lupus erythematosus.

We examined the relationship of socioeconomic status to health status, as determined by the Arthritis Impact Measurement Scales, in 78 systemic lupus erythematosus patients who had been entered into a prospective study. After controlling for age, disease duration, and disease severity, a significant relationship between socioeconomic status and outcome was not demonstrated. All study subjects had health insurance for medical services. The results have potential implications for health care policy.

Depression↗
PubMed1988

Tuberculosis of the sacroiliac joint: clinical features, outcome, and evaluation of closed needle biopsy in 11 consecutive cases.

Sacroiliac joint (SIJ) involvement has been reported in up to 9.7 percent of patients with skeletal tuberculosis. Lack of awareness of this now uncommon form of infection often leads to diagnostic delay and increased morbidity. Eleven consecutive cases of SIJ tuberculosis are reported; clinical and radiologic features, diagnosis, treatment, and outcome are discussed. Buttock pain was the presenting complaint in all patients. However, radicular pain in the lower back (seven patients) or lower limb (10 patients) was common and in one patient precipitated an unnecessary surgical intervention. SIJ tuberculosis is frequently an isolated phenomenon. Therefore, direct sampling of the SIJ is necessary to establish the diagnosis. The recently described technique of closed needle biopsy of the SIJ was employed in all 11 patients and established the diagnosis in nine of the 11.

Antitubercular Agents↗
PubMed1988

Systemic lupus erythematosus activity. An operational definition.

Improved diagnosis and treatment have reduced mortality from SLE and present us with an opportunity to consider SLE in finer distinctions than alive or dead. Although much has been learned about SLE without a gold standard of disease activity or a universally agreed-upon definition of SLE activity, standardization of one or more measures would greatly enhance our ability to compare results from different centers and to communicate more precisely. It is unlikely that any of the existing measures or any ones to be developed will completely satisfy everyone's needs but it is pointless to proliferate new ones without testing their metric properties. Some differences in concept are desirable, particularly for investigators who have specialized interests or insights, but each should meet criteria of reliability and validity and have explicit definitions of terms, rules for their ascertainment, and the time period covered. Moreover, agreement on minimum essential elements of any SLE activity measure and their operational definitions would be a boon. SLE activity is one dimension in the disease pathway of lupus and implies a continuous phenomena that is potentially reversible. Organ damage, another point in the path of causation, connotes irreversible disease. We recommend that minimum essential elements be based on their frequency of occurrence, biological sensibleness, and the likelihood that degrees of activity can be rated reliably to show a change in a clinical state. The rating should be independent of whether a therapy is employed. Since activity is always considered with severity, the two dimensions could be recognized in the scale. Severity can be used to expand a scale's gradations if a symptom or sign is present. Severity could be rated by the need to treat with immunosuppressive agents, the need to follow the patient more closely, or the functional or prognostic consequences of the manifestation. For every organ system clinical judgment should be used to decide whether and how the scale should be constructed. For instance, in skin manifestations one could construct a scale by describing the extent of the lesion over the body and whether the lesion has potential for scarring, i.e., involving the dermis. However, the presence of, rather than the number of, cytoid bodies might be the only thing that is clinically important in rating the eye.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis-Related Groups↗
PubMed1988

Antiphospholipid antibodies in systemic lupus erythematosus: evidence of an association with positive Coombs' and hypocomplementemia.

Anticardiolipin antibodies (aCL) were evaluated in 65 consecutive patients with systemic lupus erythematosus using an enzyme linked immunoassay (ELISA) and were detected in 14 (22%). There was no association of aCL with active disease, specific clinical manifestations, high DNA binding or circulating immune complex levels. The presence of aCL was associated with lupus anticoagulant activity (p less than 0.001), positive VDRL (p less than 0.05), and lower mean platelet counts (p less than 0.05) and C3 levels (p less than 0.05). Both aCL and lupus anticoagulant activity were associated with positive Coombs' (p less than 0.01) and low C4 (p less than 0.01 and p less than 0.05, respectively). Analysis of red blood cell (RBC) eluates and absorption studies using fixed RBC suggested that some aCL may act as anti-RBC antibodies, likely directed at membrane phospholipid epitopes. Furthermore, we hypothesize that complement may participate as a cofactor maximizing lupus anticoagulant activity.

Adult↗
PubMed1988

An experiment in reducing interobserver variability of the examination for joint tenderness.

This experiment was designed to test the feasibility of reducing interobserver variability of the joint examination by agreement on a standard examination. Six rheumatologists independently examined 6 patients with rheumatoid arthritis (RA) in predetermined order, before and after a standardization of examination techniques. Results of an analysis of variance showed a reduction of the percent of variability due to observers from 13.8%, before standardization, to 3.2% after standardization, and an improvement in the percent variability related to patient differences from 70.7%, before standardization, to 86.3% after standardization. Such a reduction in observer variability has a potential for allowing a reduction in sample sizes required for RA clinical trials.

Analysis of Variance↗
PubMed1987

Sudden quadriplegia complicating ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis.

The association of ossification of the posterior longitudinal ligament (OPLL) and diffuse idiopathic skeletal hyperostosis (DISH) has been recently described. It may result in devastating compressive myelopathy. We report a case of quadriplegia complicating OPLL in a patient with DISH. In addition, we present a brief review of the literature on OPLL. This report illustrates the importance of appropriate neurologic and radiologic evaluation of persons with DISH, to help prevent severe neurologic complications.

Accidental Falls↗
PubMed1987

Incidence, prevalence, and evidence. Scientific problems in epidemiologic statistics for the occurrence of cancer.

Major changes in policy for health, nutrition, and industrial safety have been proposed because of the "epidemic of apprehension" produced by statistics for the occurrence rates of cancer. The statistical information, however, contains gross violations of epidemiologic principles and scientific standards for credible evidence. The calculations often depend on an improper linkage of numerators and denominators; and the calculated rates, assembled from reports of overtly detected cases of cancer, represent neither incidence nor prevalence. Many of the secular or regional changes in rates are due to corresponding changes in the availability and dissemination of diagnostic technology, but the technologic changes have not been adequately evaluated or investigated. Improvements will require drastically altered approaches to the use of death certificates, tumor registries, and clues from necropsy data.

Cross-Sectional Studies↗
PubMed1987

Carpal alterations in adult-onset Still disease, juvenile chronic arthritis, and adult-onset rheumatoid arthritis: comparative study.

A specific pattern of pericapitate involvement of the wrist has been described in the rheumatologic literature as characteristic of adult-onset Still disease (AOSD), a relatively rare disorder that is often diagnosed by exclusion after extensive and frequently invasive tests. To evaluate the potential diagnostic value of carpal radiography in suspected cases of AOSD, a retrospective blinded analysis of 48 patients (16 each with AOSD, juvenile chronic arthritis, and adult-onset rheumatoid arthritis) was performed. Pericapitate articular alterations without radiocarpal involvement were found to be distinctly unusual among patients with rheumatoid arthritis but frequent in the setting of AOSD. In juvenile chronic arthritis severe pericapitate involvement also occurs frequently but is more likely to be associated with interosseous fusion and severe pancompartmental disease.

Adult↗