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Biomedical subjects

L Shepstone

Publications and source records attributed to L Shepstone.

At least 37 records · Page 2Linked to original sources
PubMed2001

Shape of the intercondylar notch of the human femur: a comparison of osteoarthritic and non-osteoarthritic bones from a skeletal sample.

OBJECTIVES: To compare objectively the shape of the intercondylar notch in human osteoarthritic and non-osteoarthritic femora. METHODS: A sample of 96 human femora from a large skeletal population were selected for study. These femora included subjects with evidence of late stage osteoarthritis (that is, with eburnation present) and subjects with no such evidence. The distal end of the femur, viewed axially, was recorded with a video camera, and digitised computer images were produced. The outline of the intercondylar notch was extracted and represented mathematically as two functions. A functional principal components analysis was used to identify important modes of shape variation. These variations in shape were compared between eburnated and non-eburnated femora. RESULTS: A statistically significant difference in the shape of the intercondylar notch was found between the two groups. The difference related mostly to the shape of the edge of the medial condyle: in the non-osteoarthritic group this tended to exhibit a concavity; in the osteoarthritic group it tended to be straight. CONCLUSIONS: This observed difference may be a predisposing factor to the development of osteoarthritis. The morphology of the intercondylar notch is related to the functioning of and possible damage to the cruciate ligaments, and damage to the cruciate ligaments is a known risk factor for osteoarthritis. Alternatively, this difference may be due to bony remodelling secondary to the onset of osteoarthritis, perhaps in response to altered biomechanics.

Adult↗
PubMed2001

Heavy cigarette smoking is strongly associated with rheumatoid arthritis (RA), particularly in patients without a family history of RA.

OBJECTIVES: To investigate the potential relation between cumulative exposure to cigarette smoking in patients with or without rheumatoid arthritis (RA) and a positive family history of the disease. METHODS: 239 outpatient based patients with RA were compared with 239 controls matched for age, sex, and social class. A detailed smoking history was recorded and expressed as pack years smoked. Conditional logistic regression was used to calculate the association between RA and pack years smoked. The patients with RA were also interviewed about a family history of disease and recorded as positive if a first or second degree relative had RA. The smoking history at the time of the study of the patients with RA with or without a family history of the disease was compared directly with that of their respective controls. Patients with RA with or without a family history of the disease were also compared retrospectively for current smoking at the time of disease onset. RESULTS: An increasing association between increased pack years smoked and RA was found. There was a striking association between heavy cigarette smoking and RA. A history for 41-50 pack years smoked was associated with RA (odds ratio (OR) 13.54, 95% confidence interval (95% CI) 2.89 to 63.38; p<0.001). The association between ever having smoked and RA was modest (OR 1.81, CI 1.22 to 2.19; p=0.002). Furthermore, cigarette smoking in the patients with RA without a positive family history of RA was more prevalent than in the patients with a positive family history of RA for ever having smoked (72% v 54%; p=0.006), the number of pack years smoked (median 25.0 v 4.0; p<0.001), and for smoking at the time of disease onset (58% v 39%; p=0.003). CONCLUSIONS: Heavy cigarette smoking, but not smoking itself, is strongly associated with RA requiring hospital follow up and is markedly more prevalent in patients with RA without a family history of RA.

Adult↗
PubMed2001

Calcaneal compartment syndrome after tibial fractures.

Compartment syndrome of the newly discovered calcaneal compartment of the foot is a theoretical possibility following tibial fracture due to the communication with the deep posterior compartment of the calf. Forty-nine patients were reviewed at least 18 months after open or closed tibial shaft fractures treated with tibial nailing in order to determine the prevalence of foot deformities secondary to previously undetected calcaneal or leg compartment syndromes. Ankle movements, foot height, length of feet and degree of clawing of the toes were all measured and compared with the unaffected opposite side. None of the patients complained of any symptoms from their feet and none had any significant foot deformities. Calcaneal compartment syndrome is rare after tibial fracture and routine measurement of calcaneal compartment pressures after such injuries is not indicated.

Bone Nails↗
PubMed2000

The Bristol 'OA500 study': progression and impact of the disease after 8 years.

OBJECTIVE: To study the natural history of peripheral joint osteoarthritis (OA) and assess its impact over eight years in a prospective study of 500 patients. METHODS: 500 consecutive patients with peripheral joint OA were recruited from a hospital-based rheumatology clinic. All were invited for review 3 and 8 years after entry. Joint sites involved, pain severity, change in index joints, global change in the condition, use of medication, surgery and walking aids were all recorded at each visit, and after eight years disability was assessed by the health assessment questionnaire (HAQ) and anxiety and depression by the Hospital anxiety and depression scale (HAD). RESULTS: At eight-year review, 349 patients were seen: 90% of those remaining alive. Outcome was heterogeneous. Sixty patients (17.2%) reported worsening in all three subjective parameters (pain, index joint and global change) compared with 22 (6.3%) who improved in all three parameters. Using this definition of worsening or improvement, strong baseline predictors of clinical outcome did not emerge. For further description, the group was split according to the index joint sites involved at entry to the study, there being 111 with knee OA alone, 87 with hand and knee OA, 72 with hand disease alone, and 29 with hip disease alone. Forty-four percent of those with lone hand disease at entry had acquired significant knee or hip OA 8 years later. The mean HAQ and HAD scores at 8 years were high, especially in those with knee disease, indicating significant disability as a result of the disease. Those with knee or knee and hand disease had the worst outcome in all parameters recorded. The data showed a general decrease in use of NSAIDs over the eight years, but an increase in utilization of analgesics, surgery (especially for hip disease) and walking aids. CONCLUSIONS: Patients with peripheral joint OA of sufficient severity to lead to hospital referral have a heterogeneous, but generally bad outcome over 8 years, the disease resulting in high levels of physical disability, anxiety and depression, with a high level of utilization of healthcare resources, including joint replacement, drugs and walking aids. The results were consistent with previous suggestions that peripheral joint OA in older people is characterized by the slow acquisition of new joint sites. Progression and outcome may depend on a complex set of psychosocial factors, as well as biological ones.

Aged↗
PubMed2000

Increased serum C reactive protein may reflect events that precede radiographic progression in osteoarthritis of the knee.

OBJECTIVE: Raised serum C reactive protein (CRP) and hyaluronate (HA) concentrations predict the progression of knee osteoarthritis (OA) in the long term but the consistency of these relations with time is unknown. The purpose of this work was therefore to determine if raised CRP and HA at entry and three years before entry (-3 years) predict radiological progression of knee OA in a group of patients between entry and five years. METHODS: Knee radiographs from 90 patients with knee OA at entry and five years follow up were assessed for progression of disease over five years. The concentrations of serum CRP and HA were measured at entry (n=90) and also in 40 serum samples available from -3 years. Odds ratios (OR) for predicting progression were calculated by logistic regression. RESULTS: Serum CRP at entry was not predictive of progression between entry and five years (OR 1.12, 95% CI 0.81, 1.55) but serum CRP at -3 years was predictive of progression (OR 1.90, 95% CI 1.01, 3.28). Serum HA concentration at entry predicted progression between entry and five years (OR 2.32, 95% CI 1.16, 4.66). CONCLUSION: These results are consistent with previous reports relating to HA, and suggest that raised serum CRP reflects events that precede a period of later radiographic progression in knee OA. However, because of the large overlap between groups, the serum CRP or HA concentration are not good predictors of individual patient progression and have a poor sensitivity and specificity.

Aged↗
PubMed2000

Distribution of distal femoral osteophytes in a human skeletal population.

OBJECTIVES: To examine objectively spatial patterns of osteophytes around the distal end of the femur and to identify distinct subgroups. METHODS: A sample of 107 human femora from a large skeletal population were selected for study. These femora included subjects with evidence of late stage osteoarthritis (that is, with eburnation present) and those with no such evidence. The location of osteophytes was recorded using a video camera and digitised computer images were extracted. Multidimensional scaling was used to identify clusters of femora based upon osteophyte location. RESULTS: A distinct subgroup of femora was identified with osteophytes present only within the intercondylar notch region. None of these subjects had any evidence of eburnation. CONCLUSIONS: This finding adds to an earlier study based on radiographs. Osteophytes located within the intercondylar notch of the femur appear to be a distinct subset, which may occur either as an early stage of knee osteoarthritis or for some independent reason.

Adult↗
PubMed2000

The sulcus angle and malalignment of the extensor mechanism of the knee.

Anterior knee pain due to dysplasia of the extensor mechanism is common. We have studied 137 knees (103 patients) in order to identify a rapid and reproducible radiological feature which would indicate the need for further analysis. Overall, 67 knees (49%) had at least one radiological abnormality; 70 (51%) were considered normal. There were five cases of Dejour type-3 dysplasia of the femoral trochlea, nine of type-2 and 12 of type-1. There were 49 cases of patella alta and five of patella infera. Four knees had an abnormal lateral patellofemoral angle (patellar tilt), and in 15 knees there was more than one abnormality. Classification of trochlear dysplasia was difficult and showed poor reproducibility. This was also true for the measurement of the lateral patellofemoral angle. Patellar height was more easily measured but took time. The sulcus angle is an easily and rapidly measurable feature which was reproducible and was closely related to other features of dysplasia of the extensor mechanism. The finding of a normal sulcus angle suggested that seeking other radiological evidence of malalignment of the extensor mechanism was unlikely to reveal additional useful information. The severity of other features of dysplasia of the extensor mechanism correlated with increasing sulcus angle.

Adolescent↗
PubMed1999

The shape of the distal femur: a palaeopathological comparison of eburnated and non-eburnated femora.

OBJECTIVES: To determine the difference in shape of the distal femur, viewed axially in two dimensions, between eburnated and non-eburnated femora. METHODS: A comparison of 52 non-eburnated and 16 eburnated femora drawn from a large archeological skeletal population. Eburnation was taken to indicate late stage osteoarthritis. Shape variability, based on landmarks, was quantified using a principal components analysis after a Procrustes alignment. RESULTS: A statistically significant difference was found between the two groups. This was with respect to the patellar groove and the shape of the medial condyle. The latter difference is consistent with bone remodelling as a knee stabilising mechanism. CONCLUSIONS: Anatomical shape can be quantified using an uncomplicated statistical technique. It was used to quantify the shape of the distal femur and demonstrate shape differences associated with osteoarthritis of the knee.

Bone Remodeling↗
PubMed1997

The Bristol 'OA500' study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint.

Five hundred patients with established, symptomatic limb joint OA have been recruited into an on-going prospective study of the natural history of the condition. Four hundred and fifteen patients (mean age 65.6 years, female to male ratio 2.05:1) were available for a full clinical and radiographic review 3 years after entry (mean entry to follow-up interval 37.6 months, range 31-41). The majority reported an overall worsening of their condition, although pain severity did not change. There was an overall increase in disability (Steinbrocker) and the use of walking aids in the group but 57 patients (13.7%) improved, 38 of whom had undergone joint surgery. There was a strong correlation between changes in different clinical outcome measures, but none of the baseline variables predicted change over 3 years with the exception of an association between pain severity and subsequent surgery. One hundred and ninety-three of the 415 patients had knee joint disease at entry. One hundred and forty-five of these patients had knee radiographs and full clinical data available from both time points. Some change was seen in 85 of 276 evaluable tibiofemoral joints (30.1%), but only 10 patellofemoral joints. There was a strong correlation between changes in joint space, osteophyte and subchondral bone scelerosis. However, there was no correlation between radiographic and clinical changes. It is concluded that radiographic change may not be a good surrogate for clinical outcome in established OA. This has implications for the design of long-term studies of possible structure modifying agents in OA.

Aged↗
PubMed1997

Bone formers: osteophyte and enthesophyte formation are positively associated.

OBJECTIVE: To test the hypothesis that enthesophyte formation and osteophyte growth are positively associated and to look for associations between bone formation at different sites on the skeleton so that a simple measure of bone formation could be derived. METHODS: Visual examination of 337 adult skeletons. All common sites of either enthesophyte or osteophyte formation were inspected by a single observer who graded bone formation at these sites on a 0-3 scale. The total score for each feature was divided by the number of sites examined to derive an enthesophyte and an osteophyte score. Cronbach's alpha and principal components analysis were used to identify groupings. RESULTS: Enthesophyte formation was associated with gender (M > F) and age. There was a positive correlation between enthesophytes and osteophytes (r = 0.65, 95% confidence interval, 0.58 to 0.71) which remained after correction for age and gender. Principal components analysis indicated four different groupings of enthesophyte formation. By choosing one site from each group a simple index of total skeletal bone formation could be derived. CONCLUSIONS: Osteophytes and enthesophytes are associated, such that a proportion of the population can be classified as "bone formers". Enthesophyte groupings provide some clues to aetiopathogenesis. Bone formation should be investigated as a possible determinant of the heterogeneity of outcome and of treatment responses in common musculoskeletal disorders.

Adult↗
PubMed1996

The relevance of chondroitin and keratan sulphate markers in normal and arthritic synovial fluid.

This study investigated the synovial fluid concentrations of glycosaminoglycan (GAG), keratan sulphate (KS) epitope 5D4 and chondroitin sulphate (CS) sulphation patterns in healthy volunteers and patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Synovial fluids were collected from knee joints of healthy volunteers (n = 24), and patients with OA (n = 28) and RA (n = 29). Concentrations of GAG and the keratan sulphate epitope 5D4 were measured in 15 of the healthy volunteers, and all of the OA and RA synovial fluids. Total GAG was measured using a dye-binding method and 5D4 by an ELISA. The unsaturated CS disaccharides delta C4 and delta C6 were measured by capillary electrophoresis in all synovial fluids. The concentrations of GAG, 5D4 and delta C6 in the normal synovial fluid were higher but that of delta C4 lower than those of the disease groups. The delta C6:delta C4 ratios correlated with age (r = -0.437, P < 0.001) and the mean value was lower in females than males (2.92 compared with 5.22, P < 0.001). After allowing for age and sex, the delta C6:delta C4 ratio in the control group was significantly elevated (P < 0.001) compared to both OA and RA. The ratio was also related to proteoglycan markers (r = 0.383 for 5D4 and r = 0.357 for GAG). The finding that 5D4 and delta C6:delta C4 ratios are higher in synovial fluid from healthy volunteers compared to OA and RA suggests that they may be markers of the susceptibility of articular cartilage to early damage in arthritis.

Adult↗
PubMed1995

Serum hyaluronic acid level as a predictor of disease progression in osteoarthritis of the knee.

OBJECTIVE: To investigate the prognostic value of serum hyaluronic acid (HA) and keratan sulfate (KS) levels in relation to tibiofemoral osteoarthritis (OA) of the knee. METHODS: Clinical and demographic data were collected on 94 patients. Radiographs were obtained at study entry and at 5-year followup. Disease progression was defined as 2 mm of joint space narrowing of any tibiofemoral compartment, and/or knee joint surgery during the study period. Serum HA and KS were measured and levels were correlated with entry data and disease progression. RESULTS: At entry, HA levels were significantly related to disease duration (P = 0.036), minimum joint space (P = 0.049), and previous surgery (P = 0.001). After these variables were taken into account, patients whose disease had progressed were shown to have had significantly higher levels of HA at baseline compared with those whose disease had not progressed (P = 0.019). However, there were no significant differences in levels of serum KS between those with and those without disease progression, at entry (P = 0.779) or at subsequent visits. CONCLUSION: These results suggest that serum HA levels predict disease outcome in OA of the knee and confirm that a single measurement of the serum level of KS is not useful as a prognostic marker in OA.

Age Factors↗
PubMed1995

Relationship between serum cartilage oligomeric matrix protein levels and disease progression in osteoarthritis of the knee joint.

The value of serum cartilage oligomeric matrix protein (COMP) as a marker of disease progression was investigated in 81 hospital out-patients with clinical knee osteoarthritis (OA). Progressing patients were defined by a decrease of > or = 2 mm in joint space on X-ray or requiring knee surgery during the 5 yr of follow-up. Of the 57 patients for whom full data were available, 20 progressed and 37 did not progress. Serum COMP levels increased during the first year in those who progressed (mean 6.42 micrograms/ml) (S.D. 6.64) compared to those who did not progress [mean 0.07 microgram/ml (S.D. 4.99); P < 0.001]. Changes in COMP during the first year were related to baseline COMP (r = -0.672, P < 0.001) and weight-to-height ratio (r = 0.272, P = 0.47). After allowing for these variables, serum COMP increased during the first year in progressive patients by 5.04 micrograms/ml [95% confidence interval (CI): (2.61, 7.46)] more than in non-progressive patients. Discriminant analysis gave a sensitivity of 70% and specificity of 78% at a cut-off value of 3.17 micrograms/ml. Baseline serum COMP levels did not differ between the groups but were related to late phase scintigraphy scan abnormalities. These observations suggest that the changes in serum COMP may have prognostic significance and are consistent with a model of OA in which early signs of episodic clinical progression can be found in the cartilage as well as in subchondral bone.

Cartilage↗
PubMed1995

Rheumatoid arthritis patients cannot accurately report signs of inflammatory activity.

If patients with rheumatoid arthritis (RA) could self-report symptoms in a manner which correlated with laboratory measures of inflammation this would be a valuable research or clinical tool. Developing such a tool means ensuring that the questions are understood and a variety of combinations of signs, symptoms and joints explored. Preliminary studies in two groups of 20 RA out-patients established an acceptable self-report questionnaire format by which patients could identify their joints. Fifty RA out-patients completed these self-report forms on four grades of each of four symptoms (pain, heat, stiffness, swelling) in each of 64 joints, as well as visual analogue scales (VAS) on overall pain and perceived disease activity. A clinical research assistant recorded the Thompson-Kirwan articular index (TKAI) and plasma viscosity (PV) was measured. The data were analysed in a variety of ways in an attempt to construct a self-report articular index (SRAI) which correlated with PV. The strongest models were then tested in 11 in-patients undergoing a flare of their disease. No adequate SRAI could be constructed which correlated with PV and in addition neither VAS score correlated with PV. There was a moderate correlation between the TKAI and a patient SRAI using the same joints, symptoms and weightings (r = 0.6, P < 0.01). Patients can clearly report different grades of multiple symptoms in multiple joints, but such reports cannot be shown to be a reliable indicator of inflammatory activity.

Arthritis, Rheumatoid↗
PubMed1995

The evolutionary origins of osteoarthritis: a comparative skeletal study of hand disease in 2 primates.

OBJECTIVE: To test the evolutionary hypothesis for joint failure by comparing the prevalence of osteoarthritis (OA) in 2 primate hands with different thumb usage. METHODS: We studied the hand skeletons of 32 humans and 32 macaques for OA. We defined OA as the presence of joint eburnation. RESULTS: The prevalence of OA in the distal interphalangeal joints was 26.7 and 50% for humans and monkeys, respectively. For the thumb base it was 37.5% in humans compared with 3.3% in macaques. The relative risk of thumb base OA in macaques may be due to the rudimentary design of the thumb. This finding supports the evolutionary hypothesis for joint failure and it may be applicable to many other joint sites.

Animals↗
PubMedDate not supplied

Changes in the canine femoropatellar joint space in the postsurgical, cruciate-deficient stifle joint.

In this study, we investigate the factors that influence changes in articular cartilage thickness in naturally occurring osteoarthritis of the canine stifle joint. Fifty-eight dogs with QA secondary to cranial cruciate ligament deficiency were examined radiographically at 0, 7, and 13 months using 90 degree flexed mediolateral radiographs of both stifle joints. The femoropatellar joint space widths were measured using a computer-assisted video image analysis system. The femoropatellar joint space widths were found to be significantly increased in index joints as compared to contralateral joints. In addition, there was a significant increase in femoropatellar joint space (FPJS) width over the course of the study, particularly between entry and 7 months. Factors that might influence the degree of femoropatellar joint space increase (bodyweight, age, sex, disease duration, radiographic score) were investigated using regression analysis. Body weight at baseline showed a moderate to strong relationship with change in FPJS between 0 and 7 months (Pearson's partial correlation r = 0.417, p = .006). This relationship was less strong for change in femoropatellar joint space between 7 and 13 months (r = 0.324, p = .036).

Animals↗