Arthritis

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February 17, 1999

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Record 1 from database: MEDLINE
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Title

Epidemiology of rheumatoid arthritis.

Author

Silman AJ

Address

ARC Epidemiology Research Unit, University of Manchester, UK.

Source

APMIS, 1994 Oct, 102:10, 721-8

Abstract

Rheumatoid arthritis remains the most important form of arthritis seen in rheumatological practice in the developed world. It presents some tantalizing epidemiological features. It is a relatively rare disease particularly in young life. It has a marked female excess in all populations studied. There are suggestions that it might be declining in incidence, though the reasons for this are unexplained. The geographical distribution of the disease is remarkably homogeneous. There is evidence of a genetic factor as witnessed by familial aggregation particularly by increased disease occurrence in identical twins; though the large majority of such twins remain disease discordant throughout life. Whilst undoubtedly one of the most important genetic factors in explaining disease occurrence is located in HLA class II, genes encoded in this region are neither necessary nor sufficient on their own for disease development. The female excess remains unexplained but it suggests a hormonal basis for disease development. Factors supporting this hypothesis include the observed protective effect of the oral contraceptive pill, the increased risk in women who are nulliparous and the increased susceptibility to disease during the first three months postpartum. This latter finding may be linked with breast feeding: women who have breast fed, particularly after their first pregnancy, have an increased risk for disease development. It is possible that this is explained by a massive increase in circulating prolactin levels.

Language of Publication

English

Unique Identifier

95127187

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MeSH Heading (Major)

Arthritis, Rheumatoid|*EP/GE/PP

MeSH Heading

Adolescence; Adult; Age Factors; Aged; Aged, 80 and over; Biological Markers; Female; Human; HLA-DR Antigens|GE; Incidence; Male; Middle Age; Pregnancy; Prevalence; Sex Factors

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, MULTICASE

ISSN

0903-4641

Country of Publication

DENMARK

Record 2 from database: MEDLINE
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Title

Tenidap: a novel cytokine-modulating antirheumatic drug for the treatment of rheumatoid arthritis.

Author

Breedveld F

Address

Department of Rheumatology, University Hospital, Leiden, The Netherlands.

Source

Scand J Rheumatol Suppl, 1994, 100:, 31-44

Abstract

Tenidap is a novel, once-daily, cytokine modulating antirheumatic drug indicated for the treatment of rheumatoid arthritis (RA). In vitro, tenidap significantly inhibits the production of the pro-inflammatory cytokines, interleukin-1, interleukin-6 and tumour necrosis factor in human cell lines, and inhibits cytokine-mediated processes such as cartilage degradation, bone resorption, metalloprotease synthesis, endothelial cell adhesion and monocyte differentiation. Tenidap also inhibits cyclo-oxygenase. In RA patients, tenidap 120 mg/day is clinically equivalent to the combination of disease-modifying antirheumatic agents plus non-steroidal anti-inflammatory drugs (NSAIDs) and significantly more effective than NSAIDs. Tenidap also produces rapid, profound and sustained reductions in the serum levels of the acute phase proteins, C-reactive protein and serum amyloid A, an effect suggestive of disease modifying properties. In addition, tenidap reduces circulating levels of IL-6 in RA patients. Tenidap is well tolerated.

Language of Publication

English

Unique Identifier

95167424

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MeSH Heading (Major)

Anti-Inflammatory Agents, Non-Steroidal|AE/*TU; Arthritis, Rheumatoid|CO/*DT/ME; Cytokines|DE/*ME; Indoles|AE/*TU

MeSH Heading

Acute-Phase Proteins|ME; Adult; Aged; Aged, 80 and over; Animal; Clinical Trials, Phase III; Consumer Product Safety; Disease Models, Animal; Female; Human; Male; Middle Age; Rats; Treatment Outcome

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

0301-3847

Country of Publication

NORWAY

Record 3 from database: MEDLINE
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Title

Enterococcal arthritis: case report and review [see comments]

Author

Raymond NJ; Henry J; Workowski KA

Address

Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Source

Clin Infect Dis, 1995 Sep, 21:3, 516-22

Abstract

We report a case of septic arthritis due to Enterococcus species and review 18 additional cases reported in the literature from 1966 through 1993 for which clinical or treatment data were available. In 11 of the 19 cases, prosthetic joints were affected (9 knees, 2 hips) and in 8 cases, native joints were affected. Of those patients with prosthetic joint infections, 6 had preexisting osteoarthritis and 3 had rheumatoid arthritis; only one patient with native joint infection had a recognized (although unspecified), preexisting joint abnormality. Pain, fever (temperature, > 37 degrees C), and tenderness were the most common clinical findings in patients with native joint infections. The microbiological diagnosis was made by culture of synovial fluid or synovial tissue (16 of 19), blood (1 of 19), or an unstated specimen (2 of 19). Polymicrobial infection was present in 6 (32%) of 19 patients. Of fourteen patients treated with either a parenteral penicillin (11 of 19) or a glycopeptide (3 of 19), 11 made an uncomplicated recovery. An aminoglycoside was also used to treat 7 of these 14 patients (4 of these 7 had prosthetic joints). All 11 prosthetic joint infections were ultimately clinically cured; for most of these patients, the original prosthesis was removed. For two patients with native joint infections, amputation of the infected limb was necessary to cure the infection.

Language of Publication

English

Unique Identifier

96077366

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MeSH Heading (Major)

Arthritis, Infectious|DI/*ET/TH; Enterococcus faecalis|*/PY; Gram-Positive Bacterial Infections|DI/*ET/TH

MeSH Heading

Adult; Aged; Aged, 80 and over; Case Report; Enterococcus|PY; Female; Human; Infant; Joint Prosthesis; Male; Middle Age

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES

ISSN

1058-4838

Country of Publication

UNITED STATES

Record 4 from database: MEDLINE
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Title

Clinical assessment and clinical trials in rheumatoid arthritis.

Author

van Riel PL; van de Putte LB

Address

Department of Rheumatology, University Hospital Nijmegen, The Netherlands.

Source

Curr Opin Rheumatol, 1994 Mar, 6:2, 132-9

Abstract

Important progress has been reported over the past year on evaluation and standardization of disease activity variables in rheumatoid arthritis and their relation to outcome measures. Core sets of variables have been established both in the United States and Europe, showing a high degree of resemblance. A recently proposed classification of antirheumatic drugs seeks to make a clear distinction between drugs that modify symptoms and those that actually control the disease. This classification may have a definite impact on design and methodology of future clinical trials.

Language of Publication

English

Unique Identifier

94296852

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MeSH Heading (Major)

Arthritis, Rheumatoid|*PP/TH

MeSH Heading

Adult; Aged; Aged, 80 and over; Clinical Trials; Human; Middle Age; Outcome Assessment (Health Care)

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

1040-8711

Country of Publication

UNITED STATES

Record 5 from database: MEDLINE
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Title

Thymopentin treatment of rheumatoid arthritis.

Author

Sundal E; Bertelletti D

Address

Cilag spa, Cologno Monzese, Italy.

Source

Arzneimittelforschung, 1994 Oct, 44:10, 1145-9

Abstract

Although the etiology of rheumatoid arthritis (RA) is unknown, there is solid evidence that immunological factors play a pivotal role in its pathogenesis. It seems that a hyporeactivity of local (intraarticular) T-suppressor cells would permit an excessive immune response that ultimately leads to the classical symptoms and signs of inflammation and cartilage damage. Thymopentin is a synthetic pentapeptide (Arg-Lys-Asp-Val-Tyr) which represents the active biologic site (sequence 32-36) of the native thymic hormone thymopoietin, containing 49 amino acids. Thymopoietin and thymopentin have been shown to possess immuno-normalizing properties in a number of animal model systems. Low concentrations of the hormone characteristically stimulate the OKT4-positive cells, whereas higher concentrations additionally induce stimulation of OKT8-positive cells. This report summarizes the clinical experience collected by Italian investigators, and discusses the results with a view to previously published papers.

Language of Publication

English

Unique Identifier

95118416

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MeSH Heading (Major)

Arthritis, Rheumatoid|*DT; Thymopentin|*TU

MeSH Heading

Adult; Aged; Aged, 80 and over; Amino Acid Sequence; Female; Human; Italy; Male; Middle Age; Molecular Sequence Data

Publication Type

CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; REVIEW; REVIEW, TUTORIAL

ISSN

0004-4172

Country of Publication

GERMANY

Record 6 from database: MEDLINE
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Title

Lymphoproliferative disorders in rheumatoid arthritis patients on low-dose methotrexate.

Author

Sibilia J; Lioté F; Mariette X

Address

Rheumatology Department, Hautepierre Teaching Hospital, Strasbourg, France.

Source

Rev Rhum Engl Ed, 1998 Apr, 65:4, 267-73

Abstract

Methotrexate is the most widely used second-line treatment in rheumatoid arthritis because of its excellent efficacy and safety profile. However, since 1991, about 100 cases of lymphoproliferative disorders have been reported in rheumatoid arthritis patients under methotrexate therapy. Four characteristics similar to those in lymphomas associated with immunodeficiency were identified during a review of the 48 cases for which detailed information is available. (1) Most cases were non-Hodgkin's B-cell lymphomas of the large cell or diffuse mixed type. (2) Extranodal involvement (55% of cases) was unusually common. (3) Evidence of Epstein-Barr infection was found in 46% of tested patients. (4) Of the 14 patients treated by methotrexate withdrawal alone, eight achieved a full remission, with follow-ups ranging from one to five years. These characteristics suggest a role for two factors: (1) the abnormalities in cell-mediated immunity seen in rheumatoid arthritis may promote latent Epstein-Barr virus infection, which may in turn lead to proliferation of malignant lymphoid cells; (2) the immunomodulatory effects of methotrexate may promote the development not only of opportunistic infections but also of Epstein-Barr virus-related lymphoproliferative disorders. There is no firm evidence to date that methotrexate has a direct oncogenic effect and no excess in malignant diseases has been reported with this drug. In conclusion, the rate of occurrence of lymphoproliferative disorders induced by low-dose methotrexate therapy remains controversial, although the characteristics of the malignancies and the possibility of a complete remission after methotrexate withdrawal militate against a chance association. Epidemiologic and other studies are needed to clarify this issue.

Language of Publication

English

Unique Identifier

98262529

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MeSH Heading (Major)

Antirheumatic Agents|*TU; Arthritis, Rheumatoid|*CO/*DT; Immunocompromised Host|*; Lymphoma|CI/*CO/VI; Methotrexate|*TU

MeSH Heading

Adolescence; Adult; Aged; Aged, 80 and over; Herpesviridae Infections|CO; Herpesvirus 4, Human|IP; Human; Middle Age; Tumor Virus Infections|CO

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

1169-8446

Country of Publication

FRANCE

Record 7 from database: MEDLINE
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Title

Sporotrichal arthritis in south central Kansas.

Author

Howell SJ; Toohey JS

Address

Department of Surgery, University of Kansas School of Medicine-Wichita, USA.

Source

Clin Orthop, 1998 Jan, :346, 207-14

Abstract

Sporotrichal arthritis is a rare disease, with only 51 cases reported in the English literature. Thirteen patients with sporotrichal arthritis have been treated at Wichita area hospitals since 1979. Most of the patients were middle aged men. Significant alcohol intake was noted in 77% of the patients. There were 17 joints involved in the cases, including 10 knees, three interphalangeal joints, one elbow, one midtarsal, one intercarpal, and one metatarsophalangeal joint. The typical appearance was an afebrile patient with a mildly swollen warm joint without erythema. The leukocyte counts were normal in 85% of patients, and the erythrocyte sedimentation rates were elevated in 100%. The patients had various treatments and responses. Response rates included intravenous amphotericin B (16%), ketoconazole (40%), and arthrodesis (100%). Sporotrichal arthritis may be more common than previously thought. It should be considered early in the differential diagnosis of monoarthritis.

Language of Publication

English

Unique Identifier

98238290

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MeSH Heading (Major)

Arthritis|*MI/RA/TH; Sporotrichosis|DT/*PA

MeSH Heading

Adult; Aged; Aged, 80 and over; Antifungal Agents|TU; Arthrodesis; Diagnosis, Differential; Female; Human; Kansas; Male; Middle Age; Retrospective Studies

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW LITERATURE

ISSN

0009-921X

Country of Publication

UNITED STATES

Record 8 from database: MEDLINE
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Title

Arthritis and women's health: prevalence, impact, and prevention.

Author

Callahan LF; Rao J; Boutaugh M

Address

Aging Studies Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. leigh.thurston@mhs.unc.edu

Source

Am J Prev Med, 1996 Sep, 12:5, 401-9

Abstract

INTRODUCTION: Our objectives were to review the prevalence and impact of arthritis in women and to present information regarding strategies for prevention of arthritis in women. DISCUSSION: Arthritis is one of the most prevalent chronic conditions in the United States and the most prevalent chronic condition in women. In addition, arthritis is one of the leading causes of disability and limitations in activities of daily living, and its economic, psychological, and social impact is enormous. Some of the effects of arthritis, such as medical care costs and lost wages, are easily translated into economic terms, but others, such as the inability to play sports, a reduction in housekeeping activities, or pain, are not. CONCLUSIONS: Although arthritis is the most frequent and disabling chronic condition among women, its public health importance has not been previously emphasized. Public health agencies and health care providers should consider the following strategies to reduce the impact of arthritis among women: (1) promote primary prevention of arthritis through weight reduction and the reduction of sports- or occupational-related joint injury and (2) encourage the early detection and appropriate management of arthritis in women through use of medical and physical therapy, exercise, and established educational programs.

Language of Publication

English

Unique Identifier

97066171

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MeSH Heading (Major)

Arthritis|EC/*EP/PC; Women's Health|*

MeSH Heading

Activities of Daily Living; Adaptation, Psychological; Adolescence; Adult; Aged; Aged, 80 and over; Cost of Illness; Female; Human; Mental Health; Middle Age; Prevalence; Quality of Life; Support, Non-U.S. Gov't; United States|EP

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

0749-3797

Country of Publication

UNITED STATES

Record 9 from database: MEDLINE
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Title

Group G streptococcal arthritis: case report and review of the literature.

Author

Bronze MS; Whitby S; Schaberg DR

Address

Department of Medicine, University of Tennessee, Memphis, USA.

Source

Am J Med Sci, 1997 Apr, 313:4, 239-43

Abstract

Nongonococcal septic arthritis in adults is usually caused by infections with staphylococcal or streptococcal species. In patients with underlying diseases, especially those with chronic joint disease or malignancy, bacterial isolates from infected joint spaces may include group G streptococci. Occasionally, group G streptococcal arthritis may occur in otherwise healthy individuals. We report a case of pyogenic sacroiliitis in a healthy young adult and review the pertinent literature concerning group G streptococcal arthritis.

Language of Publication

English

Unique Identifier

97253917

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MeSH Heading (Major)

Arthritis, Infectious|DI/*ET; Streptococcal Infections|DI/*ET

MeSH Heading

Adolescence; Adult; Aged; Aged, 80 and over; Case Report; Child; Female; Human; Male; Middle Age; Sacroiliac Joint

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES

ISSN

0002-9629

Country of Publication

UNITED STATES

Record 10 from database: MEDLINE
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Title

Spontaneous regression of lymphoproliferative disorders in patients treated with methotrexate for rheumatoid arthritis and other rheumatic diseases [see comments]

Author

Salloum E; Cooper DL; Howe G; Lacy J; Tallini G; Crouch J; Schultz M; Murren J

Address

Department of Medicine, Yale University School of Medicine, Yale Cancer Center, New Haven, CT 06520-8032. emile-salloum@qm.yale.edu

Source

J Clin Oncol, 1996 Jun, 14:6, 1943-9

Abstract

PURPOSE: To determine the clinicopathologic features of lymphoproliferative disorders (LPD) that occur in the setting of methotrexate (MTX) therapy for rheumatic diseases (RD) and to define the relationship between the presence of Epstein-Barr virus (EBV) in tumor cells and the response of LPD to MTX withdrawal. PATIENTS AND METHODS: In addition to nine new cases, we analyzed 28 cases previously reported in the literature of LPD in patients receiving MTX for RD. In addition to MTX, immunosuppressive therapy included corticosteroids in 19 patients, azathioprine in three, and cyclosporine in one. Extranodal disease was identified in 16 patients, but none had CNS involvement. Pathologic findings included five cases of Hodgkin's disease and seven low-grade lymphomas. The remaining patients had intermediate or aggressive lymphomas. In situ hybridization studies (ISHS) for EBV-RNA transcripts were positive in 12 of 27 patients (44%). RESULTS: Among 37 patients, 16 were initially observed after MTX withdrawal without additional antitumor therapy. Six achieved a spontaneous complete remission (CR), three had a partial response (PR), one had a minimal response, and six had no response to MTX withdrawal. Of 10 responding patients, EBV was detected by ISHS (n = 6) or polymerase chain reaction (PCR) (n = 2); one patient had a CR despite the absence of EBV by PCR and one had a CR but did not have viral assays performed. Only one of six patients with negative EBV by ISHS or PCR responded to MTX withdrawal. CONCLUSION: MTX withdrawal and observation for a short period should be considered in the initial management of patients who develop LPD while on MTX therapy. Responses were consistently observed, but not limited to patients in whom EBV was detected by ISHS or PCR. Further studies are required to confirm these findings and to evaluate the role for EBV in LPD that occur in patients receiving MTX.

Language of Publication

English

Unique Identifier

96243754

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MeSH Heading (Major)

Antirheumatic Agents|*AE/TU; Arthritis, Rheumatoid|*DT; Immunosuppressive Agents|*AE/TU; Lymphoproliferative Disorders|*CI/VI; Methotrexate|*AE/TU

MeSH Heading

Adult; Aged; Aged, 80 and over; Female; Herpesvirus 4, Human|IP; Human; Male; Middle Age; Support, U.S. Gov't, P.H.S.

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, MULTICASE

ISSN

0732-183X

Country of Publication

UNITED STATES

Record 11 from database: MEDLINE
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Title

Complications of humeral head replacement for proximal humeral fractures.

Author

Muldoon MP; Cofield RH

Address

Department of Orthopedics, Naval Medical Center, San Diego, California, USA.

Source

Instr Course Lect, 1997, 46:, 15-24

Abstract

The indications for humeral head replacement in acute fractures and in chronic fracture problems have been studied over many decades and are reasonably well defined. Complications have probably been understudied. Many different complications occur, and their frequency and the need for reoperation is quite high. Because of the variety of complications that occur, familiarity with preventive measures and treatment options is important, not only to deal with complications arising from endoprostheses, but also to treat musculoskeletal infections, nerve injuries, fractures, instability, nonunion of tuberosities, malunion, and rotator cuff or capsule contracture or tearing. Physicians also must be able to integrate reparative/reconstructive surgery with a program of postoperative rehabilitation. The challenges are many. Treatment often provides considerable improvement for the patient, but often the extent of the improvement is somewhat less than optimal.

Language of Publication

English

Unique Identifier

97289025

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MeSH Heading (Major)

Humeral Fractures|RA/*SU; Joint Prosthesis|*/AE; Shoulder Joint|RA/*SU

MeSH Heading

Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis; Arthritis|ET; Dislocations|ET; Female; Fractures, Malunited|ET; Human; Joint Instability|ET; Male; Middle Age; Prosthesis Failure; Reoperation; Rotator Cuff|IN; Surgical Wound Infection|PC

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

0065-6895

Country of Publication

UNITED STATES

Record 12 from database: MEDLINE
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Title

Radiographic evaluation of the upper cervical spine in rheumatoid arthritis: a retrospective analysis.

Author

Kuhr M; Hohmann D; Schramm M; Martus P

Address

Department of Orthopaedic Surgery, University of Erlangen, Germany.

Source

Eur Spine J, 1996, 5:2, 107-11

Abstract

We analysed retrospectively 295 lateral roentgenograms of the cervical spine in 150 patients with classic or definite rheumatoid arthritis. In addition to measuring the atlantodental interval, measurements of the different vertical parameters described by McGregor, Ranawat and Redlund-Johnell and a new measurement method with high reproducibility were described and their results compared statistically. As a control group we analysed 100 lateral roentgenograms of the cervical spine in patients with no inflammatory disease, posttraumatic lesion, tumour or osseous deformity.

Language of Publication

English

Unique Identifier

96320700

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MeSH Heading (Major)

Arthritis, Rheumatoid|*RA; Cervical Vertebrae|*RA

MeSH Heading

Adult; Aged; Aged, 80 and over; Female; Human; Male; Middle Age; Observer Variation; Reference Standards; Reproducibility of Results; Retrospective Studies

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW LITERATURE

ISSN

0940-6719

Country of Publication

GERMANY

Record 13 from database: MEDLINE
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Title

Is instillation drainage for the treatment of infected joints, bones and soft tissues still up to date?

Author

Schmidt J; Hackenbroch MH; Kumm D; Taravati V

Address

Klinik und Poliklinik fur Orthopadie der Universitat zu Koln, Koln, Germany.

Source

Arch Orthop Trauma Surg, 1996, 115:3-4, 149-52

Abstract

For the treatment of infected joints, bones and soft tissues, either an instillation drainage therapy or the use of gentamicin-polymethyl-methacrylate (PMMA) chains (Septopal) in addition to surgical revision and systemically given antibiotics is currently in clinical use. We investigated 102 patients treated in our clinic by means of instillation drainage and compared the results with those obtained with gentamicin-PMMA chains by other authors. The overall long-term success with non-recurrence of the infection is nearly comparable (80% instillation drainage, 84% gentamicin-PMMA chains); however, with instillation drainage the duration of hospitalisation is significantly longer (mean 42.26 days vs 15.3 - 33 days). Additionally, there was a high rate of germ shifts with instillation drainage (33.3%) and a disappointing result in 20 infected endoprostheses (9 recurrences with 11 revisions). Regarding the intensive nursing care required and the necessary isolation from other patients, instillation drainage can only be recommended for the therapy of infected joints, bones and soft tissues if the results are better in comparison with gentamicin-PMMA chains. An improvement may be achieved with the closed instillation drainage system.

Language of Publication

English

Unique Identifier

97014747

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MeSH Heading (Major)

Arthritis, Infectious|*TH; Drainage|*MT; Osteomyelitis|*TH; Soft Tissue Infections|*TH

MeSH Heading

Adolescence; Adult; Aged; Aged, 80 and over; Antibiotics, Aminoglycoside|AD; Child; Child, Preschool; Comparative Study; Female; Gentamicins|AD/TU; Human; Infant; Length of Stay; Life Tables; Male; Methylmethacrylates|TU; Middle Age; Reoperation

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, MULTICASE

ISSN

0936-8051

Country of Publication

GERMANY

Record 14 from database: MEDLINE
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Title

Elderly-onset rheumatoid arthritis.

Author

van Schaardenburg D; Breedveld FC

Address

Department of Rheumatology, University Hospital, Leiden, The Netherlands.

Source

Semin Arthritis Rheum, 1994 Jun, 23:6, 367-78

Abstract

Elderly-onset rheumatoid arthritis (EORA), defined as rheumatoid arthritis (RA) with onset at age 60 years or over, differs slightly at presentation from younger-onset RA (YORA) by a more equal gender distribution, a higher frequency of acute onset with systemic features, more frequent involvement of the shoulder, and higher disease activity. Longitudinal studies have showed more disease activity, radiographic damage, and functional decline in patients with EORA than in those with YORA. These differences were only found in seropositive patients. Seropositive EORA was reported to be associated with HLA-DR4, in contrast to seronegative EORA. Possible heterogeneity in the pathogenesis of seronegative EORA is supported by the recognition of subsets that overlap with the clinical manifestations of other syndromes such as polymyalgia rheumatica and remitting seronegative symmetrical synovitis with pitting edema. In addition, crystal-induced arthritis and inflammatory osteoarthritis may be difficult to distinguish from EORA. The efficacy and toxicity of second-line drugs is similar in both age groups, but in the elderly caution is needed with the use of nonsteroidal antiinflammatory drugs and prednisone.

Language of Publication

English

Unique Identifier

95025980

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MeSH Heading (Major)

Arthritis, Rheumatoid|*/DI/EP/PP/TH

MeSH Heading

Aged; Aged, 80 and over; Aging; Antirheumatic Agents|TU; Diagnosis, Differential; Female; Human; Male; Middle Age; Prognosis; Sex Hormones|ME

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC

ISSN

0049-0172

Country of Publication

UNITED STATES

Record 15 from database: MEDLINE
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Title

Sacral insufficiency fractures in the elderly.

Author

Gotis Graham I; McGuigan L; Diamond T; Portek I; Quinn R; Sturgess A; Tulloch R

Address

St George Hospital, Kogarah, Australia.

Source

J Bone Joint Surg Br, 1994 Nov, 76:6, 882-6

Abstract

Sacral insufficiency fractures are not uncommon in elderly patients. We have diagnosed 20 cases in a five-year period, and have reviewed the clinical records, radiographs, CT and bone scans. We also assessed the degree of osteoporosis by measuring bone density using dual-energy X-ray absorptiometry and bone histomorphometry, and monitored the patients' functional outcome. Bone scans were positive in all 20 patients, CT showed a fracture or sclerosis in 7 of 12 patients and was useful in excluding malignancy. Plain radiographs were the least helpful, showing sclerosis in only 4 of the 20 patients. Involutional osteoporosis with a reduced bone formation rate was the most common underlying cause. Seventeen patients had complete resolution of pain within nine months, and no patient lost independence in daily activities. Increased awareness of these fractures may help to avoid unnecessary investigation and treatment. Bedrest and analgesia followed by rehabilitation provide good relief of symptoms.

Language of Publication

English

Unique Identifier

95074217

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MeSH Heading (Major)

Arthritis, Rheumatoid|*CO/PP/RA/RI; Low Back Pain|DI/*ET; Osteoporosis|*CO/PP/RA/RI; Sacrum|*IN/RA/RI; Scoliosis|*CO/PP/RA/RI; Spinal Fractures|*ET/PP/RA/RI

MeSH Heading

Aged; Aged, 80 and over; Bone Density; Densitometry, X-Ray; Female; Follow-Up Studies; Human; Male; Middle Age; Tomography, X-Ray Computed

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES

ISSN

0301-620X

Country of Publication

ENGLAND

Record 16 from database: MEDLINE
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Title

Invasive staphylococcal infections complicating percutaneous transluminal coronary angioplasty: three cases and review [see comments]

Author

Cleveland KO; Gelfand MS

Address

Department of Medicine, Methodist Hospitals of Memphis, Tennessee, USA.

Source

Clin Infect Dis, 1995 Jul, 21:1, 93-6

Abstract

Infectious complications infrequently occur after percutaneous transluminal coronary angioplasty (PTCA) is performed. We recently treated three patients with invasive staphylococcal infections that developed after PTCA. Two patients had septic arthritis of the knee joint secondary to probable femoral endarteritis, and the third patient had an infected hematoma of the groin. Early reuse of the initial puncture site, prolonged retention of the femoral sheath, bleeding or hematoma at the femoral sheath insertion site and vascular complications such as pseudoaneurysm may predispose to infectious sequelae after PTCA. The clinician should be aware of these risks and the possibility that a patient may develop these potentially serious complications after PTCA.

Language of Publication

English

Unique Identifier

96065618

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MeSH Heading (Major)

Angioplasty, Transluminal, Percutaneous Coronary|*AE; Arthritis, Infectious|DT/*MI; Hematoma|DT/*MI; Knee Joint|*; Staphylococcal Infections|DT/*ET; Staphylococcus aureus|*IP

MeSH Heading

Aged; Aged, 80 and over; Antibiotics, Combined|TU; Case Report; Female; Groin; Human; Male; Microbial Sensitivity Tests; Middle Age; Synovial Fluid|MI

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES

ISSN

1058-4838

Country of Publication

UNITED STATES

Record 17 from database: MEDLINE
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Title

Rapid destructive arthritis of the shoulder.

Author

Nguyen VD

Address

University of Texas Health Science Center, San Antonio 78284-7800, USA.

Source

Skeletal Radiol, 1996 Feb, 25:2, 107-12

Abstract

Rapid destructive arthritis of the shoulder, although uncommon, has received much attention in the recent medical literature. It has been described by several authors under varied names: hemorrhagic shoulder of the elderly, Milwaukee shoulder syndrome, rapid destructive arthritis of the shoulder, apatite-associated destructive arthritis and idiopathic destructive arthritis of the shoulder. This particular form of arthritis affects mainly elderly patients, predominantly women, with limited pain, rotator cuff tear, joint instability, voluminous mildly inflammatory, blood-stained effusion, basic calcium phosphate crystals, and marked joint and bone destruction.

Language of Publication

English

Unique Identifier

96237372

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MeSH Heading (Major)

Arthritis|*/EP/ET/RA; Shoulder Joint|*/RA

MeSH Heading

Age Factors; Aged; Aged, 80 and over; Female; Hip Joint; Human; Knee Joint; Male; Middle Age; Rotator Cuff|RA; Sex Factors

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

0364-2348

Country of Publication

GERMANY

Record 18 from database: MEDLINE
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Title

Septic arthritis of the glenohumeral joint. A report of 11 cases and review of the literature.

Author

Lossos IS; Yossepowitch O; Kandel L; Yardeni D; Arber N

Address

Department of Medicine, Hadassah University Hospital, Jerusalem, Israel. ilos@md2.huji.ac.il

Source

Medicine (Baltimore), 1998 May, 77:3, 177-87

Abstract

Eleven cases (6 adults and 5 pediatrics) of shoulder septic arthritis are described, and the English literature from 1960 to 1997 reviewed, for a total of 168 cases. Shoulder septic arthritis is an uncommon and difficult diagnosis requiring a high index of suspicion and early evaluation of the affected shoulder by the clinician. The disease usually involves very young infants or elderly patients (65-75 years old). Associated medical conditions were identified in 60% of the patients and include systemic disorders such as liver diseases, alcoholism, and malignancies in 46%; preceding chronic arthritic disorders in 24%; and associated infectious focus in 13% of the patients. Associated infections were more prevalent in the pediatric population. Intravenous drug abuse appears not to constitute a major risk factor; it was identified in less than 5% of patients. All patients presented with acute shoulder ache or with exacerbation of existing chronic pain in joints previously damaged. Elevated body temperature (over 38 degrees C) appeared in 67% of the adult patients and in over 90% of the pediatric patients. Shoulder arthritis was frequently accompanied by an accelerated erythrocyte sedimentation rate that may rise above 100 mm/hr. Increased white blood cell count was found in approximately 40% of patients. The initial X-rays were frequently normal, while ultrasonography supported the diagnosis in some cases by demonstrating accumulation of fluid inside the joint space. Aspiration of synovial fluid from the affected glenohumeral joint was necessary to evaluate the offending pathogen. False-negative Gram stain appeared in approximately 90% of the patients, whereas synovial fluid cultures demonstrated the pathogen in 88% of patients. Blood cultures were positive in 50% of adult patients and 90% of pediatric patients. The most common isolated pathogen was Staphylococcus aureus, which accounted for 41% of infections. Gram-negative bacilli, which accounted for about 20% of infections, are more prevalent in the pediatric population, especially the neonates. Pyogenic shoulder arthritis should first be treated with intravenous antibiotics, effective at least against staphylococcal infections, until the organisms and sensitivities are identified. Duration of antibiotic therapy should be 3-6 weeks. Unfortunately, our experience in addition to the literature summary does not allow statistical analysis and firm conclusions concerning the best therapeutic approach. However, it appears that in the adult population an operative draining procedure is preferred, whereas in the pediatric population, a closed needle aspiration, if needed at all, is the optimal treatment. With prompt antibiotic therapy and drainage of the shoulder, the patient can be expected to improve clinically, with no serious long-term debilitating effects from the disease.

Language of Publication

English

Unique Identifier

98317311

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MeSH Heading (Major)

Arthritis, Infectious|*DI/*MI/TH; Gram-Negative Bacteria|*IP; Shoulder Joint|*MI/SU

MeSH Heading

Aged; Aged, 80 and over; Antibiotics|TU; Case Report; Drainage|MT; Female; Human; Humerus; Male; Middle Age; Retrospective Studies; Synovial Fluid|MI

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

0025-7974

Country of Publication

UNITED STATES

CAS Registry/EC Number

0 (Antibiotics)

Record 19 from database: MEDLINE
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Title

Osteoarticular tuberculosis.

Author

Kosinski MA; Smith LC

Address

New York College of Podiatric Medicine, New York, USA.

Source

Clin Podiatr Med Surg, 1996 Oct, 13:4, 725-39

Abstract

Over the past several years there has been a dramatic rise in the incidence of tuberculosis. Peripheral skeletal tuberculosis is, more often than not, misdiagnosed as osteoarthritis or pyogenic osteomyelitis. Tuberculosis is no longer a "zebra" among differential diagnoses. This article reviews the pathogenesis, along with practical tips for the diagnosis and treatment of osteoarticular tuberculosis.

Language of Publication

English

Unique Identifier

97058011

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MeSH Heading (Major)

Tuberculosis, Osteoarticular|*/CO/DI/EP/MI/TH/TM

MeSH Heading

Aged; Aged, 80 and over; Arthritis, Infectious|DI/MI/PA; BCG Vaccine|AE; Diagnosis, Differential; Human; Middle Age; Osteomyelitis|MI/PA; Tuberculosis, Spinal|DI/PA

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

0891-8422

Country of Publication

UNITED STATES

Record 20 from database: MEDLINE
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Title

Lyme disease: an infectious and postinfectious syndrome.

Author

Asch ES; Bujak DI; Weiss M; Peterson MG; Weinstein A

Address

Department of Medicine, New York Medical College, Valhalla 10595.

Source

J Rheumatol, 1994 Mar, 21:3, 454-61

Abstract

OBJECTIVE. To determine chronic morbidity and the variables that influence recovery in patients who had been treated for Lyme disease. METHODS. Retrospective evaluation of 215 patients from Westchester County, NY, who fulfilled Centers for Disease Control case definition for Lyme disease, were anti-Borrelia antibody positive and were diagnosed and treated at least one year before our examination. RESULTS. Erythema migrans had occurred in 70% of patients, neurological involvement in 29%, objective cardiac problems in 6%, arthralgia in 78% and arthritis in 41%. Patients were seen at a mean of 3.2 years after initial treatment. A history of relapse with major organ involvement had occurred in 28% and a history of reinfection in 18%. Anti-Borrelia antibodies, initially present in all patients, were still positive in 32%. At followup, 82 (38%) patients were asymptomatic and clinically active Lyme disease was found in 19 (9%). Persistent symptoms of arthralgia, arthritis, cardiac or neurologic involvement with or without fatigue were present in 114 (53%) patients. Persistent symptoms correlated with a history of major organ involvement or relapse but not the continued presence of anti-Borrelial antibodies. Thirty-five of the 114 (31%) patients with persistent symptoms had predominantly arthralgia and fatigue. Antibiotic treatment within 4 weeks of disease onset was more likely to result in complete recovery. Children did not significantly differ from adults in disease manifestations or in the frequency of relapse, reinfection or complete recovery. CONCLUSION. Despite recognition and treatment, Lyme disease is associated with significant infectious and postinfectious sequelae.

Language of Publication

English

Unique Identifier

94275745

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MeSH Heading (Major)

Lyme Disease|CO/DI/DT/*EP/IM

MeSH Heading

Acute Disease; Adolescence; Adult; Aged; Aged, 80 and over; Antibiotics|TU; Antibodies, Bacterial|BL; Arrhythmia|EP/MI; Borrelia burgdorferi|IM; Child; Child, Preschool; Chronic Disease; Cohort Studies; Comparative Study; Female; Follow-Up Studies; Human; Life Style; Male; Middle Age; Nervous System Diseases|EP/MI; New York|EP; Recurrence; Registries; Risk Factors; Support, Non-U.S. Gov't

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, MULTICASE

ISSN

0315-162X

Country of Publication

CANADA

Record 21 from database: MEDLINE
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Title

Evidence of hepatitis C virus antibodies in the cryoprecipitate of patients with mixed cryoglobulinemia.

Author

Muñoz Fernández S; Barbado FJ; Martín Mola E; Gijón Baños J; Martinez Zapico R; Quevedo E; Arribas JR; González Anglada I; Vázquez JJ

Address

Rheumatology Unit, Hospital La Paz, Universidad AutÆonoma de Madrid, Spain.

Source

J Rheumatol, 1994 Feb, 21:2, 229-33

Abstract

OBJECTIVE. To describe the clinical features of 8 patients with mixed cryoglobulinemia and hepatitis C virus (HCV) infection. METHODS. A clinical study of the patients was performed. Anti-HCV antibodies were determined by ELISA and confirmed by immunoblot (RIBA) in the sera and in the cryoprecipitate. RESULTS. All patients had liver dysfunction, while most had arthralgias and/or arthritis, purpura, peripheral nervous system involvement and renal disorders. Cryocrits ranged from 1 to 6%. Six patients had type III mixed cryoglobulinemia and the remaining 2 had type II. History of blood transfusion was recorded in 2 patients. Hepatitis B virus (HBV) markers were negative in all sera samples. The cryoprecipitate of 7 patients was negative for HBV markers, but anti-HCV antibodies were positive by both ELISA and RIBA. CONCLUSION. After reviewing published reports and discussing the possible role that hepatitis C virus plays in the pathogenesis of mixed cryoglobulinemia, we conclude that HCV may stimulate immune complex formation and produce cryoglobulinemia. Therefore its investigation is recommended before the diagnosis of "essential" mixed cryoglobulinemia is established.

Language of Publication

English

Unique Identifier

94238562

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MeSH Heading (Major)

Cryoglobulinemia|ET/*IM/MI; Hepatitis Antibodies|*BL; Hepatitis C-Like Viruses|*IM/PY

MeSH Heading

Adult; Aged; Aged, 80 and over; Female; Hepatitis C|CO; Human; Male; Middle Age; Support, Non-U.S. Gov't

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

0315-162X

Country of Publication

CANADA

Record 22 from database: MEDLINE
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Title

Clinical features and antibiotic treatment of septic arthritis and osteomyelitis due to Yersinia enterocolitica.

Author

Crowe M; Ashford K; Ispahani P

Address

Department of Microbiology and Public Health Laboratory, Queens Medical Centre, University Hospital, Nottingham, United Kingdom.

Source

J Med Microbiol, 1996 Oct, 45:4, 302-9

Abstract

Yersinia enterocolitica bone and joint infections are rare. Over a period of 7 months four patients with deep-seated skeletal infections due to Y. enterocolitica were seen at the University Hospital, Nottingham. Sites of infection included the knee (one patient) the hip (one) and the spine (two). None of the patients had major underlying disease or risk factors for developing invasive Y. enterocolitica infection. The organisms were sensitive to the second- and third-generation cephalosporins, gentamicin and fluoroquinolones. A literature search covering the period 1970-1994 revealed 20 other cases of skeletal infections due to Y. enterocolitica; there was no uniformity in the choice of antimicrobial agent for treating these infections. Oral ciprofloxacin was used as the principal antimicrobial agent in the patients described here and therapeutic success was achieved in three of these patients. Ciprofloxacin should be considered as first line therapy for invasive infections due to Y enterocolitica.

Language of Publication

English

Unique Identifier

97002305

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MeSH Heading (Major)

Arthritis, Infectious|*DT; Osteomyelitis|*DT; Yersinia enterocolitica|*/DE; Yersinia Infections|*DT

MeSH Heading

Administration, Oral; Adolescence; Aged; Aged, 80 and over; Anti-Infective Agents, Fluoroquinolone|PD/TU; Antibiotics, Aminoglycoside|PD; Case Report; Cephalosporins|PD; Ciprofloxacin|AD/PD/TU; Female; Gentamicins|PD; Human; Male; Middle Age

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES

ISSN

0022-2615

Country of Publication

ENGLAND

Record 23 from database: MEDLINE
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Title

Quinidine-induced rheumatic syndromes.

Author

Alloway JA; Salata MP

Address

Department of Medicine, Malcolm Grow Medical Center, Andrews Air Force Base, MD 20331, USA.

Source

Semin Arthritis Rheum, 1995 Apr, 24:5, 315-22

Abstract

Quinidine is a commonly used antiarrhythmic agent that is rarely associated with rheumatologic toxicity. However, quinidine-induced lupus, antinuclear antibody negative lupus-like syndrome, polymyalgia rheumatica-like illness, muscle weakness, and isolated creatine phosphokinase elevation have all been reported. We present one case of quinidine drug-induced lupus and another of a quinidine-induced polymyalgia rheumatica-like illness, and review the English literature for rheumatologic toxicity due to quinidine. Prompt recognition of quinidine associated rheumatologic toxicity is important because discontinuation of the medication leads to rapid resolution of clinical symptoms.

Language of Publication

English

Unique Identifier

95327974

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MeSH Heading (Major)

Lupus Erythematosus, Systemic|*CI/DI/PP; Polymyalgia Rheumatica|*CI/DI/PP; Quinidine|*AA/AE/TU

MeSH Heading

Adult; Aged; Aged, 80 and over; Antibodies, Antinuclear|AN; Atrial Fibrillation|ET; Child; Diagnosis, Differential; Female; Hematologic Tests; Human; Hydralazine|AE; Male; Middle Age; Procainamide|AE; Prognosis

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES

ISSN

0049-0172

Country of Publication

UNITED STATES

Record 24 from database: MEDLINE
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Title

Two new cancer locations accompanied with palmar fasciitis and polyarthritis.

Author

Grados F; Houvenagel E; Cayrolle G; Bellony R; Fardellone P; Sebert JL

Address

Rheumatology Department, North Teaching Hospital, Amiens, France.

Source

Rev Rhum Engl Ed, 1998 Mar, 65:3, 212-4

Abstract

Only 35 cases of cancer with palmar fasciitis and polyarthritis have been published to date. We report two new cases, one with a transitional cell carcinoma of the renal pelvis and the other with an adenocarcinoma of the uterus. Neither of these locations has been reported in association with palmar fasciitis and polyarthritis. Palmar fasciitis with polyarthritis can occur in a wide range of cancers and warrants extensive investigations for a malignant tumor.

Language of Publication

English

Unique Identifier

98235569

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MeSH Heading (Major)

Adenocarcinoma|*CO; Arthritis|*CO; Carcinoma, Transitional Cell|*CO; Fasciitis|*CO; Hand|*; Kidney Neoplasms|*CO; Kidney Pelvis|*; Uterine Neoplasms|*CO

MeSH Heading

Aged; Aged, 80 and over; Case Report; Female; Human; Middle Age

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES

ISSN

1169-8446

Country of Publication

FRANCE

Record 25 from database: MEDLINE
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Title

Clinical manifestations in 105 persons with nevoid basal cell carcinoma syndrome.

Author

Kimonis VE; Goldstein AM; Pastakia B; Yang ML; Kase R; DiGiovanna JJ; Bale AE; Bale SJ

Address

Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Disease, Bethesda, Maryland 20892-2757, USA.

Source

Am J Med Genet, 1997 Mar, 69:3, 299-308

Abstract

Nevoid basal cell carcinoma syndrome (NBCC; Gorlin syndrome), an autosomal dominant disorder linked to 9q22.3-q31, and caused by mutations in PTC, the human homologue of the Drosophila patched gene, comprises multiple basal cell carcinomas, keratocysts of the jaw, palmar/plantar pits, spine and rib anomalies and calcification of the falx cerebri. We reviewed the findings on 105 affected individuals examined at the NIH since 1985. The data included 48 males and 57 females ranging in age from 4 months to 87 years. Eighty percent of whites (71/90) and 38% (5/13) of African-Americans had at least one basal cell carcinoma (BCC), with the first tumor occurring at a mean age of 23 (median 20) years and 21 (median 20) years, respectively. Excluding individuals exposed to radiation therapy, the number of BCCs ranged from 1 to > 1,000 (median 8) and 1 to 3 (median 2), respectively, in the 2 groups. Jaw cysts occurred in 78/105 (74%) with the first tumor occurring in 80% by the age of 20 years. The number of total jaw cysts ranged from 1 to 28 (median 3). Palmar pits and plantar pits were seen in 87%. Ovarian fibromas were diagnosed by ultrasound in 9/52 (17%) at a mean age of 30 years. Medulloblastoma occurred in 4 patients at a mean age of 2.3 years. Three patients had cleft lip or palate. Physical findings include "coarse face" in 54%, relative macrocephaly in 50%, hypertelorism in 42%, frontal bossing in 27%, pectus deformity in 13%, and Sprengel deformity in 11%. Important radiological signs included calcification of the falx cerebri in 65%, of the tentorium cerebelli in 20%, bridged sella in 68%, bifid ribs in 26%, hemivertebrae in 15%, fusion of the vertebral bodies in 10%, and flame shaped lucencies of the phalanges, metacarpal, and carpal bones of the hands in 30%. Several traits previously considered components of the syndrome (including short fourth metacarpal, scoliosis, cervical ribs and spina bifida occulta) were not found to be significantly increased in the affected individuals. This study delineates the frequency of the clinical and radiological anomalies in NBCC in a large population of US patients and discusses guidelines for diagnosis and management.

Language of Publication

English

Unique Identifier

97251078

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MeSH Heading (Major)

Basal Cell Nevus Syndrome|*DI/EP/PA/RT

MeSH Heading

Adolescence; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Chromosomes, Human, Pair 9; Cross-Sectional Studies; Female; Human; Infant; Jaw Cysts|CO; Male; Medulloblastoma|CO/RT; Middle Age; Urogenital Abnormalities; Urogenital System|AB

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED CASES

ISSN

0148-7299

Country of Publication

UNITED STATES

Record 26 from database: MEDLINE
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Title

Severe infections caused by Propionibacterium acnes: an underestimated pathogen in late postoperative infections.

Author

Jakab E; Zbinden R; Gubler J; Ruef C; von Graevenitz A; Krause M

Address

Department of Medical Microbiology, University of Zurich, Switzerland.

Source

Yale J Biol Med, 1996 Nov, 69:6, 477-82

Abstract

Propionibacterium acnes belongs to the cutaneous flora of humans and is rarely considered a pathogen in human diseases. It is a frequent contaminant in blood cultures; however, in some patients it has been identified as the causative agent of life-threatening infections. Within the last years we have observed an abrupt increase in severe P. acnes infections which prompted us to study in detail the clinical and microbiological features, risk factors, and outcomes of these cases. In a retrospective review of microbiological records of 905 Propionibacterium isolates from a five-year period (1990-95), 70 were identified from 20 patients with clinical and microbiological evidence of a P. acnes infection. The clinical syndromes included endocarditis (7 patients), post-craniotomy infections (6 patients), arthritis and spondylodiscitis (4 patients), endophthalmitis (2 patients) and pansinusitis (1 patient). The predominant predisposing conditions were previous surgery preceding the infection from 2 weeks to 4 years and implantation of foreign bodies such as prosthetic heart valves, intraocular lenses and ventriculo-peritoneal shunts. Therapy consisted of intravenous antibiotics in all cases and surgical procedures to remove infected tissue in eighteen patients. The outcome was favorable in sixteen patients (80 percent) who had a complete recovery. These data confirm the pathogenic potential of P. acnes in late post-surgical infections, in particular after implantation of a foreign body, and suggest a combined therapeutic approach with intravenous antibiotics and surgical removal of the infected tissue.

Language of Publication

English

Unique Identifier

98098685

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MeSH Heading (Major)

Gram-Positive Bacterial Infections|*MI/PP/TH; Postoperative Complications|*MI; Propionibacterium acnes|*IP

MeSH Heading

Adolescence; Adult; Aged; Aged, 80 and over; Female; Human; Male; Middle Age

Publication Type

JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

ISSN

0044-0086

Country of Publication

UNITED STATES

Record 27 from database: MEDLINE
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Title

Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls.

Author

Davies NM; Anderson KE

Address

Faculty of Medicine, Department of Pharmacology and Therapeutics, University of Calgary, Alberta, Canada. ndavies@acs.ucalgary.ca

Source

Clin Pharmacokinet, 1997 Sep, 33:3, 184-213

Abstract

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) of the phenylacetic acid class. When given orally the absorption of diclofenac is rapid and complete. Diclofenac binds extensively to plasma albumin. The area under the plasma concentration-time curve (AUC) of diclofenac is proportional to the dose for oral doses between 25 to 150 mg. Substantial concentrations of drug are attained in synovial fluid, which is the proposed site of action for NSAIDs. Concentration-effect relationships have been established for total bound, unbound and synovial fluid diclofenac concentrations. Diclofenac is eliminated following biotransformation to glucoroconjugated and sulphate metabolites which are excreted in urine, very little drug is eliminated unchanged. The excretion of conjugates may be related to renal function. Conjugate accumulation occurs in end-stage renal disease; however, no accumulation is apparent upon comparison of young and elderly individuals. Dosage adjustments for the elderly, children or for patients with various disease states (such as hepatic disease or rheumatoid arthritis) may not be required. Significant drug interactions have been demonstrated for aspirin (acetylsalicylic acid), lithium, digoxin, methotrexate, cyclosporin, cholestyramine and colestipol.

Language of Publication

English

Unique Identifier

97460186