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Biomedical subjects

M H Pritchard

Publications and source records attributed to M H Pritchard.

At least 19 recordsLinked to original sources
PubMed1994

Evidence for a hypothetical non-HLA susceptibility gene in rheumatoid arthritis.

In this study investigating possible reasons for the increased female prevalence of RA, family histories were obtained from 719 patients with classical RA by direct interview. Thirty-one per cent positively identified at least one affected relative. Compared with the expected population sex distribution ratio of 3:1 and local prevalence data, mothers with RA were eight times more common than predicted and fathers with RA 15 times more frequent. Mean age of onset of clinical disease was 7 yr younger in probands with affected fathers, compared to those with no or only maternal family history (P < 0.001). On the basis of other diseases where there is a gender discrepancy in prevalence, the characteristics of a major susceptibility gene product is proposed to connect these inheritance patterns with the known female preponderance for developing RA. Although there are clearly methodological uncertainties in a study of this type, it is felt that by concentrating on parental data only that these have been kept to a minimum, and that the conclusion is not unexpected.

Adult↗
PubMed1994

Minocycline-related lupus.

Five cases of suspected drug-related lupus are described in young female patients who had been taking minocycline for several years. All were asymptomatic before starting treatment. After variable but prolonged periods of continuous therapy all abruptly developed arthralgia/arthritis and on testing were antinuclear factor positive. In four cases the symptoms and signs disappeared within a short time of stopping the drug, whereas in the remaining case the systemic nature of the illness required treatment with corticosteroids. Three patients who were rechallenged with minocycline quickly developed a recurrence of their joint symptoms. Resolution of the serological abnormalities noted in these patients occurred more slowly than the resolution of the clinical symptoms. We propose a direct relationship in these cases between minocycline therapy and the occurrence of a lupus-like syndrome.

Acne Vulgaris↗
PubMed1993

Hypnosis: practical applications and theoretical considerations in normal labour.

OBJECTIVE: To assess the effects of hypnotherapy on the first and second stages of labour in a large group of pregnant women. DESIGN: A semi-prospective case control study in which women attending antenatal clinics were invited to undergo hypnotherapy. SUBJECTS: One hundred twenty-six primigravid women with 300 age matched controls, and 136 parous women having their second baby with 300 age matched controls. Only women who had spontaneous deliveries were included. SETTING: Aberdare District Maternity Unit, Mid Glamorgan, Wales. INTERVENTION: Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy. OUTCOME MEASURES: Analgesic requirements, duration of first and second stages of labour. RESULTS: The mean lengths of the first stage of labour in the primigravid women was 6.4 h after hypnosis and 9.3 h in the control group (P < 0.0001); the mean lengths of the second stage were 37 min and 50 min, respectively (P < 0.001). In the parous women the corresponding values were 5.3 h and 6.2 h (P < 0.01); and 24 and 22 min (ns). The use of analgesic agents was significantly reduced (P < 0.001) in both hypnotised groups compared with their controls. CONCLUSION: In addition to demonstrating the benefits of hypnotherapy, the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women.

Adult↗
PubMed1992

An examination of the role of female hormones and pregnancy as risk factors for rheumatoid arthritis, using a male population as control group.

While being female is known to increase the risk of developing rheumatoid arthritis approximately threefold, this study, by making use of a male control group, suggests that female sex hormones per se are unlikely to be the main cause of this discrepancy. Apart from the teens, when rheumatoid disease is extremely rare in males, the female/male incidence ratio remains almost constant throughout the adult age range, in spite of the reduction in endogenous oestrogen levels at the menopause. Pregnancy is known to ameliorate RA, but this study found that it was also the most common identifiable event preceding the onset of RA in women of childbearing age (22%), which may explain the apparent protective role of oral contraceptives in this age group.

Adult↗
PubMed1992

Familial acne fulminans.

We report a patient of acne fulminans with arthralgia whose sister presented with the same disease at an identical age 10 years earlier. The two affected siblings in our family also had identical HLA phenotypes which further supported the role of genetic susceptibility in acne fulminans.

Acne Vulgaris↗
PubMed1991

Rapidly progressive aortic valve incompetence in a patient with rheumatoid arthritis.

A 27-year-old female with seropositive rheumatoid arthritis of onset at age 18 years developed progressive aortic valve incompetence requiring urgent aortic valve replacement. Rheumatoid aortic valve disease may be more rapidly progressive than aortic valve disease from other causes and awareness of this by the monitoring physicians may help to avoid the possible complications.

Adult↗
PubMed1991

Protection from gastrointestinal side-effects by azapropazone by its incorporation into a glucose-sodium acid citrate formulation.

Addition of glucose and sodium citrate to azapropazone, in proportions of 1:1:1 by weight reduced gastric mucosal damage in rats and there was a trend towards reduction in radiolabelled faecal red cell loss in human volunteers compared with that with azapropazone alone. The glucose and citrate did not affect the pharmacokinetics of azapropazone, or its therapeutic efficacy. While no difference was observed in endoscopic injury and in symptomatic gastrointestinal complaints in a multicentre comparison in rheumatic patients, a striking reduction in symptoms was observed in those patients with a history of severe gastrointestinal intolerance to non-steroidal anti-inflammatory drugs.

Adolescent↗
PubMed1989

Successful treatment of juvenile chronic arthritis with a specific antiviral agent.

In a previous paper we identified a group of patients with teenage onset chronic progressive arthritis (JCA or JRA) with raised antibody titres to influenza A (H2N2), an epidemic of which was present in the year they were born. On the basis that they might be chronic carriers of influenza A, and that this might be related to their arthropathy, it was decided to use the anti-influenza A drug amantadine to treat the virus and observe whether there was any effect on the joint disease. A 4-month, double-blind, placebo-controlled trial followed by a 4-month open study showed that amantadine could under these circumstances be of considerable therapeutic benefit while having no effect on patients without elevated antibody titres against influenza A.

Adult↗
PubMed1988

Antibodies to influenza A in a cluster of children with juvenile chronic arthritis.

In this study of 41 patients with progressive juvenile chronic arthritis (JCA), born between 1946 and 1970, it was noticed that 14 were born in the same year (1963). The possibility of a common environmental factor was therefore investigated. Records showed that an epidemic of influenza A H2N2 was present in that year, and the study shows that JCA patients born in 1963 still have a higher level of antibody to influenza A H2N2 than JCA patients born in other years or age-matched controls. This elevation is not seen in a survey of three control viruses. Since this group developed their clinical JCA after the appearance of influenza A H3N2 in 1977, it is suggested that these patients developed a progressive arthropathy because they had been pre-sensitized to influenza A by contact with an earlier strain when in utero.

Adolescent↗
PubMed1988

Influence of age and disease state in nonsteroidal antiinflammatory drug associated gastric bleeding.

In our study of 552 acute admissions for gastrointestinal hemorrhage, 18% were found to be taking nonsteroidal antiinflammatory drugs (NSAID) at the time of the bleed; 49% of these were found at endoscopy to have a gastric or prepyloric lesion, compared with 20% of the non-NSAID control group. Prescription data was used to calculate the risk added by age and disease state to the NSAID associated bleeding. We found that patients with chronic inflammatory disease had 2-3 times the expected bleeding incidence, but while there was a definite trend towards an age related risk in older patients, this was not statistically significant.

Aged↗
PubMed1984

Synovial protease/inhibitor ratios in erosive and nonerosive arthropathies.

Although rheumatoid joint fluids contain numerous polymorphs capable of secreting neutral proteases known to be able to digest cartilage, the high level of inhibitors (mainly alpha 1-antitrypsin and alpha 2-macroglobulin) has always been considered to be more than sufficient to inhibit their activity completely. Consequently little interest has been paid to the potential role of these enzymes in cartilage damage. Four arthropathies of different erosive potential are here compared: spondyloarthropathies, rheumatoid arthritis with and without gold or D-penicillamine therapy, and septic arthritis. The synovial concentration of the inhibitors alpha 1-antitrypsin and alpha 2-macroglobulin has been compared with the polymorph enzyme output, as measured by beta-glucuronidase. Total haemolytic complement, white cell count, and C-reactive protein have also been measured in the joint fluid. The range of white cell count and inhibitors was the same in all 4 groups, while the enzyme output varied substantially from low levels in the spondyloarthropathies to very high levels in the septic joints. The higher the erosive potential of the disease, therefore, the more disadvantageous is the inhibitor/enzyme ratio. It is also pointed out that cartilage has physiochemical properties which facilitate and enhance polymorph enzyme output while severely curtailing the activity of the inhibitors. The observation that synovial fluid is inhibitory in vitro may therefore bear little relationship to the situation at the cartilage surface in vivo.

Arthritis↗