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Biomedical subjects

O Fitzgerald

Publications and source records attributed to O Fitzgerald.

At least 37 records · Page 2Linked to original sources
PubMed1996

The diagnosis of iron deficiency in patients with rheumatoid arthritis and anemia: an algorithm using simple laboratory measures.

OBJECTIVE: Anemia of chronic disorders (ACD) and iron deficiency are common features in rheumatoid arthritis (RA), but may be difficult to distinguish without marrow sampling, which is invasive, time consuming, and expensive. We sought simple laboratory measures that identified patients with absent marrow iron stores (iron deficiency). METHODS: 45 anemic patients with RA underwent marrow sampling in addition to a complete blood count and serum ferritin and iron saturation measurements. RESULTS: 47% of patients had iron deficiency. These patients had significantly lower mean corpuscular volume (MCV), serum ferritin, and iron saturation. A 3 step algorithm was developed using these laboratory variables to identify iron deficiency. This algorithm correctly classified 94% patients with iron deficiency and 85% with ACD. CONCLUSION: Our study demonstrates that iron deficiency may be reliably identified by measuring serum ferritin, MCV, and iron saturation in many patients with RA, thereby avoiding the trauma and expense of marrow sampling.

Adult↗
PubMed1995

Technical report: ultrasound guidance for injection of soft tissue lesions around the heel in chronic inflammatory arthritis.

We describe the use of ultrasound guidance for local steroid injection of the retrocalcaneal bursa and the tibialis posterior tendon sheath in patients with chronic inflammatory arthropathy. Ultrasound guidance may be the injection technique of choice but is particularly indicated for patients with lesions unresponsive to injections guided by palpation.

Adolescent↗
PubMed1995

Immunolocalization of adhesion molecules in psoriatic arthritis, psoriatic and normal skin.

Adhesion molecule expression in synovial membrane obtained from patients with psoriatic arthritis (PA) has previously been compared with rheumatoid arthritis (RA). Although expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) was similar in both psoriatic and rheumatoid synovium, in contrast, little or no endothelial leucocyte adhesion molecule-1 (ELAM-1) was observed in psoriatic synovium. In the present study, the expression of ICAM-1, ELAM-1 and VCAM-1 was examined in the involved and uninvolved skin from patients with PA (n = 15), patients with psoriasis (Ps) but no arthritis (n = 5) and in normal skin (n = 4). ICAM-1 was intensely expressed on endothelium and keratinocytes of involved skin from patients with Ps with or without arthritis. There was constitutive expression of ICAM-1 on endothelium only in uninvolved and normal skin. In contrast, ELAM-1 expression was restricted to endothelial cells; it was widespread and intense in involved skin, but was minimal in uninvolved and normal skin. VCAM-1 was expressed on endothelium, and also on some dendritic cells in involved psoriatic skin. There was minimal VCAM-1 staining on endothelial cells in uninvolved and normal skin. In conclusion, in involved psoriatic skin from patients with and without arthritis ICAM-1, ELAM-1 and VCAM-1 expression is up-regulated on vascular endothelium, and ICAM-1 is expressed on keratinocytes. However, ELAM-1 and VCAM-1 expression seen in dermal vessels is not found in psoriatic synovial vessels. These differences suggest a mechanism for controlling cellular traffic in Ps and in PA.

Adult↗
PubMed1995

The evolution of Raynaud's phenomenon: a longterm prospective study.

OBJECTIVE: To evaluate prospectively a cohort of patients with Raynaud's phenomenon (RP) and signs, symptoms, or laboratory abnormalities suggestive of a connective tissue disease (CTD) to determine prognosis and to identify predictors of evolution. METHODS: Patients with suspected secondary RP were evaluated at baseline, 2.7 years, and 8.4 years after entry by history and examination, chest radiograph and barium esophagram, pulmonary function tests, antinuclear and anticentromere antibodies (ACA), cryoglobulins, and nailfold capillary microscopy (NCM). Logistic regression was used to identify predictors of evolution and to develop a risk factor model. RESULTS: Sixty-four patients were entered and all were subsequently evaluated. Thirty-two (50%) progressed to a definite CTD. Abnormalities of nailfold capillaries [odds ratio (OR) = 21.8] and hand swelling (OR = 18.5) at baseline were independent predictors of the development of systemic sclerosis. A positive ACA was the only risk factor identified for evolution into CREST syndrome (calcinosis, RP, esophageal dysmotility, sclerodactyly, telangiectasias) (OR = 22.5). Finally, nailfold capillary abnormalities were the only baseline feature associated with the development of any definite CTD (OR = 8.3). CONCLUSION: Fifty percent of patients with suspected secondary RP will develop a CTD over a period of 8.4 years. NCM predicts development of systemic sclerosis or any definite CTD and should be included in the evaluation of all such patients.

Adolescent↗
PubMed1994

Classification of clinical subsets in psoriatic arthritis.

The classification of PsA is controversial. Two recent papers have suggested new subgroup classifications, however both have served only to expand the controversy. In this study the clinical and radiologic features of 100 patients with PsA are recorded in order to examine possible clinical or radiologic features which may be associated with functional disability and to examine the usefulness of recent reclassification proposals in our patient population. Results indicate that an asymmetric oligoarthritis (AO) pattern of disease is most common occurring in 43%. A symmetric polyarthritis (SP) was present in 33%, and this subgroup had the highest number of erosions and deformities, and a higher proportion of patients with grade III/IV ARA functional disability. While the DIP joints were involved in 46%, predominant DIP joint disease occurred in 16%. As the DIP group had the shortest duration of arthritis, it may be that this group represents recent onset PsA which will evolve into one of the other subgroups. Sacroiliitis was a feature in 14% with predominant spondylitis (SPON) in 4%. Arthritis mutilans (AM) was rare occurring in only 2% of this population, perhaps representing patients with end-stage SP disease. Finally, 2% of patients had features of the synovitis-acne-pustulosis-hyperostosis-osteomyelitis (SAPHO) syndrome. A classification comprising just three subgroups (AO, SP, SPON) is proposed as being of most use clinically though a long-term prospective study is needed for verification.

Acne Vulgaris↗
PubMed1993

Reduced synovial membrane macrophage numbers, ELAM-1 expression, and lining layer hyperplasia in psoriatic arthritis as compared with rheumatoid arthritis.

OBJECTIVE: To define the immunohistologic features of the synovial membrane (SM) of patients with psoriatic arthritis (PA) and to compare them with those of an age- and disease-duration-matched population of patients with rheumatoid arthritis (RA). METHODS: Synovial membrane needle biopsy was performed on 15 PA patients with knee involvement (8 had asymmetric oligoarthritis and 7 had symmetric polyarthritis) and on 15 RA controls. Specimens were stained with monoclonal antibodies against T cells (CD3, CD8, CD4, CD45RO), B cells (CD20), macrophages (Mac387, CD14), and cells bearing class II antigens (DAKO-DR). Vascular endothelium was examined using a polyclonal antibody to Factor VIII-related antigen, and adhesion molecule expression was examined using antibodies 1.3B6, 6.5B5, and 1.4C3, which identify endothelial leukocyte adhesion molecule 1 (ELAM-1), intercellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1), respectively. RESULTS: There was significantly less lining layer hyperplasia, fewer macrophages, and a greater number of blood vessels in PA SM than in RA SM: ELAM-1 expression was less intense in PA than in RA SM, while there was no difference in expression of ICAM-1 and VCAM-1. Numbers of B cells, T cells, and T cell subsets (predominantly CD4, CD45RO T cells) were similar in both groups of patients. CONCLUSION: Our findings demonstrate important differences in the immunohistologic features of PA and RA SM: The PA SM is more vascular, ELAM-1 expression is less intense, and fewer macrophages invade the stroma and migrate to the lining layer than in RA SM: However, the lymphocytic infiltrate in the SM of both groups is similar.

Adult↗
PubMed1993

Anterior mediastinal fibrosis with superior vena caval obstruction complicating the synovitis-acne-pustulosis-hyperostosis-osteomyelitis syndrome.

A syndrome of predominantly palmo-plantar pustular psoriasis associated with anterior chest wall (sternoclavicular, manubriosternal) inflammation has previously been described. In this case, a further patient is reported where chest wall involvement is complicated by anterior mediastinal fibrosis and superior vena caval obstruction.

Fibrosis↗
PubMed1993

Mechanism of joint sparing in a patient with unilateral psoriatic arthritis and a longstanding hemiplegia.

The case of a 59-year-old female with a longstanding hemiplegia who developed unilateral psoriatic arthritis and unilateral psoriasis on the non-hemiplegic side only is reported. Investigations showed an erythrocyte sedimentation rate of 58 mm/h, with all classes of rheumatoid factor negative in serum and synovial fluid (SF). An inflammatory infiltrate was demonstrated in both knee joints despite the absence of clinical involvement on the hemiplegic side. In addition, while neurofilament and substance P (SP) immunoreactivity was demonstrated in both synovial specimens, conspicuously less SP was present in the clinically involved synovial membrane. Finally, SF levels of SP and IL1 beta were raised in the clinically involved knee only.

Arthritis, Psoriatic↗
PubMed1993

Morphometric analysis of synovial membrane blood vessels in rheumatoid arthritis: associations with the immunohistologic features, synovial fluid cytokine levels and the clinical course.

The morphologic characteristics of the endothelial cells lining postcapillary venules are cytokine dependent and critical in facilitating the infiltration of mononuclear cells into synovial membrane in rheumatoid arthritis (RA). We determined the relationships between endothelial cell (EC) tallness, mononuclear cell infiltration and synovial fluid levels of interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6) at different stages of RA. EC tallness was greatest in synovial tissues obtained by needle biopsy of the knee joints from 18 patients with active RA who had never received disease modifying drugs (Group 1) (p = 0.000001 versus controls). EC tallness in tissues obtained from 18 patients with advanced disease undergoing knee arthroplasty (Group 2) was greater than controls (p = 0.001) only when vessels located in focal lymphoid aggregates were considered. Vascular proliferation was noted in both groups. Synovial fluid IL-6 levels were greatest in Group 1. IL-1 beta levels were greatest in Group 2. The total numbers of infiltrating mononuclear cells and the clinical measures of disease activity were similar in both groups. The differences in EC characteristics at different stages of RA suggest changing pathogenic mechanisms as disease progresses. Disease modifying antirheumatic drugs may contribute to the findings observed.

Anti-Inflammatory Agents↗
PubMed1991

Primary fibromyalgia and the irritable bowel syndrome: different expressions of a common pathogenetic process.

Primary fibromyalgia (PFM) and the irritable bowel syndrome (IBS) are both common conditions which account for 30% or more of referrals to rheumatology and gastroenterology clinics. An association between symptoms in PFM and IBS has been suggested but the frequency with which they coexist has not been assessed. The aim of this study was to examine the prevalence of each condition in groups of patients with PFM and IBS compared to normal and disease control populations. We studied four patient groups, 20 patients in each group, with PFM, IBS, inflammatory arthritis, inflammatory bowel disease and also 20 normal controls. Using strict diagnostic criteria, each group was assessed by two investigators for symptoms and signs of PFM and IBS. Sigmoidoscopy was performed when indicated. Results indicate that 70% (14/20) of the PFM patients had IBS and 65% (13/20) of the IBS patients had PFM. This compared with the control groups where 12% (7/60) and 10% (6/60) had PFM and IBS respectively. In conclusion, these results indicate that PFM and IBS frequently coexist. A common pathogenetic mechanism for both conditions is therefore suggested.

Adult↗
PubMed1988

Prospective study of the evolution of Raynaud's phenomenon.

Seventy-four patients with Raynaud's phenomenon and no associated illness were followed prospectively to determine whether a secondary disease would develop, and clinical and laboratory assessments were performed at study entry to determine their association with the subsequent development of disease. After an average of 2.7 years of follow-up (range 0.5 to 5.7 years), outcome information was available on 58 persons (78.4 percent). A connective tissue disease developed in 11 (19.0 percent): three systemic sclerosis and eight CREST syndrome. The two variables at entry most strongly associated with the subsequent development of a connective tissue disease were an abnormal nailfold capillary pattern (adjusted odds ratio = 26.82, 95 percent confidence interval = 4.69, 153.2) and an abnormal pulmonary function test result (odds ratio = 4.78, 95 percent confidence interval = 1.02, 22.41). The positive association of an abnormal barium esophagram, presence of antinuclear antibodies, and cutaneous abnormalities did not reach statistical significance. The development of connective tissue diseases in this group of patients is not rare. An abnormal nailfold capillary pattern is strongly associated with the subsequent development of systemic sclerosis or CREST syndrome in patients with Raynaud's phenomenon.

Adolescent↗
PubMed1985

Effects of joint lavage on knee synovitis in rheumatoid arthritis.

Ten patients with rheumatoid arthritis and persistent knee synovitis had synovial fluid aspirated through a 14 gauge wide-bore needle followed by joint lavage and intra-articular triamcinolone. This resulted in the removal of variable quantities of intra-articular debris including rice bodies. When compared to a control group of patients, the addition of joint lavage to the standard procedure of aspiration and injection of corticosteroid resulted in more sustained resolution of synovitis after 12 weeks as judged by knee tenderness and circumference, recurrence of effusion, and synovial fluid leucocyte count. This study suggests that knee joint lavage may be a useful adjunct to therapy in rheumatoid arthritis patients having persistent knee synovitis.

Aged↗