The future of rheumatology: new directions.
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Humans↗
Biomedical subjects
S W Brighton
Publications and source records attributed to S W Brighton.
Samarium-153-EDTMP for palliation of ankylosing spondylitis, Paget's disease and rheumatoid arthritis.
Samarium-153-EDTMP is an effective agent for palliation of widespread skeletal metastases because it concentrates in bone metastases which have an osteoblastic component. Similar concentration in areas of osteoblastic activity in ankylosing spondylitis, Paget's disease and rheumatoid arthritis suggests a possible new treatment approach. Three patients with ankylosing spondylitis, one patient with Paget's disease and one patient with rheumatoid arthritis were treated with 153Sm-EDTMP. Objective and subjective improvement was noted, especially in ankylosing spondylitis patients. Samarium-153-EDTMP has disease-modifying potential in ankylosing spondylitis and Paget's disease and has palliative value in resistant rheumatoid arthritis. Further trials to determine optimal dose, treatment scheduling, long-term disease-modifying potential and toxicity are needed.
Arthritis, Rheumatoid↗
Visual function and long-term chloroquine treatment.
Ophthalmic examinations and selected tests of visual function were performed on 64 patients with rheumatoid arthritis who had received daily doses of 200 mg chloroquine sulphate for periods ranging from 3 to 11 months. Visual fields were determined by Humphrey automated perimetry and Amsler grids and a further battery of four tests of macular function (visual evoked potentials, critical flicker fusion threshold, Cambridge contrast sensitivity and the macular dazzle test) were administered. No case of retinal pigmentary abnormalities plus visual loss was found, but 2 patients were advised to cease chloroquine therapy on the basis of funduscopic findings. A small group of patients with relatively poor scores on one or more tests had normal visual fields and ophthalmic findings. There were no significant partial correlations between test results and the cumulative dose of chloroquine. These results support the opinion that currently recommended doses of chloroquine pose a minimal risk of retinal toxicity.
Adolescent↗
The effect of a long-term exercise programme on the rheumatoid hand.
Forty-four female patients with sero-positive active RA participated in a 48-month trial to assess the effect of simple hand exercises. Twenty-two patients in the test group were given a daily exercise regime of six exercises. The control group were not given any exercises. At the end of 48 months there was a statistically significant improvement in grip strength (P < 0.0001) and pincer grip strength (P < 0.0005) in the test group. There was a significant deterioration in the control group (P < 0.0000). A simple exercise programme is beneficial for the rheumatoid hand as far as grip and pincer grip strength are concerned.
Adult↗
The prevalence of rheumatoid arthritis in a rural African population.
We report the findings of an epidemiological study of the prevalence of rheumatoid arthritis (RA) in a rural population. The study was conducted in Venda, a very remote part of South Africa. Much of the population still follows an age old traditional lifestyle. A detailed hut-to-hut survey of 543 respondents comprising 97% of the population of one village was conducted. This included clinical, serological and radiological studies. This was supplemented by questioning local traditional doctors and showing them photographs of typical hand deformities to ascertain if they knew of any cases with these deformities. The 3 hospitals draining the area were also surveyed. The detailed survey of 543 respondents revealed no cases of definite or probable RA using a modification of the Rome criteria. No cases were recognized by the traditional doctors. The 3 hospitals together had 14 cases of definite RA out of a population of about 520,000. This gave a prevalence of 0.0026%. The marked difference in the prevalence of RA in this population as opposed to other Southern African studies as well as American and European studies is discussed.
Adolescent↗
The effect of an oral gold preparation on the gastrointestinal tract motility in two species of experimental animals.
The oral gold preparation, auranofin, used in rheumatoid arthritis has been reputed to cause chronic diarrhea. To investigate this the G.I. tract motility was measured before auranofin therapy and after 1, 3, and 5 weeks of therapy using scintigraphy following indium-111-labeled meals in three beagle dogs. The gastric emptying times of the dogs accelerated throughout the duration of the experiment, although the large bowel transit times did not seem to be affected. The affect of auranofin on the stools of the baboon Papio ursinus was also noted. The baboon stools were observed for any change in consistency. Sigmoidoscopic examination including mucosal biopsies was carried out monthly over a 6-month period. The baboon's stools were noted to become very soft in consistency, but histology indicated no mucosal changes.
Administration, Oral↗
Comparison of isoxicam and naproxen in patients with rheumatoid arthritis. A 4-week parallel group, double-blind study.
A 4-week parallel-group, double-blind study comparing isoxicam with naproxen was carried out in patients with rheumatoid arthritis. Both isoxicam and naproxen were found to be effective. In patients on isoxicam significant improvements in the articular index, grip strength, joint swelling, morning stiffness and the patients' overall clinical condition were observed: the results for naproxen were similar, but joint swelling did not improve. At the 2-week assessment naproxen produced significantly better results than isoxicam in terms of the articular index and the physician's assessment of the patients' condition, but this difference was not maintained at the 4-week assessment. This apparently more rapid onset of activity of naproxen is probably related to its shorter elimination half-life. No adverse experiences were reported during isoxicam treatment and this drug was better tolerated than naproxen.
Adult↗
Delayed skin hypersensitivity as indicator of T-cell function in three population groups.
Immunological differences between a rural under-developed black population with a low incidence of rheumatoid arthritis, and living according to old traditional ways have been compared with an urban black and urban Caucasian population with a high incidence of the disease. A delayed skin hypersensitivity test for cell-mediated immunity with seven antigens and control was used. The rural group showed a statistically significant inhibition of cell-mediated immunity with 37% showing an anergic response. A matched Caucasian group showed a more marked response while an urban black group occupied an intermediate position. The 37% anergic response in our rural group was seen despite the fact that they were very healthy and their immune systems resisted multiple parasitic and infective onslaughts. From this data interpretation of an anergic response to multiple skin antigen tests in peoples from under-developed populations must be approached with great caution. Whether this altered cell-mediated immunity plays a role in the low incidence of rheumatoid arthritis in under-developed peoples is still speculative.
Arthritis, Rheumatoid↗
The prevalence of osteoarthrosis in a rural African community.
Osteoarthrosis occurs in all population groups throughout the world. However, the pattern of the condition may differ considerably amongst various developing, traditionally living people, perhaps because of their different living habits, occupational factors and genetics. The distribution and prevalence of osteoarthrosis in a developing African population are reported in this paper. A radiological survey of the hands and feet of 543 adult respondents was undertaken. The prevalence of multiple osteoarthrosis and Heberden's nodes was very low. There was a sharp rise in the prevalence of osteoarthrosis after the age of 40 years. The prevalence in males and females was very similar; a finding which agrees with previous African studies but is in contrast to Caucasian surveys. We also found more distal interphalangeal involvement in males than in females. The incidence of proximal interphalangeal involvement was very similar to that reported in other published studies.
Adult↗
Chloroquine phosphate treatment of chronic Chikungunya arthritis. An open pilot study.
Over 12% of patients who contract Chikungunya virus infection develop chronic joint symptoms. These symptoms respond only partially to the non-steroidal anti-inflammatory drugs. An open pilot study on the efficacy of chloroquine phosphate was carried out and 10 patients completed 20 weeks of therapy. Both the Ritchie articular index and morning stiffness improved significantly. In the patient's assessment, 7 out of 10 considered their conditions to have improved. On the basis of the doctor's assessment, 5 of the 10 had improved. These results justify further controlled blind trials of chloroquine in chronic Chikungunya arthritis.
Adult↗
Rupture of Baker's cyst mimicking deep-vein thrombosis.
Synovial effusions of the knee may produce a Baker's cyst which can dissect downwards or rupture. The synovial fluid released on rupture of such a cyst in patients with rheumatoid arthritis or calcium pyrophosphate disease is highly irritating to tissues and may produce a clinical picture mimicking deep-vein thrombosis.
Diagnosis, Differential↗
A destructive arthropathy following Chikungunya virus arthritis--a possible association.
Chikungunya virus arthritis is an acute severe polyarthritis following upon the bite of infected mosquitoes in endemic areas. With rapid air transport an increasing number of tourists are being exposed to potential infection. Whether tourists returning home in the incubation viremic stage can infect local mosquito populations in their home countries is unknown. Most cases recover from the severe joint pains within several weeks but up to 12% retain some residual joint symptoms for years. A case report is given of probable Chikungunya arthritis progressing to joint destruction before ultimately subsiding after 15 years leaving a sequela of destroyed metatarsal heads and late osteoarthritic changes in the ankles.
Arthritis, Infectious↗
Chikungunya virus infection. A retrospective study of 107 cases.
A retrospective study of 107 cases of serologically proven chikungunya (CHIK) virus infection was undertaken. All respondents had contracted the disease at least 3 years previously; 87,9% had fully recovered, 3,7% experienced only occasional stiffness or mild discomfort, 2,8% had persistent residual joint stiffness but no pain, while 5,6% had persistent joint pain and stiffness and frequent effusions. Synovial fluid from 3 patients was analysed. All the patients with persistent joint pain and stiffness had very high antibody titres against CHIK virus.
Adolescent↗
Development of an inflammatory synovitis following total-dose infusion of iron-dextran. A case report.
Total-dose iron-dextran infusions have been reported to cause exacerbation of the disease in patients with rheumatoid arthritis and ankylosing spondylitis. A case of prolonged polyarthritis following a total-dose iron-dextran infusion in a patient with no evidence of rheumatoid arthritis or ankylosing spondylitis is reported.
Adult↗
The team approach to rheumatoid arthritis. Rehabilitation at the H. F. Verwoerd Hospital, Pretoria.
Rheumatoid arthritis, being a progressive destructive disease, is best treated by using a team approach. Besides intensive medical and surgical treatment, a definite programme of physiotherapy and occupational therapy is given. This includes educational lectures, home visits, group exercise therapy and an analysis of situations which may strain the joints. Splints and aids are supplied accordingly.
Arthritis, Rheumatoid↗
Social and rehabilitational aspects of rheumatoid arthritis.
A survey of 100 rheumatoid arthritis patients was conducted in order to gain insight into the problems that interfered with the patients' daily living patterns. Some of the more important problems investigated included stiffness, tiredness, functional hand problems, depression, inability to cope with daily activities and employment. Lack of understanding of the role of physiotherapy and occupational therapy has led to an underutilizaton of these services.
Activities of Daily Living↗
Chikungunya virus infections.
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Arbovirus Infections↗
The effect of long-term corticosteroid therapy on joint mobility.
Long-term corticosteroid therapy has been implicated as a cause of joint hypermobility. The joint mobility of 25 patients who had been on oral corticosteroids for at least 5 years, was compared to that of 40 controls. There was no significant difference between the two groups. It was concluded that oral corticosteroids do not contribute to joint hypermobility.
Adrenal Cortex Hormones↗