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Biomedical subjects

M C Hochberg

Publications and source records attributed to M C Hochberg.

At least 19 recordsLinked to original sources
PubMed1992

The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis.

OBJECTIVE: To develop and validate revised criteria for global functional status in rheumatoid arthritis (RA). METHODS: Revised criteria were formulated and tested for criterion and discriminant validity in 325 patients with RA. RESULTS: The revised criteria developed are as follows: class I = able to perform usual activities of daily living (self-care, vocational, and avocational); class II = able to perform usual self-care and vocational activities, but limited in avocational activities; class III = able to perform usual self-care activities but limited in vocational and avocational activities; class IV = limited in ability to perform usual self-care, vocational, and avocational activities. Usual self-care activities include dressing, feeding, bathing, grooming, and toileting; vocational and avocational activities are both patient-desired and age-, and sex-specific. The distribution properties of this classification schema were superior to those of the original Steinbrocker criteria. Mean Health Assessment Questionnaire scores were significantly (P less than 0.0001) different between, and increased across, the 4 classes. CONCLUSION: Although there are limitations inherent in the use of global ordinal scales, the American College of Rheumatology revised criteria will be useful in describing the functional consequences of RA. A more detailed quantitative measure of physical disability should be used, however, for optimal monitoring of patients' clinical status in office practice and clinical research.

Activities of Daily Living↗
PubMed1992

Risk factors for coronary artery disease in patients with systemic lupus erythematosus.

PURPOSE: To estimate the frequency of and examine risk factors for coronary artery disease (CAD) in patients with systemic lupus erythematosus (SLE) in a prospective longitudinal study. PATIENTS AND METHODS: Patients were SLE are enrolled in The Johns Hopkins Lupus Cohort, a prospective study of outcomes in 229 subjects with SLE. CAD was defined as angina, myocardial infarction, or sudden death. Data on CAD risk factors were obtained prospectively every 3 months and were analyzed using univariate and multiple logistic regression. RESULTS: CAD occurred in 19 (8.3%) of 229 patients with SLE and accounted for 3 (30%) of 10 deaths as of December 31, 1990. Compared to subjects without CAD, those with CAD were more likely to have been older at both diagnosis of SLE (37.1 years versus 28.9 years, p = 0.004) and at entry into the cohort (47.1 years versus 34.7 years, p < 0.0001), to have a longer mean duration of SLE (12.3 years versus 8.1 years, p = 0.013) and a longer mean duration of prednisone use (14.3 years versus 7.2 years, p < 0.0001), to have a higher mean serum cholesterol (271.2 mg/dL versus 214.9 mg/dL, p < 0.0001) or a cholesterol level greater than 200 mg/dL (odds ratio [OR] 14.5, 95% confidence intervals [CI] 1.9, 112.1), and to have both a history of hypertension (OR 3.5, 95% CI 1.3, 9.6) and a history of use of antihypertensive medications (OR 5.5, 95% CI 1.8, 17.2). There were no significant associations with other known CAD risk factors such as smoking, diabetes, family history of CAD, race, or sex, or variables related to steroid therapy including the presence of cushingoid features or ever use of corticosteroids. The best multiple logistic regression model for CAD included age at diagnosis, duration of prednisone use, requirement for antihypertensive treatment, maximum cholesterol level, and obesity (using NHANES-II [National Health and Nutrition Examination Survey] definitions). CONCLUSION: Primary and secondary prevention strategies directed at hypertension, hypercholesterolemia, and obesity, as well as other known CAD risk factors, should be routinely employed in the management of patients with SLE.

Adult↗
PubMed1992

Coronary artery disease risk factors in the Johns Hopkins Lupus Cohort: prevalence, recognition by patients, and preventive practices.

Known risk factors for coronary artery disease are very common in the Hopkins Lupus Cohort, in spite of the fact that the average patients age is only 38.3 years. Three or more known risk factors were found in 53% of patients. Risk factors for CAD were common even in patients not on a regimen of prednisone therapy during their cohort follow-up. Hypercholesterolemia increased significantly with greater average prednisone dose. Despite the frequency of risk factors, patients' awareness of the risk of CAD was low, with only 16.9% of patients believing they were at high risk for developing CAD within 5 years. In general, awareness of individual risk factors was lower in black than in white patients with SLE. Preventive practices were most commonly addressed towards hypertension. Preventive practices directed against obesity, hypercholesterolemia, and smoking were underutilized. Whether these known risk factors are sufficient in and of themselves to explain the high frequency of CAD in the cohort (8%) or whether they are "enabling" factors acting upon endothelium damaged by immune-complex disease cannot be addressed by this study. However, both further investigation of these risk factors and attention to lifestyle and pharmacologic approaches to risk factor reduction are indicated by this study.

Adolescent↗
PubMed1992

Association of nonsteroidal antiinflammatory drugs with upper gastrointestinal disease: epidemiologic and economic considerations.

One of the major concerns regarding the use of nonsteroidal antiinflammatory drugs (NSAID) in the treatment of patients with arthritis is the high incidence of gastrointestinal (GI) side effects. Important issues regarding NSAID and upper GI complications include the following: (1) the magnitude of the association between NSAID therapy and clinically important gastric or duodenal ulcers or upper GI bleeding; (2) the subgroup(s) of patients who are at increased risk for upper GI side effects; and (3) the economic impact of NSAID induced upper GI toxicity. A causal association between NSAID use and the development of clinically important ulcer disease or its complications, including upper GI bleeding, is supported by available epidemiologic data. Furthermore, data suggest that up to one third of all direct costs of care may be attributed to the treatment of NSAID induced GI side effects. Approaches to this problem, such as the development of safer NSAID that are equally effective, need to be pursued.

Aged↗
PubMed1991

Incidence and risk factors for gout in white men.

OBJECTIVE: To identify potentially modifiable risk factors for the development of gout. DESIGN: Longitudinal cohort study (The Johns Hopkins Precursors Study). PARTICIPANTS: Of 1337 eligible medical students, 1271 (95%) received a standardized medical examination and questionnaire during medical school. The participants were predominantly male (91%), white (97%), and young (median age, 22 years) at cohort entry. OUTCOME MEASURE: The development of gout. RESULTS: Sixty cases of gout (47 primary and 13 secondary) were identified among 1216 men; none occurred among 121 women (P = .01). The cumulative incidence of all gout was 8.6% among men (95% confidence interval, 5.9% to 11.3%). Body mass index at age 35 years (P = .01), excessive weight gain (greater than 1.88 kg/m2) between cohort entry and age 35 years (P = .007), and development of hypertension (P = .004) were significant risk factors for all gout in univariate analysis. Multivariate Cox proportional hazards models confirmed the association of body mass index at age 35 years (relative risk [RR] = 1.12; P = .02), excessive weight gain (RR = 2.07; P = .02), and hypertension (RR = 3.26; P = .002) as risk factors for all gout. Hypertension, however, was not a significant risk factor for primary gout. CONCLUSIONS: Obesity, excessive weight gain in young adulthood, and hypertension are risk factors for the development of gout. Prevention of obesity and hypertension may decrease the incidence of and morbidity from gout; studies of weight reduction in the primary and secondary prevention of gout are indicated.

Adult↗
PubMed1991

Factors associated with osteoarthritis of the hand in males: data from the Baltimore Longitudinal Study of Aging.

The association of metabolic and physiologic factors with hand osteoarthritis was studied in 888 Caucasian male subjects aged 17-102 years in the Baltimore Longitudinal Study of Aging. Left-hand radiographs taken between 1958 and 1975 were read by one investigator for grade of osteoarthritis using Kellgren-Lawrence scales. Possible risk factors, assessed at the same visit as the last radiograph during this interval, included age and measures of bone mass, body composition, muscle mass, and muscle strength. Results of bivariate analyses of these cross-sectional data showed that increasing grade of hand osteoarthritis was associated with increasing age; greater mean levels of waist/hip ratio and percentage of body fat; and lower mean levels of percentage of cortical area, grip strength, and forearm circumference. After adjustment for age using residuals from best-fit quadratic regression models, none of these independent variables remained significantly associated with grade of hand osteoarthritis. These data fail to support hypotheses that metabolic and physiologic factors are associated with hand osteoarthritis independent of their known age-related changes.

Adolescent↗
PubMed1991

Epidemiology and genetics of osteoarthritis.

Osteoarthritis is the most common of the arthropathies. Previous population-based epidemiologic studies have estimated the prevalence of osteoarthritis by age, gender, race, and site in many populations. Cross-sectional and retrospective data from these prevalence surveys have been analyzed to identify possible risk factors for the development of osteoarthritis at specific sites. Data from prospective population-based epidemiologic studies including the Framingham Osteoarthritis Study, the Tecumseh Community Health Study, the National Health and Nutrition Examination Survey I Epidemiologic Followup Study, and the Baltimore Longitudinal Study of Aging are being analyzed to estimate the incidence of osteoarthritis by age, gender, and site, and the prognosis of subjects with osteoarthritis at specific sites in terms of morbidity and mortality, as well as to confirm the association of risk factors with the development and progression of osteoarthritis by site. Additionally, the application of techniques of molecular biology to the study of the genetics of familial osteoarthritis has identified hereditary defects in type II collagen that appear to predispose to the early development of osteoarthritis in affected family members. Results of these studies highlight opportunities for the primary and secondary prevention of osteoarthritis.

Europe↗
PubMed1991

Comparison of different methods of classifying patients with systemic lupus erythematosus.

The sensitivity and percent agreement of 3 methods of classifying patients with systemic lupus erythematosus (SLE), the 1982 American Rheumatism Association (ARA) revised criteria and a simple and full classification tree, were compared using data from The Johns Hopkins Lupus Cohort, a prospective study of 198 patients with SLE. The 1982 revised criteria were significantly more sensitive than the simple classification tree, correctly identifying 184 (93%) cases compared to 168 (85%) (p = 0.016). Agreement between these 2 classification schema was noted in 174 (87%) cases with 164 classified correctly and 10 failing to satisfy either criteria set. The full classification tree correctly identified 186 (94%) cases. There was no difference in the sensitivity of either the 1982 revised criteria or the full classification tree by racial group; however, the simple classification tree was significantly less sensitive among black than Caucasian patients (80 vs 91.5% p = 0.038). Our data support the continued use of the 1982 revised ARA criteria for the classification of patients with SLE for clinical and epidemiologic research studies.

Adult↗
PubMed1991

The history of lupus erythematosus.

The history of lupus can be divided into the classical period which saw the description of the cutaneous disorder, the neoclassical period which saw the description of the systemic or disseminated manifestations of lupus, and the modern period which was heralded by the discovery of the lupus erythematosus cell in 1948.

Europe↗
PubMed1991

Epidemiology of osteoarthritis: current concepts and new insights.

Osteoarthritis (OA) is the most common of the arthropathies. Previous epidemiologic studies have described the prevalence of OA by age, gender and site in many populations. Cross sectional and retrospective data from these prevalence surveys have been analyzed to identify possible risk factors for the development of OA. Data from prospective epidemiologic studies including the Framingham Study, Tecumseh Community Health Study, and the Baltimore Longitudinal Study of Aging are being analyzed to estimate the incidence of OA by age, gender and site, and confirm the association of risk factors with the development and progression of OA. Results of these studies provide potential opportunities for the primary and secondary prevention of OA.

Europe↗
PubMed1990

Accuracy of creatinine clearance in measuring glomerular filtration rate in patients with systemic lupus erythematosus without clinical evidence of renal disease.

We sought to determine whether creatinine clearance (Ccr) gives an accurate measurement of the glomerular filtration rate in patients with systemic lupus erythematosus (SLE) with no clinical evidence of renal disease. Eighteen such SLE patients underwent measurement of Ccr and 99mtechnetium-DTPA clearance (CDTPA). The mean +/- SD Ccr:CDTPA ratio was 1.12 +/- 0.15 (95% confidence interval 1.04-1.20). These results indicate that Ccr gives an accurate measurement of the glomerular filtration rate in the majority of SLE patients who do not have clinical evidence of renal disease.

Adult↗