PubMed Health⌕ Search

Biomedical subjects

P Klimiuk

Publications and source records attributed to P Klimiuk.

8 recordsLinked to original sources
PubMed2004

The prevalence and management of hyperglycaemia in patients with rheumatoid arthritis on corticosteroid therapy.

BACKGROUND AND AIMS: Corticosteroids are commonly used in the treatment of RA. Hyperglycaemia resulting from corticosteroid use can lead to problems, particularly in those with impaired glucose tolerance and diabetes mellitus. We have examined how rheumatology clinics monitored and managed hyperglycaemia at base line and during treatment of patients with rheumatoid arthritis on corticosteroids. METHODS: Case notes of 102 patients with established RA, on long-term steroids were reviewed. We recorded a) blood glucose level at base line and whilst on steroids b) when and whether hyperglycaemia was addressed. RESULTS: There were 24 males and 78 females, with mean age of 62 +/- 15 years. Patients were on corticosteroids for a median duration of 24 months. Seventy-five per cent of patients were treated with oral prednisolone, the rest, except one patient on deflazacort, were on methylprednisolone. Blood glucose was measured at baseline in 97% of patients with 37% and 38% being monitored at three months and six months respectively and 36% annually thereafter. Nine patients (8.8%) developed diabetes mellitus during treatment, but one patient was detected and managed. There were six patients with existing diabetes mellitus in whom glycaemic control worsened between three to six months, but only one patient had treatment adjusted. CONCLUSIONS AND RECOMMENDATIONS: Physicians need to be aware that corticosteroids can increase blood glucose, worsen pre-existing diabetes and predispose to diabetes mellitus. Patients on long-term corticosteroids should be monitored at regular intervals as corticosteroid induced glycaemic excursions may lead to the development of diabetes mellitus and increased coronary risk.

Adrenal Cortex Hormones↗
PubMed2004

Influence of doxycycline on the epiphyseal plate cartilage of the rats in experimental osteoarthrosis, induced by iodoacetate.

In 36 Wistar rats with the iodoacetate-induced experimental osteoarthrosis (OA), effects of doxycycline, given orally, were determined on histochemical reactions of glycosaminoglycans (GAG) in the epiphyseal plate cartilage. The epiphyseal plate of rats with OA was reduced in height (especially the proliferative zone), cell columns were disorganized, many chondrocytes were irregular and polygonal, their nuclei were pycnotic, the intensity of GAG staining was irregular and predominantly reduced, which can be interpreted as signs of degeneration. A concomitant administration of doxycycline in the second group of rats prevented, to some extent, the negative effects of iodoacetate on chondrocytes and led to a more pronounced intensity of GAG reactions in the matrix of the epiphyseal plate.

Animals↗
PubMed2000

Corticosteroids do not alter the threshold for vertebral fracture.

Corticosteroid use is one of the most important secondary causes of osteoporosis. Generally, it has been believed that in addition to its effect on bone mineral density (BMD), it also causes an alteration in bone quality that means that fractures occur at a lower BMD than might be expected. To establish if this is the case, we have compared the relationship between BMD and vertebral fracture in patients receiving corticosteroids with that in patients who had never received such therapy. Information was gathered on those patients who had been referred to the participating centers and had both BMD measurements and lateral thoracolumbar radiographs. In all, 452 patients (391 female) were identified; of these 82 (63 female) were receiving corticosteroids. There was no significant difference in BMD between the patients on corticosteroids and those with other suspected causes of osteoporosis. Vertebral fractures were present in 53% of patients on steroids compared with 35% of those who had no such treatment (p = 0.0035). The fractures were more likely to be multiple in patients on corticosteroids (p = 0.0042). However, if the relationship between bone density and fracture is investigated by plotting the cumulative prevalence of fracture against the bone density, measured by T score, the median BMD for fractures actually was marginally lower in patients on steroids, -2.74 (95% confidence interval [CI], -2.77 to -2.70) compared with -2.65 (95% CI, -2.66 to -2.65) in those who had not received steroids. Our results fail to support the notion that the fracture threshold is altered in patients on long-term steroids and suggest that the same diagnostic criteria should be used for osteoporosis in patients whether or not they are taking corticosteroid therapy.

Adrenal Cortex Hormones↗
PubMed1991

Peripheral nerve dysfunction in scleroderma.

Peripheral neuropathy in patients with scleroderma is thought to be rare. We have undertaken a quantitative assessment of peripheral nerve function in 29 patients with either limited cutaneous scleroderma or progressive systemic sclerosis. Tactile thresholds were raised in the fingers in 28 per cent of patients and in the foot in 50 per cent. Two-point discrimination was abnormal in 10 patients, thermal thresholds were abnormal in five and vibration thresholds were abnormal in one. Nerve conduction studies showed abnormalities in six patients, five of whom had clinical signs of a mild peripheral neuropathy: the mean duration of disease in these six patients was 10 years longer than that in the remainder of the patients. There was electrophysiological evidence of a subclinical carpal tunnel syndrome in two patients. The sympathetic skin response was recorded in 16 patients who had not been subjected to sympathectomy for Raynaud's phenomenon, and was abnormal in four. These results indicate that peripheral nerve dysfunction in scleroderma, though mild, is not as uncommon as previously thought. The abnormal cutaneous sensory thresholds may be partly due to altered viscoelastic properties of the skin, but abnormal responses in the lower limbs to tests of tactile sensitivity, the clinical findings and the disturbances of nerve conduction argue in favour of an additional neuropathic process in some patients. Low grade distal nerve trunk ischaemia may be responsible.

Adult↗
PubMed1990

Platelet and plasma vasoactive amines in type 1 (insulin-dependent) diabetes mellitus with and without vascular disease.

Platelet and plasma vasoactive amine concentrations were measured in healthy controls and in type 1 (insulin-dependent) diabetic patients with or without vascular disease. Platelet concentrations of serotonin and noradrenaline were similar in all groups and were unrelated to age or gender, or to duration of diabetes, blood pressure, glycaemia or renal function in the diabetic subjects. Plasma concentrations of serotonin in the diabetic groups were comparable (118 +/- 16 (mean +/- SEM) and 127 +/- 21 pmol/mL), and were significantly higher in comparison to the healthy controls (66 +/- 12 pmol/mL, P = 0.002).

Adolescent↗
PubMed1985

Genetic variants of properdin factor B (Bf) in rheumatoid arthritis.

Properdin factor B (Bf) phenotyping was carried out in 392 patients with rheumatoid arthritis (RA) and in 360 controls. In RA there were increased frequencies of both the Bf*S gene (83 vs 78%; pc = 0.0003) and the BfSS genotype 73 vs 61%; pc = 0.0002) and reduced frequencies of the Bf*F1 gene (0.5 vs 2.2%; pc = 0.03) and the BfFS genotype (20 vs 29%; pc = 0.0007). The frequencies of Bf*S in DR4 positive and DR4 negative RA were similar so that the findings were not accounted for by linkage disequilibrium between DR4 and Bf*S.

Arthritis, Rheumatoid↗