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Biomedical subjects

T Pullar

Publications and source records attributed to T Pullar.

87 records · Page 5Linked to original sources
PubMed1985

Spontaneous fractured neck of femur in rheumatoid arthritis: absence of radiographic changes on initial X-ray.

Spontaneous fractures have been documented in patients with osteoporosis and have been described in patients with rheumatoid arthritis. Two patients with rheumatoid arthritis who sustained femoral neck fractures in the absence of trauma are documented. Despite severe pain initial radiograph failed to demonstrate evidence of fracture, but subsequent radiographs later showed fractures in both cases. It is important in rheumatoid patients with continuing severe hip pain of sudden onset to suspect a stress fracture even if initial radiographs are normal.

Aged↗
PubMed1984

Sulphasalazine: a 'new' antirheumatic drug.

Sulphasalazine was first introduced for the treatment of rheumatoid arthritis in 1942. Following initial enthusiasm, interest waned until 1978 when a large open study suggested that it might have a 'second-line effect'. Since then further studies have confirmed this effect and once again rheumatologists are starting to use sulphasalazine in the treatment of rheumatoid arthritis. In this review we examine the pharmacology of sulphasalazine and its metabolites, comment upon the possible modes of action and review the recent literature pertaining to its use in rheumatoid arthritis.

Agranulocytosis↗
PubMed1984

Does second-line therapy affect the radiological progression of rheumatoid arthritis?

The effect of 'second-line' drugs on radiological progression in rheumatoid arthritis is not clear, and previous studies have yielded contradictory results. Sixty-seven patients with rheumatoid arthritis have been followed up clinically and radiologically for approximately 2 years (26 patients were receiving intramuscular gold, 21 penicillamine, 10 levamisole, and there were 10 controls who had consistently refused second-line therapy). Patients on gold and penicillamine showed improvement in erythrocyte sedimentation rate and haemoglobin over 2 years which was not seen in levamisole and control patients, but hand radiograph scores in all 4 groups showed statistically significant deterioration. There was a trend towards slowing of the rate of erosion in the gold and penicillamine groups in comparison with controls, but healing of erosions was extremely unusual.

Adult↗
PubMed1983

Sulphasalazine in rheumatoid arthritis: a double blind comparison of sulphasalazine with placebo and sodium aurothiomalate.

Uncontrolled studies have suggested that sulphasalazine may be an effective second line agent in rheumatoid arthritis. Sulphasalazine was therefore compared with placebo and intramuscular sodium aurothiomalate in 90 patients with active rheumatoid arthritis. After six months' treatment both sulphasalazine and sodium aurothiomalate had produced significant clinical and laboratory benefit, whereas placebo had produced no significant change in any variable. Thirteen patients stopped taking the placebo because of lack of effect whereas only two patients stopped taking sulphasalazine and one sodium aurothiomalate for this reason. The major toxicity encountered in the group treated with sulphasalazine was nausea or vomiting, or both; this may be related to slow acetylator phenotype. Sulphasalazine appears to be an effective second line agent, and further pharmacokinetic studies might prove useful in diminishing gastrointestinal side effects.

Adolescent↗
PubMed1983

Reduced steady-state plasma concentrations of chlorpromazine and indomethacin in patients receiving cimetidine.

Chronic administration of cimetidine was found to produce a fall in steady-state plasma concentrations of chlorpromazine and of indomethacin in patients. In each case there was some evidence of inhibition of metabolism, suggesting that the mechanism must therefore be decreased absorption sufficient to over-ride the metabolic change. This was confirmed by measurement of excretion of metabolites in the indomethacin study. The fall in indomethacin plasma concentrations was not associated with a change in the clinical effectiveness of the anti-inflammatory therapy.

Absorption↗
PubMed1983

Adrenal response in rheumatoid arthritis treated with long-term steroids.

Twenty eight patients who received corticosteroids for rheumatoid arthritis for at least five years were studied. Short synacthen tests were carried out in twenty two of these patients and twelve showed a subnormal response. This response was unrelated to initial or present dose, duration of treatment or activity of disease. Ten patients accepted our offer of steroid reduction. Reduction proved difficult because of patient resistance although the only index of inflammation to worsen was the articular index. We postulate that patient resistance to withdrawal may be due to some factor other than the loss of the anti-inflammatory effect of corticosteroids.

Adrenal Glands↗
PubMed1982

Alternative medicine: cost and subjective benefit in rheumatoid arthritis.

Seventy-eight patients with seropositive rheumatoid arthritis were asked about money spent in an attempt to help their arthritis. This included expenditure on alternative medicine, aids for the home, and conventional medicine. Most money was spent on, and most benefit was derived from, aids for the home. Sixty per cent of the patients had tried alternative medicine, but expenditure on this was relatively low and only a small proportion found it helpful.

Arthritis, Rheumatoid↗
PubMed1982

Gold and penicillamine therapy: is shared care with general practitioners effective and safe?

One hundred patients with definite or classical rheumatoid arthritis were commenced on gold or penicillamine therapy. The patient's general practitioner was asked to participate in monitoring these patients. No reduction in efficacy or increase in serious adverse effects was present in this shared-care group. A 65% reduction in hospital clinic visits was achieved thus allowing more patients to benefit from this therapy.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Compliance with prescribed medicines in general medical and surgical wards.

A total of 6833 doses of medication were prescribed to 753 hospital inpatients in general wards over a 24-hour period (excluding medicines prescribed on an as-required basis and medicines prescribed for the first time during the 24-hour period). Of these, 574 (8.4%) doses were omitted, representing at least one omitted dose in 242 (32.1%) patients. Many of the omitted doses were of symptomatic treatments and in 43% of instances omission was deemed, retrospectively, to have been beneficial. Some omissions, however, were of a potentially life-threatening nature. The most common reasons for omission were that the patient refused the drug or that the nurse thought the drug unnecessary, the patient was on 'nil by mouth' or was too ill or unable to take the medicine. Thus, omission of prescribed medicines in general wards is common, often of little consequence or even beneficial, but of a potentially serious nature.

Drug Therapy↗