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Biomedical subjects

R Wernick

Publications and source records attributed to R Wernick.

At least 19 recordsLinked to original sources
PubMed2000

Update in rheumatology.

Explore the source record for details and available documents.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Common nonarticular syndromes in the elbow, wrist, and hand.

Nonarticular elbow, wrist, and hand discomfort commonly results from periarticular or tendon disorders or nerve entrapment. Physicians with a practical knowledge of upper extremity anatomy and mechanics and an awareness of the typical features of disease are best equipped to treat these often-encountered conditions. Therapy is based on an accurate diagnosis and should be tailored to each disorder.

Arm↗
PubMed1992

Tophi as the initial manifestation of gout. Report of six cases and review of the literature.

The development of tophi in the absence of prior episodes of gouty arthritis is unusual. We present six such cases and review 26 previously published cases. These patients differ from those with typical gout in that they were older, more likely to be women, and usually had predominant or exclusive finger involvement. Most had renal insufficiency and many were receiving an anti-inflammatory or diuretic. Although several possibilities for the lack of gouty arthritis in the presence of tophi exist, usually no clear explanation is found.

Adult↗
PubMed1991

"Tumoral" enthesopathy: a juxtacortical osteosarcoma simulation.

A patient with psoriatic arthritis involving the ankles and feet developed a rapidly progressive large juxtacortical bony proliferative lesion arising from the right proximal radius at the bicipital tendon insertion site. The radiographic pattern was compatible with a juxtacortical periosteal osteosarcoma. We discuss the similar radiographic findings between a surface osteosarcoma and florid inflammatory enthesopathy that was found upon biopsy.

Adult↗
PubMed1990

The utility of routine screening of patients with uveitis for systemic lupus erythematosus or tuberculosis. A Bayesian analysis.

The indications for many laboratory tests in patients with uveitis are controversial. Bayes' theorem allows a mathematical approach to the assessment of the utility of a laboratory test based on the sensitivity of the test, the specificity of the test, and the pretest likelihood that the disease the test is intended to identify is present. We have utilized Bayes' theorem to assess the utility of routine antinuclear antibody and purified protein derivative testing in patients with uveitis. Based on published data about the sensitivity and specificity of each of these tests, as well as the prevalence of systemic lupus erythematosus and tuberculosis among patients with uveitis, we calculated that a patient with uveitis and a positive antinuclear antibody test result has less than a 1% chance of having systemic lupus erythematosus and that a patient with uveitis and a positive purified protein derivative test result has a 1% likelihood of having tuberculosis. These low probabilities mean that neither test is useful in the routine evaluation of patients with uveitis, and indiscriminate use may lead to improper diagnosis, increased costs, and, occasionally, inappropriate therapy.

Adult↗
PubMed1989

Central nervous system toxicity associated with weekly low-dose methotrexate treatment.

Central nervous system (CNS) toxicity from low-dose methotrexate (MTX) has been reported rarely, and reported symptoms consist primarily of dizziness and headache. We reviewed the records of 25 consecutive patients treated with low-dose MTX, and found 5 who had spontaneously reported unpleasant cranial sensations, mood alteration, or memory impairment. Rechallenge with MTX on 5 occasions in 3 patients led to recurrent CNS symptoms in all cases. CNS toxicity was the sole reason for discontinuation of MTX in 2 patients. These 5 patients differed from the 20 without CNS toxicity in age (mean 68 versus 50) and baseline serum creatinine level (1.3 mg/dl versus 0.9 mg/dl), but not in weekly dosage of MTX (12 mg versus 16 mg). These results suggest that CNS toxicity is more common than previously reported, particularly in older patients with mild renal insufficiency.

Adolescent↗
PubMed1989

Bilateral hypothenar hammer syndrome: an unusual and preventable cause of digital ischemia.

Unilateral ischemia of hand digits is usually caused by thoracic outlet obstruction, arterial emboli from a cardiac source, or atherosclerosis. The case of a metal press worker with unilateral ischemia due to hypothenar hammer syndrome, a condition caused by the repetitive use of the hypothenar eminence as a hammer with resultant damage to the ulnar artery, is described. Most such patients present with unilateral ischemia in the ulnar artery distribution of the dominant hand. This patient had used both hands repeatedly to pound the edges of large steel plates and presented with nondominant-hand ischemia, but was found to have the syndrome bilaterally by angiography. The distinctive features of this syndrome, a preventable and treatable cause of digital ischemia, are emphasized.

Adult↗
PubMed1989

Avoiding laboratory test misinterpretation in geriatric rheumatology.

In this review, basic principles of test selection and interpretation are applied to those serologic studies of most value to the clinician attempting to diagnose rheumatic disease in the elderly--erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and fluorescent anti-nuclear antibody (FANA). Essentials of each test are discussed and the significance of "normal" and "abnormal" results is illustrated in varied clinical circumstances. None of the tests is diagnostic and because false positive results are more common in healthy elderly subjects, the clinician faces the pitfall of overdiagnosis. Clinical findings remain the cornerstones for the diagnosis of rheumatic disease, and selected tests are used to refine the pretest assessments of disease probability.

Aged↗
PubMed1983

IgG and IgM rheumatoid factors in rheumatoid arthritis. Quantitative response to penicillamine therapy and relationship to disease activity.

Penicillamine treatment of patients with rheumatoid arthritis (RA) leads to falling titers of agglutinating IgM rheumatoid factor (RF), but its effect on IgG RF has not been described. Using specific solid phase radioimmunoassays, we have determined serial levels of IgM RF and IgG RF in 18 patients receiving penicillamine for 1 year, and correlated the results with the change in RA activity. Mean IgM RF levels fell to 76 +/- 10% (mean +/- SEM) after 3 months, and 30 +/- 5% of the pretreatment value after 1 year of penicillamine treatment. This decline was greater than that for total IgM (P less than 0.0001), indicating a selective reduction of RF. Patients receiving maintenance doses of 750 mg/day manifested more rapid and greater decreases than did those given 250 mg/day. In contrast, serial mean IgG RF levels did not change significantly, and actually increased in 6 of 18 cases. At onset, there was a significant correlation with erythrocyte sedimentation rate for both IgM RF (r = 0.535, P = 0.05) and IgG RF levels (r = 0.570, P = 0.02). But changes in RF concentration demonstrated no correlation with changes in either erythrocyte sedimentation rate or joint score over the 1-year period, suggesting that circulating IgM RF or IgG RF levels may be unrelated to the degree of RA activity.

Adult↗
PubMed1981

Serum IgG and IgM rheumatoid factors by solid phase radioimmunoassay. A comparison between adult and juvenile rheumatoid arthritis.

In this report, solid phase radioimmunoassays that specifically measure IgG rheumatoid factor (RF) and IgM RF in absolute concentrations are described. Polyclonal RF preparations were utilized as standards, and as little as 40 ng/ml of IgG RF and I ng/ml of IgM RF were detected. The IgG RF concentration of 26 seropositive rheumatoid sera was 439 +/ 755 micrograms/ml (mean +/- 1 SD), a level 107 times that of normal controls (P less than 0.001). In contrast, levels for 49 children with juvenile rheumatoid arthritis (JRA) were 6.1 +/- 3.7 micrograms/ml for those with a polyarticular onset (JRA-Po), and 27.3 +/- 113 micrograms/ml for the pauciarticular group (JRA-Pa), and 12.6 +/- 20.7 micrograms/ml for the group with a systemic onset (JRA-S). None of these values differed significantly from the value of 6.0 +/- 3.9 micrograms/ml measured in a juvenile control group. The IgM RF level in adult rheumatoid arthritis (RA) of 175 +/- 221 micrograms/ml was also significantly elevated compared to controls (P less than 0.001). In JRA, however, mean levels of 1.4 +/- 2.0 micrograms/ml (JRA-Po), 2.8 +/- 8.3 micrograms/ml (JRA-Pa), and 1.1 +/- 0.7 micrograms /ml (JRA-S) were not elevated significantly above the value of 1.2 +/-1.2 micrograms/ml measured in the juvenile control group. Hidden IgM RF was not found in 9 JRA sera tested. These marked differences in RF levels provide another indication that adult RA and JRA are distinct diseases.

Adult↗