Biomedical subjects
S R Weiner
Publications and source records attributed to S R Weiner.
Frequency of late potentials in systemic sclerosis.
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Raynaud's syndrome. Using a range of therapies to help patients.
Raynaud's syndrome is a common medical problem. Approach to diagnosis must involve a search for underlying causes. Treatment includes avoidance of precipitating factors, biofeedback, and possibly pharmacologic therapy, after careful consideration of risks.
Extreme weakness and pain in both legs.
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Kaposi's sarcoma in a patient with rheumatoid arthritis and polymyositis treated with corticosteroids.
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Measuring disease activity: comparison of joint tenderness, swelling, and ultrasonography in rheumatoid arthritis.
In a prospective study of 6 patients with classic rheumatoid arthritis, we evaluated 3 measures of disease activity: comprehensive joint swelling and joint tenderness counts, and ultrasonography of joints. After baseline data were obtained on these 6 patients, therapy with fenbufen, a new nonsteroidal antiinflammatory drug, was begun. Followup examinations were performed at 4 weeks and 24 weeks after baseline. There were statistically significant differences between joint tenderness and joint swelling findings and between joint tenderness and joint ultrasonography findings (P less than 0.05 by kappa test statistic). In comparisons of joint swelling and ultrasonography, no difference was found (P greater than 0.05). When measures of changes over 6 months were compared, there was a high concordance between improvement in joint swelling and improvement in joint ultrasonography (P less than 0.01). Our results demonstrate that clinical assessment of joint swelling provides an accurate measure of synovial effusion, as confirmed by the more objective ultrasound measurements.
Rheumatic manifestations of Wegener's granulomatosis.
Wegener's granulomatosis is a necrotizing granulomatous vasculitis with multisystem involvement. We reviewed the rheumatic manifestations among 50 patients with Wegener's granulomatosis. Arthralgia, myalgia and/or arthritis occurred in 2/3 of patients and 28% had nonerosive and nondeforming polyarthritis. Noninflammatory synovial fluid was found upon arthrocentesis of one patient with a knee effusion. Unexpected findings included soft tissue calcifications in 9 patients, sacroiliitis in 3, and relapsing polychondritis in 2. Rheumatoid factor was present in 1/2 of the patients tested. Additionally, both antinuclear antibodies and anti-DNA antibodies were detected in 14 and 38%, respectively, of patients tested.
Wegener's granulomatosis in the elderly.
Wegener's granulomatosis is a systemic necrotizing granulomatous vasculitis in which the average age at onset is in the forties. The disease has an excellent response to treatment with cyclophosphamide. We proposed that the tendency to accept multisystem disease in elderly patients (greater than or equal to 60 years old) and a reluctance to administer aggressive therapy would be reflected in the diagnosis and treatment of Wegener's granulomatosis in the elderly, and that as a consequence, the delay in diagnosis and implementation of therapy could result in a needlessly higher morbidity and mortality rate for this population of patients.
Whipple disease.
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Chronic arthropathy occurring after augmentation mammaplasty.
Augmentation mammaplasty has been associated with a broad spectrum of connective-tissue disease, systemic illness and autoimmune phenomena. The three cases reported herein suggest a possible relationship between silicone gel implants for augmentation mammaplasty (with capsular contractures as complicating feature) and the development of chronic arthropathy.
Protective effect of poliomyelitis on psoriatic arthritis.
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Comparison of low-dose oral pulse methotrexate and placebo in the treatment of rheumatoid arthritis. A controlled clinical trial.
One hundred eighty-nine patients with rheumatoid arthritis were entered into a prospective, controlled, double-blind multicenter trial comparing placebo and methotrexate (MTX). One hundred ten patients completed 18 weeks of therapy. No remissions were seen, but patients able to tolerate low-dose pulse MTX therapy were significantly improved, compared with patients receiving placebo therapy, for all clinical variables measured, including joint pain/tenderness and swelling counts, rheumatoid nodules, and patient and physician assessment of disease activity. MTX treatment demonstrated statistically significant improvement over placebo in patients with anemia, elevated erythrocyte sedimentation rate, and rheumatoid factor. However, nearly one-third of the patients receiving MTX were withdrawn for adverse drug reactions, of which elevated levels of liver enzymes was the most common. Pancytopenia occurred in 2 patients taking MTX. All adverse drug effects resolved without sequelae. MTX appears to be effective in the treatment of active rheumatoid arthritis but requires close monitoring for toxicity.
Bypass disease.
Intestinal bypass surgery as a treatment for morbid obesity was quite popular from 1965 to 1975 in the United States. The procedure was successful in reducing body weight but was controversial because of a high rate of complications which included an arthritis-dermatitis syndrome. Herein we review the knowledge garnered from a study of the complications from intestinal bypass surgery. Emphasis is placed on an analysis of the clinical manifestations, and the pathogenesis of the arthritis-dermatitis bypass syndrome, and how bypass disease may serve as a model for immune complex-mediated disease and for extra-intestinal complications in other enteropathies.
Twins discordant for Wegener's granulomatosis.
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