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Biomedical subjects

M Ostensen

Publications and source records attributed to M Ostensen.

At least 37 records · Page 2Linked to original sources
PubMed1998

Obstetrical and neonatal outcome in pregnant patients with rheumatic disease.

Possible associations between inflammatory rheumatic and connective tissue disease and adverse pregnancy outcome were assessed by using the Medical Birth Registry of Norway during the years 1967-95. All women with rheumatic disease were compared to women without such disease. Data on pregnancy outcome and deliveries were analyzed after adjustment for possible confounding factors. Women with rheumatic disease had significantly higher rates of preeclampsia, premature delivery and cesarean section as well a significantly increased relative risk of SGA children in all diagnostic groups in 1967-95. These findings emphasize the importance of close monitoring of pregnancy and delivery not only in patients with connective tissue disease, but also in patients with other inflammatory rheumatic disease.

Adult↗
PubMed1998

Detection of cytokine mRNA in human, articular cartilage from patients with rheumatoid arthritis and osteoarthritis by reverse transcriptase-polymerase chain reaction.

Cytokines are signalling glycoproteins mediating acute inflammation, chronic inflammation, and connective tissue destruction. The present study was designed to characterize the profile of cytokine message in normal human articular cartilage and from patients with rheumatoid arthritis (RA) and osteoarthritis (OA), by means of the reverse transcriptase-polymerase chain reaction (RT-PCR). Message RNA (mRNA) was extracted from fresh or frozen cartilage. The results showed expression of mRNA for IL-6, IL-6R, IL-7, IL-8, IL-10, and IL-12 (p35 and p40) exclusively in the RA cartilage. Except for mRNA for IL-8 and IL-10, no other cytokine or cytokine receptor was expressed in OA and control cartilage. mRNA for IL-1beta, IL-4, TNF-alpha, and TNFR-p75, was not detected in any cartilage sample except for one RA specimen expressing IL-1beta mRNA. However, the expression of message for pro-inflammatory cytokines was far more prominent than anti-inflammatory cytokines. This may suggest a disturbed balance of pro- and anti-inflammatory activity in RA cartilage.

Adult↗
PubMed1998

Three dimensional CT evaluation of occipito-atlanto-axial dislocation in rheumatoid arthritis.

Involvement of the upper cervical spine, with possible instability and dislocation of the atlanto-axial-cervico-occipital joints in patients with rheumatoid arthritis (RA), is routinely monitored with conventional radiographs. As disease progresses severe interpretation problems occur, especially when looking for cranial migration of the odontoid process. The aim of the present study was to evaluate whether three dimensional CT examination should be considered for such monitoring. After clinical and biochemical examination of 20 consecutive patients, diagnostic information about cranial migration of the odontoid process was obtained by conventional radiograms and by three dimensional CT examination. When using conventional radiographs the odontoid process and the its relation to the skull base could be outlined in 8 of the 20 patients. whereas all bony structures could be well demonstrated on the CT examination and the degree of cranial migration into the foramen magnum could be quantified. Three dimensional CT should be considered as a reliable examination for monitoring RA patients with involvement of the upper cervical spine and a possible cranial migration of the odontoid process.

Adult↗
PubMed1998

Treatment of inflammatory rheumatic disorders in pregnancy: what are the safest treatment options?

The interaction of pregnancy and the rheumatic diseases varies, ranging from life-threatening conditions such as thromboembolic events and progressive renal disease in some autoimmune disorders, to minor flares of peripheral arthritis in inflammatory rheumatic disease. As a consequence, treatment strategy will vary according to the maternal or fetal compromise expected. All nonsteroidal anti-inflammatory drugs (NSAIDs), including high dose aspirin (acetylsalicylic acid), can cause adverse effects during pregnancy related to the inhibition of prostaglandin synthesis. Prolongation of gestation and labour, constriction of the ductus arteriosus, persistent fetal circulation, impairment of renal function and bleeding are risks of third trimester exposure of pregnant women to all inhibitors of cyclo-oxygenase. Most of these adverse effects can be prevented by discontinuing NSAIDs 8 weeks prior to delivery. Low dose aspirin has not been associated with fetal or neonatal toxicity. Some corticosteroids such as prednisone and prednisolone do not readily cross the placenta and can be safely used during pregnancy as immunosuppressive drugs. Maternal complications related to corticosteroids may occur and close monitoring is therefore mandatory. There is limited information on the safety of disease-modifying antirheumatic drugs including gold, antimalarials, penicillamine (D-penicillamine), sulfasalazine and cyclosporin. Of these agents, sulfasalazine has the best record for tolerability and can be used by pregnant patients. Gold compounds and penicillamine should be discontinued when pregnancy is recognised. Hydroxychloroquine has not been associated with congenital malformations and seems preferable to chloroquine in patients requiring treatment with antimalarials. Use of cyclosporin may be an alternative to other therapy in pregnant patients with severe rheumatic disease. Indications for treatment with colchicine during pregnancy are few, except for familial Mediterranean fever. Azathioprine can be used when the maternal condition requires a cytotoxic drug during the first trimester. Cyclophosphamide, chlorambucil and methotrexate are contraindicated during pregnancy because of their teratogenic potential. Their use may be considered in late pregnancy if the mother has a life-threatening condition.

Adrenal Cortex Hormones↗
PubMed1998

Ankylosing spondylitis--the female aspect.

OBJECTIVE: To study reproductive performance and interaction between ankylosing spondylitis (AS) and pregnancy in a large population of female patients. METHODS: In collaboration with the Ankylosing Spondylitis International Federation, a questionnaire including clinical data and details on past and recent pregnancies was sent to the female members of national and regional AS societies in the USA, Canada, and 11 European countries. RESULTS: Nine hundred thirty-nine questionnaires were completed, showing the following clinical data. Mean age at onset of AS was 23 years. The onset was related to a pregnancy in 21%. The frequency of accompanying features of AS was as follows: peripheral arthritis 45%, acute anterior uveitis 48%, psoriasis 18%, and inflammatory bowel disease 16%. Six hundred forty-nine women with previous pregnancies had on average 2.4 pregnancies per woman, of which 1.4 pregnancies were during disease. Of pregnancies 15.1% ended with miscarriage. Disease activity during 616 previous and 366 recent pregnancies was unchanged in 33.2%, improved in 30.9%, and worsened in 32.5%. Improvement of disease activity during pregnancy was correlated with a history of peripheral arthritis. It was also observed more often among those having a female than a male child (p = 0.02). A postpartum flare within 6 months after delivery was experienced by 60%, most often patients with active disease at conception. Delivery occurred at term in 93.2% of cases. The rate of cesarean section was high and due to AS in 58% of cases. The majority of neonates were healthy and had a mean birthweight of 3339 g. AS had an adverse effect on being a mother and a caregiver. CONCLUSION: AS did not adversely affect fertility, pregnancy outcome, or the neonate. Improvement during pregnancy was related to a history of peripheral arthritis and a female fetus. Active disease at conception was a predictor of a postpartum flare.

Adult↗
PubMed1998

Nonsteroidal anti-inflammatory drugs during pregnancy.

As inhibitors of cyclooxygenase nonsteroidal anti-inflammatory drugs (NSAID) given during pregnancy have the potential to cause adverse maternal and fetal effects. Maternal effects include prolongation of pregnancy and labour, whereas constriction of the ductus arteriosus, renal dysfunction and hemostatic abnormalities can occur in the fetus and neonate. Teratogenicity has not been found for the NSAID surveyed in this review. NSAIDs are excreted in small amounts into breastmilk with little risk for adverse effects in the suckling infant.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

[Systemic sclerosis. A diagnostic and follow-up program].

Systemic sclerosis (scleroderma) is a rare chronic progressive multiorgan disease characterized by elevated collagen content in affected organs. The condition is classified in the group connective tissue diseases, and appears in both a systemic and a limited form. The rate of progression and the prognosis differ for the two forms. The heterogeneity of the disease makes systematic examination of the patients necessary in order to provide a correct diagnosis and classification as a basis for therapy and prognosis. Based on the low incidence and prevalence of the disease, the care of these patients should be a specialist task. At our department, a programme has been introduced consisting of clinical examination, immunological and biochemical analysis, histological examination and different imaging techniques, and with an interdisciplinary approach. This programme has made the management of these patients more standardized.

Follow-Up Studies↗
PubMed1997

Pregnancy and rheumatoid arthritis.

Amelioration of rheumatoid arthritis (RA) occurs in about three quarters of pregnancies. Most women who improve experience initial relief in the first trimester. RA almost invariably recurs within 3 to 4 months of delivery. The effect of pregnancy upon the risk of first developing RA is similar in some respects but also differs from that observed in women with established disease. Analogous to women with established disease, the chance of a woman first developing RA is significantly reduced during pregnancy but increased in the first year post partum; thereafter risk is decreased. There is no indication of any adverse effects of RA on pregnancy outcome. Although limited, some medications can be used during pregnancy and during lactation without jeopardizing the well-being of the fetus.

Arthritis, Juvenile↗
PubMed1997

The effect of reproductive events and alterations of sex hormone levels on the symptoms of fibromyalgia.

The fibromyalgia syndrome (FS) is a chronic pain disorder frequently affecting women of fertile age. However, the relationship of FS and pregnancy has been given little attention. In the present retrospective analysis, based on personal interviews, the influence on FS symptomatology by pregnancy, abortion, menstruation, use of oral contraceptives, and breast feeding was investigated. Twenty-six women with an established diagnosis of FS and a total of 40 pregnancies during disease were included in the study. With the exception of one patient, all women described worsening fibromyalgia symptoms during pregnancy with the last trimester experienced as the worst period. A new change of fibromyalgia symptoms within 6 months after delivery was reported for 37 of the 40 pregnancies, to the better in four and to the worse in 33 cases, resulting in a prolonged sick leave for 14 patients. An increase in depression and anxiety was a prominent problem in the post partum period. FS had no adverse effect on the outcome of pregnancy or the health of the neonate. In the majority of patients with FS, hormonal changes connected with abortion, use of hormonal contraceptives, and breast feeding did not modulate symptom severity. A pre-menstrual worsening of symptoms was recorded by 72% of the patients. Comparing the 26 patients who had borne children during disease with 18 patients who had all their children before the onset of FS revealed a negative effect of pregnancy and the post partum period of FS and increased functional impairment and disability in the 26 patients.

Adult↗
PubMed1997

Sociodemographic characteristics and gynecological disease in 40-42 year old women reporting musculoskeletal disease.

The study, which was part of a cardiovascular screening programme of 40-42 year old women organised by the National Health Screening Service, wanted to assess the prevalence of locomotor complaints in Middle-Norway. Forty-nine percent of the respondents reported the occurrence of musculoskeletal disorders. Low back pain and myalgia was the most and chronic inflammatory joint diseases the least frequent. Between healthy women and some groups of women reporting musculoskeletal disorders, significant differences in sociodemographic background, workload, working ability, and health care utilisation emerged. Among lifestyle factors, smoking was significantly more frequent for women reporting fibromyalgia. Analysing the occurrence of symptoms and diseases in the genital tract revealed that a significantly higher proportion of women reporting musculoskeletal disease answered positively. Differences between healthy women and women reporting pelvic joint syndrome, fibromyalgia, whiplash, or arthritis were significant in bleeding disorders chronic pelvic pain and inflammatory pelvic disease. Patients with rheumatoid arthritis reported oophorectomy significantly more often than healthy women. In conclusion, a high rate of musculoskeletal symptoms and disorders was reported by middle-aged women. A strong association between musculoskeletal disorders and gynecological disease was found.

Adult↗
PubMed1996

[Arthritis after BCG treatment of bladder cancer. A rare complication].

Since 1976 intravesical instillation of bacillus Calmette-Guerin (BCG) has been used after surgical treatment of bladder cancer. Local side effects like cystitis are common, but a small share of the patients develop influenza-like symptoms, arthritis and other complications. We describe two patients with arthritis.

Administration, Intravesical↗
PubMed1996

[Use of estrogen in women with systemic lupus erythematosus--should, should not?].

Changes in sex hormone metabolism seem to play a role in the expression of systemic lupus erythematosus (SLE). Epidemiological studies have demonstrated an increased risk of developing SLE in women using oestrogens for more than ten years. Onset or aggravation of symptoms have been described in case reports and small retrospective series of SLE patients. Oestrogen replacement therapy is generally well tolerated whereas oral contraceptives containing oestrogen can induce flares in a small proportion of SLE patients. A generally negative attitude towards oestrogens seems inadequate since controlled prospective studies are lacking. Patients with stable disease may use oestrogen provided there is close follow-up, particularly during the first six months of treatment. Treatment with oestrogen is contraindicated in SLE patients with a history of thromboembolism, positivity for phospholipid antibodies, and in the presence of severe organ involvement.

Adult↗
PubMed1996

Safety of nonsteroidal antiinflammatory drugs in pregnant patients with rheumatic disease.

OBJECTIVE: To determine whether active arthritis in pregnant patients can be safely treated with nonsteroidal antiinflammatory drugs (NSAID) without harm to the neonate or longterm adverse effects in the offspring. METHODS: Patients were recruited from a prospective study on pregnancy and rheumatic disease. A cohort of 88 pregnant patients with inflammatory rheumatic disease was divided into 2 groups, 45 who were treated 43 not treated with NSAID during pregnancy. Possible longterm effects of NSAID on physical and mental development of the offspring were evaluated by telephone interview. RESULTS: Groups did not differ with regard to demographic data. Fourty-nine pregnancies had been exposed to standard doses of NSAID for a mean duration of 15.3 weeks. A comparison of pregnancies exposed with those not exposed to NSAID revealed no differences in pregnancy outcome, duration of labor, complications at delivery, or neonatal health. No significant differences were found between the groups with respect to health and development of offspring at followup. CONCLUSION: This study of a limited number of pregnancies in rheumatic patients showed no teratogenicity or adverse effects of NSAID on the neonate, nor did it reveal harmful longterm effects caused by intrauterine exposure to these drugs.

Adolescent↗
PubMed1995

Can maternal antiphospholipid antibodies predict the birth of a small-for-gestational age child?

BACKGROUND: The aim of this study was to examine the relationship between the maternal level of antiphospholipid antibodies (aPA) measured by anticardiolipin antibodies (aCL) and fetal growth retardation (SGA). METHODS: A nested case control design was carried out in a prospective cohort study of 1552 para I and para II women. The study group consisted of all 138 women who gave birth to a SGA-child (defined as birthweight < 10th percentile). A control group of 276 women was randomly selected from mothers of non-SGA children. Levels of aPA were measured in banked sera drawn from the women in the 33rd week of pregnancy and compared between cases and controls. RESULTS: There were 3 (2.5%) sera with aPA above 97.5 percentile among the cases and 3 (1.2%) among the controls. This difference was not statistically significant. CONCLUSION: Antiphospholipid antibody measurements obtained at 33 weeks of gestation cannot be used to assess the risk of birth of a small for gestational age infant among parous women.

Antibodies, Anticardiolipin↗
PubMed1995

HLA-B27 negative ankylosing spondylitis in a father and a son.

Only 5% of AS patients are B27 negative. We describe two cases of HLA-B27 negative AS in a father and a son who both developed clinical and radiological features characteristic of AS. Tissue typing for HLA-A,-B,-C was performed in all 1.degree family members except for the father who died in 1990. All family members possessed B40. HLA-B40 may contribute to an increased susceptibility for AS not only in B27 positive individuals but also in B27 negative cases.

Adult↗
PubMed1994

[Drug therapy of rheumatoid arthritis. Recommendations to specialists and general practitioners].

We report from a workshop on pharmacological treatment for rheumatoid arthritis, arranged by the Swedish Medical Product Agency in October 1991. The purpose was to reach consensus and make recommendations concerning treatment with corticosteroids and anti-rheumatic drugs. It was recommended to start treatment with anti-rheumatic drugs as soon as the diagnosis of an active rheumatoid arthritis was established. The selection of drugs for the individual patient should be determined both by patient and drug factors. The therapy requires close monitoring, a co-operative task for the specialist and general practitioner. Use of anti-rheumatic drugs during pregnancy and lactation was not recommended, except for sulphasalazine.

Adrenal Cortex Hormones↗