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Biomedical subjects

P Sheldon

Publications and source records attributed to P Sheldon.

At least 19 recordsLinked to original sources
PubMed2004

A randomised placebo controlled 12 week trial of budesonide and prednisolone in rheumatoid arthritis.

OBJECTIVES: To compare budesonide, a locally acting glucocorticoid with minimal systemic exposure, with conventional glucocorticoid treatment and placebo in rheumatoid arthritis. METHODS: A double blind, randomised, controlled trial over 12 weeks in 143 patients with active rheumatoid arthritis, comparing budesonide 3 mg daily, budesonide 9 mg daily, prednisolone 7.5 mg daily, and placebo. Particular attention was paid to the pattern of clinical response and to changes in the four week period following discontinuation of treatment. RESULTS: There were improvements in tender joint count and swollen joint count on budesonide 9 mg compared with placebo (28% for tender and 34% for swollen joint counts, p<0.05). Prednisolone 7.5 mg gave similar results, while budesonide 3 mg was less effective. ACR20 response criteria were met by 25% of patients on placebo, 22% on budesonide 3 mg, 42% on budesonide 9 mg, and 56% on prednisolone 7.5 mg. A rapid and significant reduction in symptoms and signs in response to budesonide 9 mg and prednisolone 7.5 mg was evident by two weeks and maximal at eight weeks. There was no evidence that budesonide provided a different pattern of symptom control from prednisolone, or that symptoms became worse than placebo treatment levels after discontinuation of glucocorticoid treatment. Adverse effects attributable to glucocorticoids were equally common in all groups. CONCLUSIONS: The symptomatic benefits of budesonide 9 mg and prednisolone 7.5 mg are achieved within a short time of initiating treatment, are maintained for three months, and are not associated with any rebound in symptoms after stopping treatment.

Adult↗
PubMed2003

Ileum-targeted steroid therapy in rheumatoid arthritis: double-blind, placebo-controlled trial of controlled-release budesonide.

In order to determine whether budesonide, which is believed to exert most of its anti-inflammatory effects in the intestinal tract, has a beneficial effect on disease activity in rheumatoid arthritis (RA), we treated 26 patients with active RA in double-blind fashion with either controlled ileal-release budesonide (9 mg by mouth) ( n=14) or placebo ( n=12). All patients remained on their existing disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs (NSAIDs). Paracetamol was used for escape analgesia. Evaluations were performed at 0, 2, and 4 weeks and included tender and swollen joint counts, duration of morning stiffness, visual analogue scale for pain (VAS) on a 100-mm horizontal scale, grip strength using a vigorimeter (lb/in(2)), haemoglobin, erythrocyte sedimentation rate (ESR) (Westergren method, mm/1st h), plasma viscosity (PV) in cP (normal range 1.5-1.72), C-reactive protein (CRP) (normal upper level 1 mg/dl), random plasma cortisol (nmol/l) drawn between 10 a.m. and 2 p.m., and blood pressure. Disease activity scores based on 28 joints (DAS 28) were also derived at all time points. Within-group comparisons revealed significant improvement in the budesonide-treated but not the placebo group with respect to numbers of tender and swollen joints, duration of morning stiffness, grip strength, pain, ESR, PV, and DAS 28. Between-group comparisons showed significant differences for ESR, PV, pain, and random plasma cortisol (drawn between 10 a.m. and 2 p.m.). There were no significant side effects in either group.

Administration, Oral↗
PubMed2003

Comparative study of bone mineral density, calcium, and vitamin D status in the Gujarati and white populations of Leicester.

OBJECTIVES: To evaluate differences in bone mineral density (BMD), calcium, and vitamin D status between the Gujarati (South Asian) and white populations resident in Leicester and to determine whether this was linked to lifestyle factors. DESIGN: An observational cross sectional study of randomly selected Gujarati and white volunteers aged from 20-40 years. SETTING: City of Leicester. PARTICIPANTS: Subjects were randomly selected by age (20-40 years) and ethnicity. A total of 262 individuals volunteered to participate, of which 201 (51 white females, 71 Gujarati females, 37 white males, 42 Gujarati males) were eligible for the study. MAIN OUTCOME MEASURES: Results of questionnaire, BMD at the hip and lumbar spine, and measurement of serum calcium, albumin, alkaline phosphatase, and 25-hydroxyvitamin D. RESULTS: Male and female white subjects were significantly taller and heavier than their Gujarati counterparts. There was a statistically significant difference in BMD both at the spine (p<0.001) and hip (p<0.001) between the white and Gujarati females with the Gujaratis having a lower BMD. There was a trend for Gujarati males to have a lower BMD at the hip and spine than their white counterparts but these figures did not reach statistical significance. The intensity of cigarette smoking and the amount of alcohol consumption were both higher in the white male and female subjects. Sunlight exposure (>4 hours per day) was significantly higher in white subjects compared with Gujaratis. There were no significant differences in the mean level of serum calcium or alkaline phosphatase between the Gujaratis and whites. A significantly higher proportion (p<0.001) of the Gujarati men and women had a vitamin D level that was not measurable (that is, below the lower limit of the laboratory range of normal). Of those who had a measurable level (that is, in the normal range) mean levels of vitamin D were lower (p<0.05) in the Gujarati men and women. CONCLUSION: The present study is the first of its kind to note a low BMD in Gujarati subjects of South Asian origin compared with their white counterparts, living in Leicester. This study also confirms the presence of low serum vitamin D levels in Gujaratis. There is a need for more research in South Asians with regard to the collection of normal BMD values. This could provide a more meaningful reference range for identifying South Asians at risk of osteoporotic fractures and may have public health implications of relevance to this ethnic group.

Adult↗
PubMed1998

Steroid pulse therapy for rheumatoid arthritis: effect on lymphocyte subsets and mononuclear cell adhesion.

Eighteen patients with clinically active rheumatoid arthritis, satisfying the ARA criteria, were admitted to hospital for i.v. methylprednisolone pulse therapy. Studies of circulating lymphocyte subsets 1 h before and 24 h after pulsing were carried out together with studies on their adhesion to endothelium-containing lamina propria of porcine gut at various time points. Additionally, circulating VCAM-1 was estimated pre- and post-pulse by ELISA. We observed a marked fall (59%) in mononuclear cell adhesion 24 h post-pulse therapy (P < 0.001). Accompanying this was a significant, though slight, fall in circulating mononuclear cells (P < 0.01), mainly involving T cells. However, the degree of reduction in cell adhesion did not appear to reflect change in any particular circulating subset, but was more likely due to changes in adhesion molecule expression of several subsets. No significant change in circulating VCAM-1 was observed. It would appear, therefore, that the early beneficial effect of steroid pulsing in rheumatoid arthritis coincides with a demonstrable reduction in cell adhesion to gut. This may have implications for the pathogenesis of this disease.

Aged↗
PubMed1996

Adhesion of rheumatoid lymphocytes to mucosal endothelium: the gut revisited.

By a study of the adhesion of rheumatoid mononuclear cells, we have sought to clarify the homing properties and origins of cells likely to be involved in the pathogenesis of this disease. The adhesion of mononuclear cells from patients with rheumatoid arthritis (RA) was enumerated by an in vitro adherence assay using frozen sections of endothelium-containing gut lamina propria (EGLP) from porcine small intestine. Preliminary studies verified the involvement of known adhesion molecules by inhibition assays using monoclonal antibodies Meca-367, Mel-14 and Hermes-3. Twenty-five paired samples of peripheral blood (PB) and synovial fluid (SF) were studied, plus six from synovial membrane (SM) and eight from patients with other diseases. There was a significantly greater degree of adherence to EGLP by SF cells than PB (mean adherence 266 +/- 22 cells/mm(2), compared to 136 +/- 13 cells/mm(2), respectively, the majority of which were CD8+ cells; P=0.02, Mann-Whitney U-test for 25 paired samples). The results of the monoclonal antibody inhibition assays were in keeping with the involvement of homing receptors to gut endothelium in our assay system. Synovial fluid lymphocytes from RA patients exhibited adhesion properties more in keeping with lymphocytes of mucosal than of lymph node origin. Synovial membrance lymphocytes, by contrast, showed poor adherence to endothelium-containing lamina propria. The gut, as an immune lymphoid organ, may thus play a contributory role in this disease, possibly through the pathological seeding of cells into the synovial space.

Animals↗
PubMed1995

Effect of corticosteroid on lymphocyte adhesion.

Pulse steroid therapy is utilised in the treatment of vasculitis and active rheumatoid arthritis. Decreased entry of lymphocytes to sites of cell-mediated immune reactions is well recognised, though the mechanism is not fully understood. It may involve adhesion to endothelium. We have therefore measured the effect of methylprednisolone on lymphocyte adhesion to porcine lamina propria endothelium. A marked decrease in adhesion was found after incubating cells at 4 degrees C or at room temperature, with a clear dose response effect, from 0.46mM to 6.3mM. We have previously demonstrated binding of rheumatoid synovial fluid mononuclear cells to lamina propria endothelium. It is suggested that the ameliorating effect of steroid pulsing may be mediated by down-regulating adhesin expression of a gut-seeking population of cells.

Animals↗
PubMed1994

Cryptic Wegener's granulomatosis revealed after 18 years.

A 48-yr-old female is described. She presented with subglottic stenosis requiring permanent tracheostomy, followed after 2 yr by an inflammatory polyarthritis, treated as rheumatoid. Eighteen years later, a vasculitic illness characterized by rash, weight loss, fever, and mononeuritis multiplex drew attention to the likelihood of a unifying diagnosis. A solitary lung opacity in the absence of nodules elsewhere and a positive ANCA (albeit of perinuclear specificity), made the diagnosis of Wegener's granulomatosis most likely. The combined exhibition of systemic corticosteroids and immunosuppressive drugs was only required 18 yr after onset, and illustrates the relatively benign course that this disorder can take.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1994

Systemic lupus erythematosus: considerations for a genetic approach.

There is a powerful evidence suggesting that etiology and pathogenesis of systemic lupus erythematosus has both genetic and environmental components. Unfortunately, understanding the genetics of lupus has been impeded by knowing the pattern of inheritance. Indeed, a complex mode of inheritance for the lupus disease phenotype is suggested by the known characteristics of this disorder. Twenty-five multiplex pedigrees for lupus have been enrolled and have been used to evaluate power to reveal linkage. The power to find linkage in these pedigrees is greater for autosomal recessive than for autosomal dominant modes of inheritance. Once 100 similar pedigrees are available for analysis our results predict that linkage is likely to be present for genetic models with relatively relaxed requirements. At loci operating by autosomal recessive inheritance linkage should be detectable despite genetic homogeneity as low as 40% and penetrance as low as 50%. For loci operating by autosomal dominant inheritance genetic homogeneity must be 60% or more when penetrance is as low as 50% to be able to establish linkage. Available preliminary data are also consistent with a possible genetic linkage of Fc gamma RIIIPMN with lupus in American Black pedigrees multiplex for lupus.

Alleles↗
PubMed1994

Dorrigocins: novel antifungal antibiotics that change the morphology of ras-transformed NIH/3T3 cells to that of normal cells. I. Taxonomy of the producing organism, fermentation and biological activity.

The dorrigocins are new secondary metabolites produced by submerged fermentation of a streptomycete which was isolated from a soil sample collected in Australia. The dorrigocins show moderate antifungal activity and reverse the morphology of ras-transformed NIH/3T3 cells from a transformed phenotype to a normal one. The producing culture was identified as Streptomyces platensis subsp. rosaceus strain AB1981F-75.

3T3 Cells↗
PubMed1994

High-technology in home care. An overview of intravenous therapy.

The administration of i.v. medications in the home environment has proven to be a viable and highly desirable alternative to traditional hospitalization. Technology has been the driving force behind the safe transition of the more acutely ill patient from the hospital to the home. The variety of infusion pumps and venous access devices available provides a number of therapy choices, each tailored to the needs of the individual patient. Home infusion therapy allows for the integrity of the family to remain intact and provides the option for greater participation by the patient and caregiver in the development and implementation of the treatment plan. Most important, technology has led to the evolution of home infusion therapy as a high-quality, cost effective approach to care in a troubled health delivery system.

Catheterization, Central Venous↗