Anne Louise Dolan - Academia.edu (original) (raw)

Papers by Anne Louise Dolan

Annals of the Rheumatic Diseases, 2013

The objective was to compare the eYcacy and safety of intramuscular methylprednisolone acetate (i... more The objective was to compare the eYcacy and safety of intramuscular methylprednisolone acetate (i.m. MP) with oral prednisolone (OP) in the treatment of polymyalgia rheumatica (PMR), a common steroid-treated illness where prolonged therapy can lead to steroid side-eVects. The cumulative dose with i.m. MP injections given every 3–4 weeks is considerably smaller than that with conventional OP, and may therefore be associated with fewer long-term side-eVects. A hybrid design was used with an initial 12 week double-blind placebo-controlled phase followed by an open phase on active treatment up to 96 weeks. The study was multicentre hospital out-patient based and included 60 patients with untreated PMR. In the double-blind phase, either 120 mg 3-weekly i.m. MP or gradually tapering daily OP (initial dose 15 mg) were administered. In the open phase, subjects continued their active treatment with gradual tapering of the steroid dosage. The remission rate at 12, 48 and 96 weeks, and other m...

$Research paper thumbnail of High incident fractures and comorbidities in patients with inadequate response to antiresorptive osteoporosis therapy: One year results from the UKOSSO study$

Rheumatology, 1996

Lumbar facet disease is sometimes implicated in low back pain. Identification is difficult and th... more Lumbar facet disease is sometimes implicated in low back pain. Identification is difficult and this may account for a variable response. Single photon emission computerized tomography (SPECT) is a scanning technique which enables localization of facet joint pathology. We determined whether recognition of facet disease by this method improved the response to corticosteroid injection treatment. Fifty-eight patients with low back pain and displaying accepted clinical criteria for facet joint disease were evaluated by SPECT. Twenty-two had facetal uptake of isotope. These and the tender facet joints of 36 scan-negative patients were injected with 40 mg methylprednisolone and 1 ml 1% lignocaine under X-ray control. Pain was assessed by a blind observer using the McGill questionnaire (MGQ), Present Pain Intensity score (PPI) and a Visual Analogue Scale (VAS). VAS, PPI and MGQ were reduced in the scan-positive patients at 1 month (P = 0.05, P = 0.0005, P = 0.005) and MGQ at 3 months (P = 0.01), whilst scan-negative patients were unchanged. The percentage of scan-positive patients who reported improvement was 95% at 1 month and 79% at 3 months, significantly greater than the control group (P = 0.0005, P =» 0.01). Within 6 months, pain improvement in the SPECT-positive group was no longer statistically significant. Tenderness did not correlate with increased uptake on SPECT scan. Osteoarthritis of the facets was more common in the SPECT-positive patients (P < 0.001), but did not correspond with sites of increased uptake on SPECT scan. These results suggest that SPECT can enhance the identification of back pain sufferers likely to obtain short-term benefit from facet joint injection.

$Research paper thumbnail of Does giving osteoporosis patient information to women who have had a fracture improve access to health care?$

Rheumatology, 2002

Objective. Generalized bone loss in rheumatoid arthritis (RA) is multi-factorial, with the inflam... more Objective. Generalized bone loss in rheumatoid arthritis (RA) is multi-factorial, with the inflammatory disease itself thought to contribute to bone loss. To study the extent to which control of disease activity affects bone turnover in RA and whether treatment with diseasemodifying anti-rheumatic drugs (DMARDs) reduces bone turnover and loss of bone mass, we measured bone density and biochemical markers of bone resorption in a group of patients with active RA starting on DMARDS. Methods. Patients with active RA were enrolled on starting a new DMARD. Patients were mobile and none took steroids or any treatment for osteoporosis. Clinical and laboratory measures of disease activity were made at 3-monthly intervals and an index of disease activity (DAS) calculated. Bone density was assessed at 0, 1 and 2 yr (Hologic QDR 4500c). Urinary deoxypyridinoline (D-PYR) and pyridinoline (PYR) were measured by ELISA at 0, 3, 6, 9 and 12 months. Results. Forty patients were enrolled, mean age 59.5 (range 31-76), 26 female, 14 male, 25 had established RA, 15 had RA for <2 yr. Baseline D-PYR was elevated (8.4"4.55 nmolummol creatinine) and correlated with ESR (r=0.6, P<0.01) and DAS (r=0.4, P<0.05). On treatment ESR and DAS fell by 38.5 and 29.3%, respectively. D-PYR was reduced by 12.3% by 9 months (P<0.01). Spearman rank order correlation showed ESR to be the most significant determinant of D-PYR over 1 yr (r=0.43, P<0.001). Serial bone density was available on 21 patients. There was no significant change in BMD over the 2 yr. The change in DAS over 0-3 months showed an inverse relationship with the percent change in spine over 1 yr (r=20.5, P=0.05). The change in D-PYR over 0-3 months was not closely related to the change in BMD at hip or spine at 1 yr. Conclusion. Disease activity is a significant determinant of bone turnover in RA. Bone resorption markers fall on treatment of RA with DMARDs and no change in BMD was demonstrated at 2 yr. This study suggests the need to control disease activity in RA in order to prevent systemic bone loss.

British Journal of Clinical Pharmacology, 1984

To study the absorption of levodopa and interaction with the extracerebral dopamine antagonist do... more To study the absorption of levodopa and interaction with the extracerebral dopamine antagonist domperidone, 15 patients with idiopathic Parkinson's disease were given levodopa 500 mg p.o., alone, and with domperidone pre-treatment. Domperidone pretreatment (10, 20, 40 mg, p.o., i.v. or i.m.) caused a mean 12% increase in peak plasma levodopa concentration, which occurred a mean of 10 min earlier than when levodopa was given alone. Parkinsonian disability scores were improved and peak clinical response occurred 16 min earlier with domperidone than without. Domperidone slightly increases the immediate bioavailability (over 4 h) and anti-parkinsonian response to a given dose of levodopa.

BMJ, 1989

Infection with HIV may be transmitted to a victim of sexual assault.' 2 Seroconversion to HIV occ... more Infection with HIV may be transmitted to a victim of sexual assault.' 2 Seroconversion to HIV occurred in the three months after a rape in a woman who had no other identifiable risk factors for HIV infection. Case report In Mav 1987 a 24 year old woman was examined and

Annals of the Rheumatic Diseases, 1995

Testicular function in active ankylosing spondylitis: therapeutic responses to chorionic gonadotr... more Testicular function in active ankylosing spondylitis: therapeutic responses to chorionic gonadotropin. Rheumatol 1991; 18: 841-8. 12 Gordon D, Beastall G H, Thomson J A, Sturrock R D. Androgenic status and sexual function in males with rheumatoid arthritis and ankylosing spondylitis. QJrMed 1986; 60: 671-9. 13 Ollier W, Spector T, Silman A, et al. Are certain HLA haplotypes responsible for low testosterone levels in males? Dis Markers 1989

Annals of the Rheumatic Diseases, 2004

There is no widely accepted treatment for the calcinosis which occurs in scleroderma and dermatom... more There is no widely accepted treatment for the calcinosis which occurs in scleroderma and dermatomyositis. We report a case of a 62-yr-old woman with active scleroderma complicated by tuberose calcinosis. The calcinosis, which had previously been unchanged for several years, regressed over a 2-yr period during which diltiazem was used to treat hypertension. This effect could not be explained by altered disease activity or renal function but, we suggest, may be due to inhibition of calcium influx into cells. This treatment merits further evaluation. KEY WORDS: Systemic sclerosis, Calcinosis, Treatment, Diltiazem. CALCINOSIS, an accumulation of calcium hydroxy-apatite, is often seen in scleroderma and juvenile dermatomyositis. It may result in local pain, loss of function and recurrent aseptic suppuration or second-ary infection. There is no widely accepted treatment [1] and no controlled therapeutic trials have been undertaken although anecdotal success has been reported with a number...

The Journal of rheumatology, 1994

Two men with longstanding ankylosing spondylitis (AS) developed spastic paraparesis. Extensive in... more Two men with longstanding ankylosing spondylitis (AS) developed spastic paraparesis. Extensive investigation failed to find a cause and it was concluded that some acute undetermined intrinsic spinal cord lesion had occurred. Similar descriptions in the past have been attributed to associated multiple sclerosis, but we suggest that the finding may represent a rare complication of AS with an unknown etiology.

The Journal of rheumatology, 1995

To determine whether the low absolute numbers and percentages of CD8 positive T cells in the circ... more To determine whether the low absolute numbers and percentages of CD8 positive T cells in the circulation of patients with polymyalgia rheumatica (PMR) could be used as a new diagnostic criterion for the disease. The % CD4 and CD8 positive T lymphocyte sub-populations were measured in 37 patients with PRM before treatment and during steroid treatment over the subsequent 2 years, in 21 patients with rheumatoid arthritis (RA), and in 27 normal (N) control subjects. During the study, 10 patients, who were initially diagnosed as PMR, were reclassified as having had a myalgic onset of RA (PMR-RA), according to the American College of Rheumatology criteria for the diagnosis of RA. No decreased %CD8+ T lymphocyte subset had been observed in these patients at presentation, before steroid therapy, or during treatment with steroids when compared with the RA and N groups. The measurement of %CD8+ T cell subset may provide a simple method for determining whether patients presenting with myalgia ...

Rheumatology, 1997

CD4 and CD8 T lymphocyte subsets, the late T cell activation marker, HLA-DR, and serum interleuki... more CD4 and CD8 T lymphocyte subsets, the late T cell activation marker, HLA-DR, and serum interleukin-6 (IL-6) levels of 57 polymyalgia rheumatica (PMR) patients were followed over 2 yr to investigate whether they could be used to predict the safe withdrawal of steroid therapy. Cell phenotypes were studied by¯ow cytometry and IL-6 levels by ELISA. %CD8 cells were reduced below the normal range in PMR patients prior to steroid therapy. In 56% of patients, the %CD8 T lymphocytes failed to return to normal levels when quiescent disease allowed cessation of steroid therapy. Activated CD8 T cells, as detected by HLA-DR positivity, were above the normal range at the initiation of therapy and showed a negative correlation with %CD8 T cells. The serum concentration of IL-6¯uctuated over 24 months, and the correlation between IL-6 and erythrocyte sedimentation rate (ESR) seen prior to treatment was not seen at later intervals. The %CD8 T cell and serum IL-6 levels are not a good indicator of disease activity in PMR and are, therefore, unable to predict the safe withdrawal of steroids.

Rheumatology, 1997

Cardiac abnormalities such as mitral valve prolapse (MVP) are reported to be common features of t... more Cardiac abnormalities such as mitral valve prolapse (MVP) are reported to be common features of the Ehlers-Danlos syndrome (EDS), and it has been suggested that the majority of patients with type IV EDS will have cardiac involvement and vascular aneurysms. However, the evidence for valve lesions is inconsistent and often based on early clinical studies using mainly M-mode echo. We studied 33 patients (six male, 27 female; median age 35 yr) with EDS (30 type I, II or III, three type IV) and 30 ageand sex-matched controls. The study assessed skin stretch and joint hypermobility using Beighton and Contompasis scores. Echocardiographic examination included standard two-dimensional views from the parasternal and apical windows, and measurement of the aorta at four sites (annulus, sinotubular junction, arch and abdominal aorta). Echocardiographic abnormalities were found in four patients (12.1%) (one atrial septal aneurysm, one tricuspid prolapse, two MVP) and two controls (6.7%). MVP was found in 6.1% of EDS patients and 7% of controls. Seven patients had previously been diagnosed as having MVP; only two were shown to have true MVP using current criteria. None of those with type IV EDS had any echocardiographic abnormality. No patients with EDS had mean aortic dimensions outside the normal range at any of the points tested. Cardiac symptoms were more frequent amongst the patients than controls (atypical chest pain 48%, P = 0.0001; palpitation 39%, P = 0.001; exertional dyspnoea 30%). A wide range of rheumatological complaints were reported (current arthralgia 75%; recent back pain 72%, P = 0.005; recurrent dislocation 72%). Contrary to earlier published observations, we have not found an increased incidence of cardiac abnormalities in EDS. This syndrome may be relatively more benign, from the cardiac point of view, than was previously thought.

Rheumatology, 1995

Osteoporosis International, 1996

Without Abstract

Annals of the Rheumatic Diseases, 2013

$Research paper thumbnail of High incident fractures and comorbidities in patients with inadequate response to antiresorptive osteoporosis therapy: One year results from the UKOSSO study$

Rheumatology, 1996

$Research paper thumbnail of Does giving osteoporosis patient information to women who have had a fracture improve access to health care?$

Rheumatology, 2002

British Journal of Clinical Pharmacology, 1984

BMJ, 1989

Annals of the Rheumatic Diseases, 1995

Annals of the Rheumatic Diseases, 2004

The Journal of rheumatology, 1994

The Journal of rheumatology, 1995

Rheumatology, 1997

Rheumatology, 1995

Osteoporosis International, 1996

Without Abstract