RESUMO
OBJECTIVE: Diagnostic technologies are often assessed merely by their accuracy, rather than by their impact on diagnosis and patient management. To this end the authors have undertaken a study to assess the diagnostic and therapeutic impact of magnetic resonance imaging (MRI) and arthrography of the shoulder for patients referred from a rheumatology clinic. METHODS AND PATIENTS: Patients referred from a rheumatology clinic with symptoms warranting imaging of the shoulder were randomised to either MRI or arthrography. Data on the clinician's diagnostic confidence and management were recorded before and after imaging using questionnaires. Patients were followed-up at least 10 months after imaging to see how management plans evolved, and what proportion of patients required further imaging. RESULTS: Fifty three shoulders underwent imaging over a year and entered into the study; 29 randomised to MRI and 24 to arthrography. Both MRI and arthrography had a similar beneficial diagnostic impact in terms of clinical diagnoses (refuted and retained) and new diagnoses established. MRI and arthrography had a similar therapeutic impact, although MRI was associated with a significant shift towards surgical intervention. CONCLUSION: MRI and arthrography a have similar diagnostic and therapeutic impact.
Assuntos
Artrografia , Imageamento por Ressonância Magnética , Articulação do Ombro , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/terapia , Masculino , Pessoa de Meia-IdadeRESUMO
We have investigated the biological and therapeutic properties of a humanized anti-CD4 MoAb, hIgG1-CD4, in patients with refractory psoriasis and rheumatoid arthritis (RA). hIgG1-CD4 is a modulating, non-depleting MoAb, which induced a first-dose reaction in most patients treated. It provided brief symptomatic relief in both conditions, and psoriasis appeared easier to control with conventional agents after MoAb therapy. At the doses used, hIgG1-CD4 did not synergize therapeutically with the panlymphocyte MoAb CAMPATH-1H (C1H) in patients with RA treated sequentially with both agents. There were no serious adverse effects definitely attributable to therapy. Our results are compared with those of other CD4 MoAb studies, and factors influencing the outcome of therapy are discussed.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Antígenos CD4/imunologia , Psoríase/tratamento farmacológico , Psoríase/imunologia , Adolescente , Adulto , Idoso , Animais , Anticorpos Biespecíficos/imunologia , Anticorpos Biespecíficos/uso terapêutico , Anticorpos Monoclonais/imunologia , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/imunologia , Feminino , Humanos , Imunoterapia , Masculino , Pessoa de Meia-Idade , RatosRESUMO
Studies conducted in Europe suggest an association between IgG glycosylation abnormalities and rheumatoid arthritis (RA). Glycosylation abnormalities have been shown in other inflammatory diseases such as tuberculosis, systemic lupus erythematosus (SLE) and Crohn's disease. These observations led us to study glycosylation abnormalities among patients with RA and healthy controls in the tropics (sub-Saharan Africa). Using a lectin binding assay, we found that glycosylation differences were present in both groups when compared with British rheumatoid and healthy controls. This suggests that IgG glycosylation abnormalities may occur in association with chronic infections in the tropics.
Assuntos
Artrite Reumatoide/metabolismo , Imunoglobulina G/metabolismo , Infecções/complicações , Fator Reumatoide/metabolismo , Adolescente , Adulto , Idoso , Artrite Reativa/complicações , Artrite Reumatoide/etnologia , Doença Crônica , Feminino , Glicosilação , Hepatite B/complicações , Humanos , Imunoglobulina A/metabolismo , Imunoglobulina G/sangue , Malária/complicações , Masculino , Pessoa de Meia-Idade , Nigéria , Análise de Regressão , Clima TropicalAssuntos
Flurbiprofeno/administração & dosagem , Osteoartrite/tratamento farmacológico , Propionatos/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Preparações de Ação Retardada , Feminino , Flurbiprofeno/efeitos adversos , Flurbiprofeno/uso terapêutico , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como AssuntoRESUMO
The in vitro transformation response of peripheral blood lymphocytes to human arterial and muscle homogenates has been studied in patients with polymyalgia rheumatica (PMR), giant cell arteritis (GCA) and in unrelated controls. Homogenates that stimulated PMR/GCA cells also stimulated controls. There was no greater stimulation to human or bovine elastin than to artery and muscle homogenates. Our results do not confirm a lymphocyte abnormality in these diseases.