Abstract:
STUDY OBJECTIVE:To assess the efficacy and toxicity of cyclosporin A in patients with severe, treatment-refractory rheumatoid arthritis. DESIGN:Prospective randomized, double-blind 6-month trial. PATIENTS:Thirty-one patients who had classic seropositive rheumatoid arthritis with active synovitis unresponsive to conventional therapy. INTERVENTIONS:Patients were randomly assigned to high-dose (10 mg/kg body weight.d) or low-dose (1 mg/kg.d) cyclosporin A therapy. A reduction in the dose was permitted for adverse side effects. After 6 months of therapy, patients who showed clinically relevant improvement, defined as a 40% or greater reduction in their total joint activity score, were given the option to continue receiving the therapy for an additional 6 months. MEASUREMENTS AND MAIN RESULTS:At 6 months, clinically relevant improvement occurred in 10 of 15 patients (95% CI, 38 to 88) receiving high-dose therapy and in 4 of 16 patients (CI, 7 to 52) receiving low-dose therapy (P = 0.02). Statistically significant improvements in individual measures were shown only in the high-dose group. Improvements were noted in the number of tender joints (-18.8; CI, -24.5 to -13.1) and swollen joints (-12.1; CI, -15.4 to -8.6), as well as in physician's global scores (-1.5; CI, -2.1 to -0.9) and patient's global scores (-1.1; CI, -1.9 to -0.5). Improvement in disease activity was maintained through 12 months in the high-dose group. The clinical responses to cyclosporin A were most evident in patients with depressed in-vitro proliferative responses of peripheral blood mononuclear lymphocytes to soluble recall antigens. Toxicities, such as fatigue, gastrointestinal and neurologic complaints, and hypertrichosis were frequent but often reversible with a reduction in the dose. Nephrotoxicity, with a 20% increase in the serum creatinine level, was seen in 27 of 31 patients (CI, 71 to 97). CONCLUSIONS:Cyclosporin A is an effective therapy for severe, treatment-refractory rheumatoid arthritis. Side effects, particularly nephrotoxicity, are common.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Yocum DE,Klippel JH,Wilder RL,Gerber NL,Austin HA 3rd,Wahl SM,Lesko L,Minor JR,Preuss HG,Yarboro Cdoi
10.7326/0003-4819-109-11-863subject
Has Abstract,Author List Incompletepub_date
1988-12-01 00:00:00pages
863-9issue
11eissn
0003-4819issn
1539-3704journal_volume
109pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVE:To assess the use of L-tryptophan by patients with eosinophilic fasciitis and compare this with its use by patients with progressive systemic sclerosis (scleroderma). DESIGN:Retrospective and prospective analysis. Six patients with eosinophilic fasciitis were identified retrospectively and two prospectively....
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-10-758
更新日期:1990-05-15 00:00:00
abstract::The experience of serving as an expert witness can add considerably to a physician's knowledge of medicine and the forces that affect the profession. Each case compels the physician to examine carefully all the clinical data. The physician must assess the quality of care given and render an opinion that is consistent ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-1-139
更新日期:1984-01-01 00:00:00
abstract::We diagnosed Waldenström's macroglobulinemia in a father and three offspring. Clinical and subclinical autoimmune disorders occurred excessively in the family. The HLA haplotype A2, B8, DRw3 was detected in all patients with Waldenström's macroglobulinemia and all but one family member with autoimmune manifestations. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-6-830
更新日期:1980-12-01 00:00:00
abstract:BACKGROUND:The accuracy and harms of brief cognitive tests for identifying clinical Alzheimer-type dementia (CATD) are uncertain. PURPOSE:To summarize evidence on accuracy and harms of brief cognitive tests for CATD in older adults with suspected cognitive impairment. DATA SOURCES:Electronic bibliographic databases (...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M19-3889
更新日期:2020-05-19 00:00:00
abstract:OBJECTIVE:To describe the relation between glycated hemoglobin and the incidence or progression, or both, of diabetic microvascular complications in persons with insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). DESIGN:Population-based on cohort study. SETTING:An 11-county area in southern...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-1_part_2-199601011-00003
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:The current standard initial therapies for deep venous thrombosis are low-molecular-weight heparin and unfractionated heparin. In a dose-ranging study of patients with symptomatic deep venous thrombosis, fondaparinux had efficacy and a safety profile similar to those of low-molecular-weight heparin (daltepar...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-140-11-200406010-00007
更新日期:2004-06-01 00:00:00
abstract::Effective health care is a core determinant of successful aging, and medications are one of the most important therapeutic tools of health care providers. Most older adults use at least one prescription drug. Costs for these drugs are a substantial out-of-pocket expense for Medicare beneficiaries, and low-income older...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-139-5_part_2-200309021-00009
更新日期:2003-09-02 00:00:00
abstract::We compared the effects of quinidine and three alternate antiarrhythmic drugs on serum digoxin concentration in 63 patients before and during administration of quinidine, procainamide, disopyramide, or mexiletine. Quinidine increased digoxin concentration by at least 0.5 nmol/L in 21 of 22 patients: Mean serum digoxin...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-92-5-605
更新日期:1980-05-01 00:00:00
abstract:BACKGROUND:The number of very elderly persons who are candidates for implantation of a permanent pacemaker is increasing, but the effect of cardiac pacing on long-term survival and functional variables has not been determined. OBJECTIVE:To determine long-term survival after implantation of a permanent pacemaker in oct...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-125-6-199609150-00008
更新日期:1996-09-15 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the usefulness and safety of hydroxychloroquine in patients with decompensated, treatment-refractory noninsulin-dependent diabetes mellitus. DESIGN:Prospective, randomized, placebo, double-blind 6-month trial. PATIENTS:Thirty-eight patients with noninsulin-dependent diabetes resistant to c...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-112-9-678
更新日期:1990-05-01 00:00:00
abstract::Type 2 diabetes mellitus is a chronic metabolic disorder that results from defects in both insulin secretion and insulin action. An elevated rate of basal hepatic glucose production in the presence of hyperinsulinemia is the primary cause of fasting hyperglycemia; after a meal, impaired suppression of hepatic glucose ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-131-4-199908170-00008
更新日期:1999-08-17 00:00:00
abstract:OBJECTIVE:To identify and describe patients with hepatotoxicity possibly caused by flutamide, an antiandrogen drug. DESIGN:Case series of reports, submitted to the Adverse Drug Event Reporting System of the Food and Drug Administration. SETTING:Outpatient clinics and physicians' offices in the United States. PATIENT...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-118-11-199306010-00006
更新日期:1993-06-01 00:00:00
abstract::The causes, therapy for, and consequences of hypernatremia in elderly patients are not well understood. We found that in 15,187 consecutive hospital admissions, 162 (1.1%) patients who were at least 60 years of age had serum sodium levels that measured greater than 148 meq/L. Of that 162, 57% had become hypernatremic ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-2-309
更新日期:1987-09-01 00:00:00
abstract::Sixty-eight patients clinically suspected of having (33), or at high risk for (35), deep venous thrombosis were studied with contrast venography, radiofibrinogen leg scanning, and impedance plethysmography as well as ventilation and perfusion lung scans. Thrombosis limited to the veins in the calf of the leg (unilater...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-4-439
更新日期:1981-04-01 00:00:00
abstract:PURPOSE:To examine the cost-effectiveness of test-treatment strategies for patients suspected of having Lyme disease. DATA SOURCES:The medical literature was searched for information on outcomes and costs. Expert opinion was sought for information on utilities. STUDY SELECTION:Articles that described patient populati...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-1-199801010-00007
更新日期:1998-01-01 00:00:00
abstract::In patients with end-stage renal disease, nervous system dysfunction remains a major cause of disability. Patients with chronic renal failure who have not yet received dialysis may have symptoms ranging from mild sensorial clouding to delirium and coma. Dialysis itself is associated with at least three distinct disord...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-109-2-143
更新日期:1988-07-15 00:00:00
abstract:BACKGROUND:Without population-based evidence, some clinicians recommend short-term suspension of hormone therapy to improve the performance of mammography. Hormone therapy increases breast density, and abnormal screening mammograms are more common among women with denser breasts and among women using hormone therapy. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/0003-4819-150-11-200906020-00003
更新日期:2009-06-02 00:00:00
abstract::Recent reviews have suggested a higher frequency of the lupus anticoagulant or related antiphospholipid antibodies in patients with systemic lupus erythematosus (21% to 65%) than was found in earlier studies (6% to 18%). In our study of 60 consecutive patients, we found the frequency of the lupus anticoagulant by Russ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-106-4-524
更新日期:1987-04-01 00:00:00
abstract::A patient with a retained bullet developed lead poisoning in association with thyrotoxicosis. The clinical and laboratory data suggest that lead was mobilized from an increased mobile bone pool during the hypermetabolic period with resultant poisoning. The findings give factual support to earlier concepts that lead po...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-4-509
更新日期:1978-10-01 00:00:00
abstract:BACKGROUND:Persons with abdominal aortic aneurysm are more likely to have a higher prevalence of risk factors for and clinical manifestations of cardiovascular disease. It is unknown whether these factors explain the high mortality rate associated with abdominal aortic aneurysm. OBJECTIVE:To describe the risk for mort...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-134-3-200102060-00008
更新日期:2001-02-06 00:00:00
abstract:OBJECTIVE:To explore how frequently physicians lose medical malpractice cases despite providing standard care and to assess whether severity of patient injury influences the frequency of plaintiff payment. DESIGN:Retrospective cohort study. SETTING:Physicians from the state of New Jersey insured by one insurance comp...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-117-9-780
更新日期:1992-11-01 00:00:00
abstract::One half of 42 subjects treated for painful shoulders received classic acupuncture, and one half received a placebo in which the needles did not penetrate the skin. Half of each of these groups was treated in a positive setting to encourage the subject, and half in a negative setting designed to keep encouragement at ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-84-4-381
更新日期:1976-04-01 00:00:00
abstract::A prospective pretreatment staging evaluation was done on 49 consecutive patients with mycosis fungoides or the Sézary syndrome to study patterns of disease spread and prognostic factors. Routine staging procedures included complete blood count, blood chemistries, chest roentgenogram, lymphangiogram, radionuclide scan...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-2-223
更新日期:1980-08-01 00:00:00
abstract:BACKGROUND:Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared. OBJECTIVE:To compare the effectiveness of 2 common nonsurgical treatments for SIS. DESIGN:Randomized, single-blind, comparative-effectiveness,...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/M13-2199
更新日期:2014-08-05 00:00:00
abstract::Dietary deficiency of vitamin B-12 has been reported, yet most people ingesting vitamin-B12-deficient diets even for many years appear to achieve a balance that does not lead to overt signs and symptoms of deficiency. I present the case of a vegan of 25 years' duration who developed severe neurologic abnormalities due...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-88-5-647
更新日期:1978-05-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the effects of dopamine, which has an inotropic effect on the myocardium and increases renal and splanchnic blood flow, on diaphragmatic contraction. DESIGN AND PATIENTS:We studied the changes in transdiaphragmatic pressure during electrical bilateral supramaximal stimulation of the phrenic n...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-110-1-17
更新日期:1989-01-01 00:00:00
abstract::Low back pain is common, but a herniated intervertebral disk is the cause in only a small percentage of cases. Most symptomatic disk herniations result in clinical manifestations (pain, reflex loss, muscle weakness) that resolve with conservative therapy, and only 5% to 10% of patients require surgery. Sciatica is usu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-8-598
更新日期:1990-04-15 00:00:00
abstract::Although the efficacy of hepatitis vaccine is well documented, the duration of immunity of healthy adults after vaccination is unknown. We studied 245 hospital employees 3 years after primary vaccination with hepatitis B vaccine to determine the prevalence of immunity indicated by levels of antibody to hepatitis B sur...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-108-2-185
更新日期:1988-02-01 00:00:00
abstract:BACKGROUND:Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care. OBJECTIVE:To compare the care received at retail clinics for 3 acute conditions with that received at other care settings. D...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-151-5-200909010-00006
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:The appropriate roles for several diagnostic tests for coronary disease are uncertain. OBJECTIVE:To evaluate the cost-effectiveness of alternative approaches to diagnosis of coronary disease. DESIGN:Meta-analysis of the accuracy of alternative diagnostic tests plus decision analysis to assess the health ou...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-130-9-199905040-00003
更新日期:1999-05-04 00:00:00