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Biomedical subjects

J R Kirwan

Publications and source records attributed to J R Kirwan.

At least 19 recordsLinked to original sources
PubMed1992

Knee pain and disability in the community.

In order to investigate the strength of any relationship between knee pain and disability, a postal questionnaire was sent to 2102 men and women aged over 55 registered at a general practice in Bristol. A response rate of 80.6% was achieved at second reminder. Knee pain was common particularly in women (27.6% overall). Disability was also more frequently reported in women (P less than 0.05) and rose with increasing age. Respondents with knee pain had significantly more disability relating to upper as well as lower limb activities (P less than 0.05).

Aged↗
PubMed1992

Radiographic assessment of the knee joint in osteoarthritis.

The development of radiographic systems for the grading of osteoarthritis requires knowledge of the reproducibility of their individual component features. This paper reports the reproducibility, both within and between observers, for five commonly used radiographic features of osteoarthritis in the tibiofemoral and patellofemoral compartments of the knee joint. The results suggest that assessments of joint space narrowing, osteophyte, and bony contour in the tibiofemoral compartments are more reproducible than those of sclerosis and cyst. Patellofemoral assessments, with the exception of osteophyte, are considerably less reproducible between observers than tibiofemoral assessments.

Aged↗
PubMed1991

Which patients see a rheumatologist? SWRACR (South Western Regional Advisory Committee on Rheumatology).

Rheumatology outpatient consultations were recorded throughout the South Western Regional Health Authority for one month. Of 2987 consultations (equivalent to 32,600 annually), 630 (21%) were new referrals who waited 60 days (mode) before their consultation. Rheumatoid arthritis and polyarthritis accounted for 43% of new referrals and 75% of follow-up patients. For these categories, 6.5 follow-up patients were seen for each new referral, but this ratio varied from 3.7 to 11.7. Other diagnoses also had variable patterns of follow-up but because they represented only a small proportion they were less relevant to overall service provision and resource consumption. These data not only outline current outpatient working patterns but also indicate areas of further investigation which might elucidate methods of providing good patient care and appropriate use of resources.

Ambulatory Care↗
PubMed1991

Localization of circulating immune complexes from patients with rheumatoid arthritis in murine spleen germinal centres.

In previous studies we have demonstrated high levels of rheumatoid factor (RF) and large-size (greater than 22S) circulating immune complexes (CIC) in the serum of rheumatoid arthritis (RA) patients with extra-articular disease. These findings were paralleled by a concurrent increase in the level of RF-associated cross-reactive idiotypes (CRI) and an apparent diversification of the RF repertoire detected in the serum of the same patients. In the present study we examine the ability of CICs to activate the complement system in vivo, and its possible influence on expanding the RF repertoire in RA patients with extra-articular disease. Activation of complement by CICs is the key for germinal centre localization and long-term retention of such complexes on the surface of follicular dendritic cells (FDC), and so provides a source for the selection of cells with high affinity receptors for IgG and leads to the establishment of immunological memory. CICs containing different immunoglobulin isotypes and from different patients localized in mouse spleen germinal centres. However, intense localization was mainly seen for IgG-containing complexes from the serum of patients with large-size (greater than 22S) IgG-IgM RF complexes. The ability of these complexes to localize in mouse spleen germinal centres was related to activation of the complement system via the classical pathway in the patients' sera. Localization of IgG complexes was significantly (P less than 0.05) higher in sera from RA patients with extra-articular disease than those with articular disease alone. This study demonstrates the ability of large-size (greater than 22S) IgG-IgM RF complexes to activate complement, and suggests a possible role for such complexes in modulating the immune response to IgG in RA patients with extra-articular disease.

Animals↗
PubMed1991

Characterisation of the size and composition of circulating immune complexes in patients with rheumatoid arthritis.

The size and composition of circulating immune complexes in the sera of patients with rheumatoid arthritis (RA) were studied in relation to different manifestations of the disease. Circulating immune complexes from the sera of 94 patients (50 with extra-articular disease) and 10 matched controls were fractionated by sucrose density gradient ultracentrifugation. The composition, immunoglobulin and rheumatoid factor (RF) concentrations within each of the fractions were determined by a sensitive enzyme linked immunosorbent assay (ELISA). Intermediate size (14S-21S) IgG complexes containing RF activity and 22S IgG-IgM RF complexes were found in the sera of 40 patients with RA, while intermediate size complexes of self associated IgG RF and larger size complexes (greater than 22S) of IgG RF and IgM RF were associated with extra-articular features of RA (50% of extra-articular disease). Complexes containing IgA were found in the sera of many patients with RA, and dimeric IgA RF mainly in patients with extra-articular disease. These results support the view that whereas small size circulating immune complexes are of no primary pathogenic importance in synovitis, large size (greater than 22S) circulating immune complexes may play a role in extra-articular disease in RA. Current understanding of the formation of large complexes provides a biological explanation for their occurrence and effects.

Antigen-Antibody Complex↗
PubMed1990

Brown's syndrome: an unusual ocular complication of rheumatoid arthritis.

A 55 year old man with rheumatoid vasculitis and an apparent left inferior oblique palsy is described. This unusual extraocular complication of rheumatoid arthritis probably resulted from a tenosynovitis of the superior oblique tendon sheath, and resolved with steroid treatment.

Arthritis, Rheumatoid↗
PubMed1990

Clinical judgment analysis.

Judgement is central to the practice of medicine and occurs between making clinical observations and taking clinical decisions. Clinical judgment analysis has developed as a method of making statistically firm models of doctors' judgments. Computed models reveal the differential importance attached to items of clinical, social, or other data which are determinants of clinical decisions. These models can both reveal the causes of conflicts of judgment and may help resolve them in a way that unaided discussion cannot. Revealing experts' models to students speeds learning of diagnostic skills. Clinical judgment analysis offers a method of probing the judgments not just of students and doctors but also of patients who have shown systematic differences in their perceptions of risk and benefit. The power and relevance of clinical trials can be improved by the consistent application of judgment policies generated from both the trialists and those who will use their results.

Clinical Competence↗