Subject(s)
Lung Diseases, Interstitial/therapy , Lung/pathology , Biopsy/methods , Bronchoalveolar Lavage , Exercise Test , Humans , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Lung Diseases, Interstitial/diagnosis , Lung Transplantation , Medical History Taking , Physical Examination , Respiratory Function Tests , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Respiratory System Agents/therapeutic use , Terminology as TopicABSTRACT
BACKGROUND: Clearance of inhaled technetium 99m-labelled diethylenetriamine penta-acetic acid ((99m)Tc-DTPA) from the lungs is a potential indicator of disease progression in patients with idiopathic pulmonary fibrosis (IPF). METHODS: We prospectively analysed the usefulness of this technique for predicting survival in 106 non-smoking patients with usual interstitial pneumonia (UIP) pattern IPF diagnosed by high resolution CT (HRCT) scanning or histological examination (M/F 65/41, mean (SD) age 61 (11) years). DTPA clearance was analysed according to both mono-exponential and bi-exponential models. Half times for the fast (t(0.5)F) and slow (t(0.5)S) components of clearance, the percentage contribution of the fast component (fF), and half time for mono-exponential approximation to the early part of the clearance curve (t(0.5)) were calculated. RESULTS: The patients had substantially faster t(0.5) (mean 23.9 (9.6) minutes) than normal values (>45 minutes). Thirty seven patients (35%) died during follow up (median 15 months). Univariate Cox regression analysis identified significant predictors of survival as age, forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), % predicted TLC, carbon monoxide transfer factor (TLCO), % predicted TLCO, arterial oxygen tension (PaO(2)), oxygen saturation, t(0.5)F, and HRCT fibrosis score. Multiple stepwise Cox regression analysis identified t(0.5)F (p=0.03, hazard ratio 0.747, 95% CI 0.578 to 0.964), % predicted TLC (p=0.02, hazard ratio 0.976, 95% CI 0.956 to 0.995), % predicted TLCO (p=0.003, hazard ratio 0.960, 95% CI 0.935 to 0.986), and age (p=0.003, hazard ratio 1.062, 95% CI 1.021 to 1.104) as independent predictors of survival. CONCLUSION: These data suggest that (99m)Tc-DTPA clearance t(0.5)F measurement may predict survival in patients with UIP pattern IPF.
Subject(s)
Pulmonary Fibrosis/metabolism , Radiopharmaceuticals/pharmacokinetics , Technetium Tc 99m Pentetate/pharmacokinetics , Aged , Bronchoalveolar Lavage Fluid/cytology , Female , Humans , Male , Metabolic Clearance Rate , Middle Aged , Predictive Value of Tests , Prognosis , Proportional Hazards Models , Prospective Studies , Regression Analysis , Respiratory Function Tests , Survival AnalysisABSTRACT
Sulphasalazine is an effective treatment for rheumatoid arthritis but the response in any individual is unpredictable. We have sought to establish a relationship between dose (in mg/kg body weight) and metabolism of the drug in 79 patients selected for an extremely good response (43) or no response (36) to treatment with sulphasalazine. The dose of sulphasalazine in relationship to body weight showed no difference between the two treatment outcome groups. The distribution of acetylator phenotype showed only a trend for slow acetylators to occur more frequently in the group of good responders to treatment. There is no advantage in the routine assessment of acetylator phenotype as a predictor of response to treatment with sulphasalazine.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Sulfasalazine/therapeutic use , Acetylation , Adolescent , Adult , Aged , Arthritis, Rheumatoid/genetics , Blood Sedimentation , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Phenotype , Sulfasalazine/administration & dosage , Time FactorsSubject(s)
Arthritis, Rheumatoid/drug therapy , Sulfasalazine/therapeutic use , Female , Humans , MaleABSTRACT
The differentiation between psoriatic arthritis and rheumatoid arthritis can be clinically difficult if there is no manifest psoriasis of skin or nail. In order to clarify this diagnostic problem, the amino acid patterns in seventy-five psoriatic and non-psoriatic nails have been studied. Using gas--liquid chromatographic techniques and discriminant analysis, a high degree of differentiation (96%) has been established between the normal looking nails of patients with psoriatic arthritis and those with rheumatoid arthritis. This biochemical/statistical approach to the fingernail enhances diagnosis in difficult clinical problems, particularly where there are no overt manifestations of psoriasis.
