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Biomedical subjects

R S Panush

Publications and source records attributed to R S Panush.

At least 19 recordsLinked to original sources
PubMed1992

Assessment and prognosis of rheumatoid arthritis.

Efforts continue to identify and consistently utilize those clinical, laboratory, imaging, and other features of rheumatoid arthritis that best reflect the disease process and its impact on individual patients. We seek descriptions that are accurate, reproducible, simple, sensitive, and predictive. Such assessments will lead to development of prognoses for individual patients and to more rational patient management. The past year has witnessed reemphasis of health status indexes (instruments) and other simple approaches to clinical assessment of patients, eg, use of standardized grip strength, button test, walk time, and modified articular indexes. Computed tomography and magnetic resonance imaging provided clinically important and otherwise unappreciated (but expensive) information about joint integrity and inflammatory disease with sensitivity and resolution considerably beyond conventional techniques. Laboratory assessment of patients included consideration or reconsideration of the utility of measurements of C-reactive protein, rheumatoid factors, immune complexes, complement receptors and complement activation products, antiperinuclear factors, trace elements, interleukins and interleukin receptors, soluble cell surface receptors, lymphoid cell phenotypes, and synovial immunohistology; all are important in the pathogenesis of rheumatoid arthritis and all have contributed variably to predicting patient outcomes. None were shown to be more clinically informative than erythrocyte sedimentation rate or C-reactive protein. The variables that have been associated with unfavorable prognosis for rheumatoid arthritis are also discussed. We hope that continued study will lead to identification and adoption of simple assessments that will prove to be powerful predictors of good or poor patient outcomes and stratification of patient risk. This uniform measure of disease assessment will improve judgments of potential benefits of therapeutic interventions.

Arthritis, Rheumatoid↗
PubMed1991

An animal model of food allergic arthritis.

Progress in understanding rheumatoid arthritis has been slow in large part because no widely accepted animal model exists that clearly reflects naturally occurring human disease, and because the clinical expression of rheumatoid arthritis may represent multiple etiologies with shared or subtly different immunopathogenic pathways. New insights about pathogenesis and causes are needed to understand this disease and ultimately to care for patients better.

Animals↗
PubMed1991

Does food cause or cure arthritis?

Rheumatoid arthritis and most other forms of inflammatory joint disease--systemic rheumatic diseases--remain illnesses of unknown cause for which current therapy often is inadequate. The possibility that food antigens induce or perpetuate symptoms in at least some patients is novel, rational, and exciting. Studies that relate diet with arthritis might offer the potential of identifying new therapeutic approaches for selected patients and of developing new insights into disease pathogenesis.

Arthritis↗
PubMed1991

Should nonsteroidal anti-inflammatory drugs be stopped before elective surgery?

PURPOSE: --To determine if perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) might be associated with increased postoperative morbidity. PATIENTS AND METHODS: --Records from 165 patients undergoing total hip arthroplasty from 1984 to 1987 were reviewed. Patients taking NSAIDs at hospital admission were compared with those who were not. RESULTS: --Patients taking NSAIDs had more postoperative bleeding complications (gastrointestinal tract bleeding and/or hypotension) than did patients not taking those agents. Complications were more frequent in patients using NSAIDs with half-lives longer than 6 hours. CONCLUSION: --Patients undergoing elective surgery should stop taking NSAIDs in time to allow elimination of the drug; those patients who need to take these agents perioperatively should use drugs with short half-lives.

Adult↗
PubMed1990

Corot's 'gout' and a 'gipsy' girl.

Representations of rheumatic disease in art provide insight into artistic expression, help us understand the evolution and perhaps the etiology of rheumatic diseases, and remind us of great contributions by artists in adverse circumstances. We noted hand deformities characteristic of inflammatory arthritis in Jean-Baptiste-Camille Corot's Gipsy Girl With Mandolin (1870 to 1875), National Gallery of Art, Washington, DC. Corot suffered with what probably was gout beginning in 1866. We are unaware that arthritis has been observed in Corot's subjects or that Corot's depiction of arthritis has been appreciated from the perspective of his own rheumatic disease. Examination of other Corot portraits identifies some with blurred hand details consistent with the artist's style and the remainder with normal hands. These observations suggest that the artist portrayed specific anatomic abnormalities in the "Gipsy Girl's" hand, indicating familiarity with inflammatory arthritis. It is speculative whether this was Corot's own or the model's arthritis; we favor the interpretation that Corot's gout was reflected in this particular work. We thus add a new perspective to Corot's Gipsy Girl With Mandolin-a subject with arthritis, a painter knowledgeable about arthritis, and a painting that therefore might be understood at least in part from an appreciation of the artist's specific illness.

Art↗
PubMed1990

Magnetic resonance imaging in patients with inflammatory arthritis of the knee.

Magnetic resonance imaging (MRI) permits visualization of anatomic structures not appreciated by conventional radiographic imaging and may quantify inflammatory disease and its progression with greater sensitivity than available techniques. We therefore compared MRI with clinical evaluation and with radiographic examination of 17 patients with inflammatory arthritis of the knee. We sought to determine anatomic integrity of bone, cartilage, menisci, and ligaments, and to quantify joint effusion and synovial proliferation. Patients studied had rheumatoid arthritis (10 patients), juvenile rheumatoid arthritis (4 patients), ankylosing spondylitis (1 patient), and monoarticular arthritis (2 patients). In all patients MRI revealed clinically important abnormalities not detected by physical or conventional radiographic exams. These included proliferative synovitis (13 patients), cartilage thinning (2 patients), cartilage erosion (8 patients), bone infarction (1 patient), meniscal injury (1 patient), and synovial invagination into bone (1 patient). Also MRI indicated inflammatory disease to be quantitatively greater than had been appreciated on clinical examination or routine X-ray studies--proliferative synovitis (12 patients), erosion (7 patients), effusion (8 patients), cartilage thinning (11 patients), and ligamentous/meniscal damage (1 patient). These findings led to reassessment of anatomic staging and influenced therapeutic decision for these patients. Thus MRI provides clinically important information about joint integrity and inflammatory disease, with a sensitivity and resolution considerably beyond conventional techniques.

Adult↗
PubMed1990

Does exercise cause arthritis? Long-term consequences of exercise on the musculoskeletal system.

Recreational exercise has achieved great popularity. Possible benefits to participants include increased longevity, decreased risk of cardiovascular disease, improved psychological well-being, and greater fitness. An important but yet unanswered concern is whether exercise or physical overuse conditions play a role in the pathogenesis of OA. In humans, anecdotal observations have suggested relationships between recreational activities and degenerative joint disease. The few controlled studies that exist, however, reported have indicated that exercise need not be deleterious to joints. Available data may be interpreted to suggest that reasonable recreational exercise--carried out within limits of comfort, putting joints through normal motions, and without underlying joint abnormality--need not inevitably lead to joint injury, even over many years. Finally, we are witnessing thoughtful re-evaluation of physical exercise as a therapeutic modality for arthritis patients. It is possible that certain patients may achieve psychological and clinical benefit from selected exercise programs.

Exercise↗
PubMed1990

Food induced ("allergic") arthritis: inflammatory synovitis in rabbits.

Progress in understanding rheumatoid (RA) and inflammatory arthritis has been limited in part because there has been no widely accepted animal model of naturally occurring human disease and because the clinical syndrome of RA may reflect the expression of multiple etiologies. We have considered that inflammatory joint disease may be induced and/or exacerbated by food related antigens. To facilitate our investigations, we studied inflammatory synovitis in rabbits induced by oral exposure to environmental antigens. In our preliminary experiments, we examined 9 Florida White, 30 New Zealand White, and 9 Old English rabbits. They were nourished with normal rabbit chow supplemented with either water or cow's milk beginning at age 7 to 26 weeks and observed for 81 to 204 days. Animals were then sacrificed. Histological sections of the knees were examined and graded in a blinded fashion for synovial cell hyperplasia, inflammation, and lymphoplasmocytic infiltration. In addition, serum levels of IgG antimilk, IgG antibovine serum albumin, IgG anticasein, and IgG-C3 complexes were quantified. We found no abnormalities among Florida White rabbits but observed histological synovitis in 53% of the milk fed New Zealand White (9/17), 40% of the water fed Old English (2/5), and all of the milk fed Old English rabbits (4/4) (p = 0.05, milk fed vs water fed animals). Milk fed animals had significantly (p less than 0.0005) greater levels of antibodies and complexes than water fed animals. Our data suggest that environmental antigens may be arthritogenic for some rabbit strains. These observations may provide an important model for the study of inflammatory joint disease analogous to oral, environmental antigen exposure in man.

Animal Husbandry↗
PubMed1990

Food induced ("allergic") arthritis: clinical and serologic studies.

These studies sought to confirm our recent report of a patient with rheumatoid-like arthritis (RA) with clinical and immunologic milk sensitivity, to assess the prevalence of food related rheumatic symptoms, and to identify clinical and serological features of these patients. Thirty percent of our patients with RA alleged food related ("allergic") arthritis. Sixteen patients have now completed 19 double blind, controlled food challenge studies: 3 demonstrated subjective and objective rheumatic symptoms after double blind, encapsulated food challenges. The 3 were virtually asymptomatic when receiving elemental nutrition or not taking the offending foods. One was our milk sensitive patient who had increased IgG4 anti-alpha-lactalbumin, IgG-milk complexes, and delayed skin and cellular reactivity to milk; one developed inflammatory synovitis after shrimp ingestion and had increased IgG antishrimp; and another was a cardiac care unit (CCU) nurse who experienced rheumatic symptoms after exposure to nitrates. All were seronegative with palindromic symptoms and nonerosive disease. IgG, G4, A, M, and E antifood, Ig-food immune complexes, and in vitro cellular reactivity to foods were not otherwise distinctively abnormal in these or other patients with rheumatic diseases. Thus most patients alleging food induced rheumatic symptoms did not show these on blinded challenge, but some did. Probably not more than 5% of rheumatic disease patients have immunologic sensitivity to food(s). Such patients have been identified only by controlled challenge studies. These observations suggest a role for food allergy in at least some patients with rheumatic disease.

Adolescent↗
PubMed1989

Human mononuclear cells and neutral proteinases. III. Neutral proteinases and rheumatoid arthritis: monocytes as a source of cathepsin G and proteinase potentiation of IgM rheumatoid factor elaboration.

We have been interested in contributions of certain cells and mediators to synovial inflammation rheumatoid arthritis (RA). The present studies were designed to determine (1) whether monocytes contained the neutral proteinase cathepsin G and (2) if neutral proteinase could induce or potentiate cellular IgM rheumatoid factor (RF) production. Monocyte-rich and monocyte-poor populations were isolated by Ficoll-Hypaque density sedimentation followed by glass adherence, and cellular lysates were obtained by repetitive freezing and thawing as we have reported for neutrophil-derived neutral proteinase. Cathepsin G was quantified immunochemically by an enzyme-linked immunoassay (ELISA) we developed utilizing commercially available anti-cathepsin G antibodies. Mononuclear and B-cell-enriched cell cultures were prepared by standard methods and IgM RF measured by our ELISA. Cell-derived lysates from monocyte-enriched populations (84 +/- 3% monocytes, less than 1% neutrophils) contained considerably greater amounts of measurable cathepsin G (OD280 = 0.393 +/- 0.153) than lysates from equal numbers of monocyte (15 +/- 2% monocytes, less than 1% neutrophils)-depleted cells (OD280 = 0.071 +/- 0.038; P less than 0.05). Eighteen patients with RA and three normal individuals did not have consistently increased cellular elaboration of Ig or IgM RF in vitro in response to proteinase (trypsin) stimulation; however, patients manifested 80% potentiation by trypsin of pokeweed-stimulated cellular IgM RF production in vitro (pokeweed-stimulated IgM RF 137 +/- 53 ng/ml, pokeweed/trypsin-induced IgM RF 246 +/- 100 ng/ml; P less than 0.02), changes being most striking for those patients seropositive by latex fixation test (84% increase, P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adjuvants, Immunologic↗
PubMed1989

Profile of a meeting: how abstracts are written and reviewed.

We analyzed submissions to a recent scientific program to determine (1) how abstracts were reviewed and (2) what constituted a successful abstract. We found that (1) reviewers' gradings varied from 2-29%, in some instances differing significantly; (2) many (<74%) abstracts had inadequacies in form, title, introduction, aims, methods, results, and conclusions(collectively termed "content") or lacked numerical or statistical data; (3) accepted abstracts had fewer inadequacies and better "content"; and (4) abstract grades correlated closely with "content". The quality of preparation and of individual features of abstracts led to favorable review. This information is of potential value to scientists preparing and reviewing abstracts and planning programs.

Abstracting and Indexing↗
PubMed1989

How to evaluate patients for rheumatic diseases.

The rheumatic diseases encompass many common and uncommon disorders. The information derived from a careful history and physical examination can help define the urgency of the problem, classify the disease, provide diagnosis, and permit optimal therapy.

Arthritis↗
PubMed1989

Incomplete lupus erythematosus.

Thirty-eight patients with incomplete lupus erythematosus (ILE) (defined as the presence of fewer than four of the criteria of the American College of Rheumatology for systemic lupus erythematosus [SLE]) were identified and compared with 42 patients with SLE. Both groups were comparable with respect to age, sex, and race. Patients with ILE had symptoms for an average of 38 months before seeking rheumatologic care and were followed up for a mean of 19 months; patients with SLE averaged 9 months with symptoms before their diagnosis was made and were followed for a mean of 30 months. Characteristic clinical features of patients with ILE included positive antinuclear antibody titers (83%), polyarticular nonerosive arthritis (47%), and cutaneous findings (61%). These were comparable with findings in the the SLE group. However, patients with ILE had significantly fewer systemic manifestations than did those with SLE. Patients with ILE were treated with nonsteroidal anti-inflammatory drugs more frequently (47%) than were patients with SLE, while the latter group received more topical and oral corticosteroids and immunosuppressives. Only two of the patients with ILE went on to have typical SLE. Thus, ILE may be frequent, mild, and relatively stable or benign, apparently evolving slowly if at all into SLE or other rheumatic disease.

Adolescent↗
PubMed1988

Pharmacologic immunoenhancement in the elderly: in vitro effects of isoprinosine.

The loss of immune competence that occurs with aging may be responsible for increased morbidity and mortality in elderly individuals. Pharmacologic modulation of the immune response might reverse the immunologic aberrations associated with aging. We, therefore, investigated the effects of isoprinosine, an immunoenhancing drug, on selected in vitro immune responses in elderly subjects. Subjects studied were 65 years of age or older, and all had chronic diseases. We chose this population since they were at greatest risk for morbid events. Isoprinosine significantly enhanced mitogen-stimulated mononuclear cell proliferation, did not affect unstimulated cell growth, and needed to be present for the entire culture period for maximum effect. Isoprinosine is a potent in vitro immunoenhancing agent in aged humans.

Aged↗
PubMed1988

Vasculitis associated with malignancy. Experience with 13 patients and literature review.

Vasculitis is a syndrome which may complicate certain infectious, rheumatic, and allergic diseases. We identified 13 patients, over the past 17 years, who had both vasculitis and lympho- or myeloproliferative disorders and relate their clinical, laboratory, histologic, and immunologic features, course, therapy, and outcome. Nine patients were male, 4 female; ages ranged from 28 to 82 years. Ten of 13 patients presented with cutaneous vasculitis antedating malignancy by an average of 10 months. Three of 13 developed cutaneous vasculitis after malignancy. A statistically significant association between cutaneous vasculitis and lympho- or myeloproliferative malignancies was noted when compared with all other tumors. Dermatologic manifestations included palpable purpura (5 patients), maculopapular eruptions (4), urticarial and petechial lesions (3), and ulcers (1). Hepatitis B surface antigen, Coombs antibodies, rheumatoid factor and antinuclear antibodies were not found. Serum cryoglobulins were detected in 3 patients; serum C3 and C4 were normal in 8 of 9 patients evaluated. Histologic examinations revealed necrotizing leukocytoclastic vasculitis with disruption of endothelial integrity, destruction of endothelium, and neutrophil infiltration. Occasional perivascular mononuclear cell invasion was also noted in 4 patients. Immunofluorescent staining for IgG, IgA, IgM, C3, and C4 was negative in all patients studied. Symptoms were, in general, poorly responsive to therapy, which included nonsteroidal antiinflammatory drugs, antihistamines, antiserotonin agents, and corticosteroids. Chemotherapy directed at the underlying malignancy was also generally ineffective, although the vasculitis appeared to lessen in severity. Vasculitis appeared to lessen in severity as bone marrow function deteriorated. Ten patients died, all as a direct result of their malignancy. We have described a unique clinical syndrome of lympho- and myeloproliferative disease presenting with small-vessel vasculitis. Recognition that rheumatic symptoms may reflect or antedate malignancy may permit early diagnosis, aggressive treatment, and elucidation of pathogenesis.

Adult↗