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Biomedical subjects

Jan Tore Gran

Publications and source records attributed to Jan Tore Gran.

16 recordsLinked to original sources
PubMed2007

[Scalp necrosis in temporal arteritis].

BACKGROUND: Temporal arteritis is a systemic granulomatous vasculitis affecting large and medium sized arteries. Scalp necrosis is a rare complication that can appear before, during and after treatment. MATERIAL AND METHODS: A patient with temporal arteritis and scalp necrosis is presented and relevant literature reviewed. RESULTS: Scalp necrosis is seen in a few patients with temporal arteritis. The skin manifestations are most often bilaterally distributed and localised to the frontal, parietal and temporal parts of the scalp. Scalp necrosis often signifies a severe and extensive vasculitis, and is therefore associated with a high incidence of other disease-related complications, among them visual disturbances and blindness. CONCLUSION: Awareness of scalp necrosis as a complication of temporal arteritis could reduce unnecessary time-consuming assessments and lead to a more rapid diagnosis and start of treatment.

Aged↗
PubMed2006

[Ischemic ulcers in systemic connective tissue disorders].

BACKGROUND: Ischemic ulcers (digital ulcers) are often observed in systemic connective tissue disorders. MATERIAL AND METHODS: This review article is based on a Pubmed search with the terms "digital ulcers" and "ischemic ulcers", and on the authors' clinical experience. RESULTS AND INTERPRETATION: Up to 40 % of patients with systemic sclerosis have digital ulcers. Non-rheumatic causes of compromised blood circulation must be excluded. The treatment consists of analgesics, prevention of cooling and antibiotics if the ulcers are infected. Other possible treatments are vasodilators, prostacyclin analogues, endothelin receptor antagonists, sildenafil and chemical or surgical sympathectomy.

Connective Tissue Diseases↗
PubMed2005

[Pathophysiologic aspects of systemic sclerosis].

BACKGROUND: The pathological changes in systemic sclerosis are characterised by severe organ fibrosis, obliteration of arteries and arterioles and disturbance of immunological functions. Recent research has yielded new insight into the complex pathogenesis of systemic sclerosis, with new therapeutic options as a possible consequence. MATERIALS AND METHODS: Relevant medical literature has been reviewed. RESULTS: The pathological deposition of extracellular matrix in systemic sclerosis is most probably caused by changes in the regulation of dermal fibroblasts. The review focuses on three of the many molecules involved in the regulation of fibrosis; Transforming growth factor beta, Connective tissue growth factor and Endothelin-1. INTERPRETATION: Treatment of organ-specific disease complication has for long remained the only therapeutic option in systemic sclerosis. Based on current knowledge of the process of fibrosis, new therapeutic trials employing substances directed towards pro-fibrotic molecules are now in progress.

Connective Tissue Growth Factor↗
PubMed2005

Non-inflammatory joint pain in patients with inflammatory bowel disease is prevalent and has a significant impact on health related quality of life.

OBJECTIVE: To describe the prevalence and characteristics of non-inflammatory joint pain (NIJP) in patients with chronic inflammatory bowel disease (IBD) and its impact on patients' health related quality of life (HRQOL). METHODS: In a population based cohort, 521 patients (80%) were clinically investigated 6 years after onset of IBD. NIJP was defined as a history of joint pain during the last 3 months prior to examination and the absence of concomitant signs or symptoms of inflammatory or degenerative joint disease or chronic pain syndromes. HRQOL was registered by the generic Medical Outcome Study Short Form 36 (SF-36) and by the disease specific IBDQ. RESULTS: NIJP was reported by 85 (16%) patients and significantly more often in conjunction with Crohn's disease (CD, 22%) compared to ulcerative colitis (UC, 14%). The prevalence of NIJP was similar in men and women. No correlation with extension of intestinal disease, use of systemic medication, or frequency of surgery was found. NIJP exerted significant impact on HRQOL measured by SF-36 and IBDQ. CONCLUSIONS: NIJP occurs frequently in IBD and more often in CD than in UC. NIJP significantly alters HRQOL and should be taken into account in trials estimating outcome in IBD and in clinical practice by attending clinicians.

Adult↗
PubMed2003

[Treatment and diagnosis of polymyalgia rheumatica and temporal arteritis].

BACKGROUND: Studies of polymyalgia rheumatica and temporal arteritis have shown that a low initial dose of oral corticosteroids should be preferred. It is, however, uncertain whether or not the suggested recommendations have been implemented by practising physicians. MATERIAL AND METHODS: Questionnaires were mailed to members of the Norwegian association for patients with polymyalgia rheumatica or temporal arteritis. RESULTS: The average initial dose of prednisolone in polymyalgia rheumatica was 35 mg; 51 of 62 patients were given a starting dose exceeding 15 mg. INTERPRETATION: The recommended low initial dose of prednisolone has still been not implemented by the majority of general practitioners and rheumatologists.

Aged↗
PubMed2003

The epidemiology of chronic generalized musculoskeletal pain.

Chronic widespread musculoskeletal pain has been subjected to several epidemiological studies during the last decade. According to these, approximately 10% of the general population report such complaints, clearly indicating chronic widespread musculoskeletal pain as a major health problem in the Western world. Almost unanimously, all studies found higher rates of such complaints among women compared with men, but the mechanisms responsible for the skewed gender ratio remain unknown.Chronic widespread musculoskeletal pain is the clinical hallmark of fibromyalgia and has been the subject of numerous epidemiological studies. The prevalence of fibromyalgia is reportedly 3-5%, again with a significant female predominance. Although the aetiopathogenesis of both fibromyalgia and chronic widespread musculoskeletal pain without other features of fibromyalgia remains an enigma, there is a body of evidence suggesting psychological and sociocultural factors as important for contracting such pain syndromes.

Chronic Disease↗
PubMed2003

Causes of death in polymyalgia rheumatica. A prospective longitudinal study of 315 cases and matched population controls.

OBJECTIVE: To determine causes of death in patients with pure polymyalgia rheumatica (PMR) compared to matched population controls. METHODS: In a population based study from 1987-1997, 315 patients were diagnosed with PMR. The patients were each randomly assigned four population controls, totally 1,260 controls. The date and causes of death were identified from the data files at Statistics Norway up to the end of 1997. RESULTS: A total of 65 cases (20.6%) with PMR died compared to 338 (26.8%) among the controls (mortality rate ratio (MRR) = 0.73, 95% CI 0.56-0.97, p = 0.03). No statistically significant difference was found between patients and controls with regard to mortality from coronary heart disease or stroke (MRR=0.78, 95% CI 0.52-1.18), cancer (MRR = 0.59, 95% CI 0.30-1.17), and other causes (MRR=0.75, 95% CI 0.48-1.17). CONCLUSION: The increased survival found in patients with PMR could not be explained by reduction in any particular cause of death.

Aged↗
PubMed2002

[Antisynthetase syndrome].

BACKGROUND: Traditionally, idiopathic inflammatory myopathies have been classified into three groups; polymyositis, dermatomyositis and inclusion body myositis. Recent developments in immunology have improved our knowledge and it is now possible to classify these disorders according to the presence of myositis specific autoantibodies. MATERIALS AND METHODS: Four adult patients with anti-Jo-1 antibodies, one male and three females are presented. RESULTS: All patients had myositis, but interstitial lung disease represented the main clinical manifestation. One patient had polyarthritis and mechanic hands. Two patients had Gottron's sign, one had Gottron's papules and one female patients had subcutaneous calcinosis. Raynaud's phenomenon was present in two patients. INTERPRETATION: Patients presenting with interstitial lung disease should be carefully evaluated for the antisynthetase syndrome.

Adolescent↗
PubMed2002

[Control of patients in an outpatient clinic of rheumatology].

BACKGROUND: A high number of patients attending outpatient clinics of rheumatology are control cases. This study aimed at investigating the causes of such controls and how necessary they are. MATERIAL AND METHODS: 400 consecutive control patients selected from a local hospital were included. RESULTS: Inflammatory rheumatic diseases constituted 89% of the controls; rheumatoid arthritis was the diagnosis in 28% of cases. Routine control of patients with chronic disease was the main cause of control (41%). 15% of controls were regarded as partly or completely unnecessary; 95% of these were not repeated. INTERPRETATION: The reasons for controlling patients in rheumatology should be better defined. Regular evaluation could result in improved service to outpatients.

Adolescent↗
PubMed2002

Some thoughts about the etiopathogenesis of temporal arteritis--a review.

The three most striking features of temporal arteritis (TA) are the high incidence in populations of Nordic origins, the remarkable rarity of the disease among persons younger than 50 years, and the predilection for the superficial temporal arteries. At present, neither genetic susceptibility, environmental factors nor occurrence of specitic infections offer complete explanations to why Scandinavians are at increased risk of contracting TA. Similarly, recent developments in immunology and pathology of inflamed arteries cannot explain the preference of TA for this particular medium-size artery or why the disease almost exclusively affects persons older than 50 years. Although significant contributions regarding the pathogenesis of TA during the last decade are encouraging, the etiology of this disease still remains an enigma.

Aged↗
PubMed2002

Diagnosis and definition of primary Sjögren's syndrome.

During the last years, several sets of criteria for the diagnosis and classification of primary Sjögren's syndrome (SS) have been promulgated. So far none has achieved universal acceptance. It is conceivable that the lack of pathognomonic features of SS and the frequent coexistence of SS with other connective tissue di-seases partly explain the lack of agreement. Regardless of criteria preference the final diagnosis of SS should reflect the definition of the syndrome, being an inflammatory and autoimmune rheumatic disease. It is therefore suggested that any criteria employed should include a mandatory combination of measurements of exocrine dysfunction. histological confirmation of inflammation, serological evidence of autoimmunity and exclusion or diseases mimicking primary Sjögren's syndrome.

Diagnosis, Differential↗
PubMed2002

Prevalence of ankylosing spondylitis and other spondyloarthropathies among patients with inflammatory bowel disease: a population study (the IBSEN study).

OBJECTIVE: To study the occurrence of spondyloarthropathies (SpA) in patients with inflammatory bowel disease (IBD) seen 6 years after IBD diagnosis. METHODS: In a population based cohort of 654 patients with IBD, 521 patients (80%) were investigated, which included a complete rheumatological examination. Radiographs of the sacroiliac joints and lumbar spine were performed in 406 of these patients (78%). The development of SpA was analyzed with regard to the presence of HLA-B27, duration of IBD symptoms, and the extent of intestinal inflammation. RESULTS: The occurrence of ankylosing spondylitis (AS) was 2.6% in ulcerative colitis and 6% in Crohn's disease (p = 0.08), yielding an overall prevalence of 3.7% in IBD. No correlation between localization or extent of the intestinal inflammation and presence of AS was found. HLA-B27 was present in 73% of cases with AS. The overall prevalence of SpA was 22%. Inflammatory back pain without AS (IBP) was found in 18% of the patients. Typical features of SpA were rare, while fibromyalgia was common in IBP, indicating that IBP is not a precursor or manifestation of SpA in patients with IBD. The prevalence of radiological sacroiliitis without clinical features of SpA was 2.0%. CONCLUSION: AS occurred frequently in patients with newly diagnosed IBD. IBP did not seem to predispose to AS or other forms of SpA. The overall prevalence of SpA was 22%, whereas the prevalence of asymptomatic radiological sacroiliitis was low.

Adolescent↗
PubMed2002

Estimation of Sjögren's syndrome among IBD patients. A six year post-diagnostic prevalence study.

OBJECTIVE: To study the prevalence of Sjögren's syndrome (SS), tear and saliva production and sicca symptoms in patients with inflammatory bowel disease (IBD) seen six years after IBD diagnosis. METHODS: In a population based cohort of 654 patients with IBD, 521 patients (80%) and a control group consisting of 68 healthy subjects were investigated. SS was diagnosed according to the European Criteria proposed by the American-European Consensus Group (US-EU criteria) and the European criteria. Maximum (supposing positive biopsies) and minimum prevalences (supposing negative biopsies) were estimated. RESULTS: Dryness of eyes and mouth were similarly distributed between patients with ulcerative colitis (UC) and Crohn's disease (CD) and between patients and controls. The prevalence of SS was 0-4.2% and 0-5.7% (minimum-maximum) according to the US-EU criteria and the European criteria, respectively. The controls fulfilled neither of the criteria. CONCLUSION: Sjögren's syndrome, sicca symptoms, tear and saliva production were not increased in patients with IBD compared to controls, indicating a lack of association between SS and IBD.

Adult↗
PubMed2002

No increased frequency of malignant neoplasms in polymyalgia rheumatica and temporal arteritis. A prospective longitudinal study of 398 cases and matched population controls.

OBJECTIVE: To determine the prevalence and incidence of cancer in patients with polymyalgia rheumatica (PMR) and temporal arteritis (TA) compared to matched population controls. METHODS: In a population based study 1987-97, 398 patients were diagnosed with PMR or TA. Each patient was randomly assigned 4 age and sex matched controls from the same county, totaling 1592 controls. All patients and controls were cross-checked with data files at the Cancer Registry of Norway, for cancers registered up to the end of 1998. RESULTS: Prior to inclusion, cancer was diagnosed in 32 patients with PMR or TA (8.0%) and 153 controls (9.6%) (OR 0.82, 95% CI 0.55-1.22, p = 0.3). After inclusion, malignant neoplasms were discovered in 34 patients with PMR or TA (9.3%) compared to 143 controls (10.8%) (relative risk 0.86, 95% CI 0.59-1.26, p = 0.4). Thus there was no difference between patients with PMR or TA and their controls regarding prevalence or incidence of cancer. The interval between inclusion and the time of diagnosis of malignant neoplasm did not differ between patients and controls. No significant difference in types or localization of malignant neoplasms was found in patients compared to controls. CONCLUSION: No differences were found in frequencies or types of malignant neoplasms between patients with PMR or TA and population controls. Neither PMR nor TA as defined by present diagnostic criteria appears associated with cancer.

Giant Cell Arteritis↗