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Up to 70% of patients with long-standing rheumatoid arthritis (RA) may present with rheumatic hand disease and benefit from hand surgical procedures (HSPs).Through retrospective review, the present study aimed to report HSPs in RA patients at a tertiary care centre to identify patient adverse outcomes (AOs) and their predictors.From 1989 to 2013, 96 patients who underwent ≥1 HSP(s) were identified from two local registries; their clinical records were independently reviewed by two trained physicians (surgeon and clinical) who used a standardized format. AOs were defined by consensus; data abstracter agreement was found in 90% of cases. Descriptive statistics were used in addition to Kaplan-Meier curves to determine the time to each AO, while logistic regression models were used to determine predictors of AOs.At first HSP, 89.6% of patients were female, had a mean (± SD) age of 49.1±12 years, a disease duration of 12.2±7.2 years, 93.6% were positive for rheumatoid factor and 24% were receiving intensive treatment. A total of 130 HSPs were performed: the most frequent interventions were arthrodesis (25.4%), resection of the ulnar head (15.4%) and tenorrhaphy (14.6%). During follow-up, 33 AOs were reported in 27 (28.1%) patients, 87% of which occurred after the first HSP. The most frequent AO subsets were impaired wound healing (18.2%) and exposed pin (15.2%). Longer disease duration at first HSP (OR 3.07 [95% CI 1.04 to 9.08]; P=0.04) and intensive treatment (OR 1.08 [95% CI 1.002 to 1.156]; P=0.045) were predictors of AOs. The optimal disease duration cut-off to predict AOs was 20.1 years.Early referral of long-standing RA patients for hand surgery, along with less aggressive treatment, favoured improved surgical outcomes.Jusqu’à 70 % des patients atteints d’une arthrite rhumatoïde (AR) de longue date font du rhumatisme de la main et pourraient profiter d’interventions chirurgicales de la main (ICM).Au moyen d’une analyse rétrospective, la présente étude visait à signaler les ICM chez les patients atteints d’AR dans un centre de soins tertiaires afin d’en déterminer les effets indésirables (EI) et les prédicteurs.De 1989 à 2013, les chercheurs ont extrait de deux registres locaux 96 patients qui ont subi une ICM ou plus. Deux médecins formés (un chirurgien et un clinicien) ont fait une analyse indépendante standardisée de leur dossier clinique. Les EI étaient définis par consensus, et l’extraction des données concordait dans 90 % des cas. Les chercheurs ont utilisé des statistiques descriptives en plus des courbes de Kaplan-Meier pour déterminer la période avant l’apparition de chaque EI, et les modèles de régression logistique pour déterminer les prédicteurs d’EI.À la première ICM, 89,6 % des patients étaient des femmes. Les patients avaient un âge moyen (± ÉT) de 49,1±12 ans, étaient atteints depuis 12,2±7,2 ans, 93,6 % étaient positifs au facteur rhumatoïde et 24 % étaient sous traitement intensif. Au total, 130 ICM ont été effectuées, notamment l’arthrodèse (25,4 %), la résection de la tête du cubitus (15,4 %) et la ténorrhaphie (14,6 %). Pendant le suivi, 33 EI ont été signalés chez 27 patients (28,1 %) dont 87 % après la première ICM. Un problème de cicatrisation (18,2 %) et l’exposition d’une broche (15,2 %) étaient les sous-groupes d’EI les plus fréquents. Une maladie de plus longue date à la première ICM (RC 3,07 [95 % IC 1,04 à 9,08]; P=0,04) et un traitement intensif (RC 1,08 [95 % IC 1,002 à 1,156]; P=0,045) étaient prédicteurs d’EI. Le seuil optimal de durée de la maladie pour prédire les EI était de 20,1 ans.L’orientation rapide de patients atteints d’AR de longue date vers une chirurgie de la main, de même qu’un traitement moins énergique, favorisent de meilleurs résultats chirurgicaux.

Background In 2004, we initiated an inception cohort of patients with recent-onset rheumatoid arthritis (RA). Hand function was incorporated into evaluations from 2014 onward. The objectives were to examine hand function in our cohort, compare hand function with function in healthy controls and determine the factors associated with impaired function. Methods From February 2014 to June 2015, 139 patients (97.2 % of the cohort) had disease activity scored (28 joints, [DAS28]); the Michigan Hand Outcome Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) were completed, and the tip-, key- and palmar-pinch and grip strengths were measured. Sixty-nine healthy controls underwent the same evaluations. Ninety-nine patients underwent a second evaluation one year after their baseline. Descriptive statistics and linear regression models were used. Patients and controls signed informed consent. Results Patients were primarily middle-aged females with a median disease duration of 7 years; 91 patients had DAS28-remission, and 16, 23, and 9 patients had low, moderate and high disease activity, respectively. Controls scored better than did patients with (any) disease activity level; remission patients had similar DASH and key pinch function as did controls with poorer MHQ and both tip and palmar pinch and grip strength. DAS28 was consistently associated with impaired hand function. Among the patients with a one-year re-assessment, changes in DAS28 correlated (rho = 0.34 to 0.63) with changes in hand function (p ≤ 0.01 for all comparisons), but there was no correlation with palmar pinch strength. Conclusions Disease activity was associated with hand function impairment in RA patients with variable follow-up. MHQ discriminated poorer hand function in remission patients who otherwise had similar DASH scores as the controls did.

Plasma concentrations of various lipid fractions (total lipids, free glycerol, true triglycerides, free fatty acids, and cholesterol) were studied in 20 normally grown neonates ranging in birthweight from 820 to 1500 gm and in gestational age from 28 to 34 weeks. They were subdivided into three weight categories: 750 to 999, 1000 to 1249, and 1250 to 1500 gm. A lipid emulsion was infused at a constant rate over 24 hours, beginning with an hourly infusion rate of 0.04 gm/kg and increasing each day by 0.04 gm/kg up to a maximum of 0.16 gm/kg. Neonates who weighed less than 1000 gm had higher mean plasma concentrations of total lipids and free glycerol at hourly infusion rates of 0.08 and 0.16 and of triglycerides and free fatty acids at hourly infusion rate of 0.16 gm/kg than their heavier peers. These data suggest that extreme caution be used when administering parenteral fat emulsions to neonates who weigh less than 1000 gm and that we need to monitor plasma closely for signs of hyperlipemia.

Tolerance to parenterally administered fat emulsions was studied in 45 normally grown neonates ranging from 820 to 1550 gm in birthweight, from 27 to 34 weeks in gestational age, and from 2 to 10 days postnatal age. Concentrations of total lipids, free glycerol, true triglycerides, free fatty acids, and cholesterol in plasma were studied over an 8-day period. The aim was to determine whether the concentrations of any one lipid fraction could be used to predict those of other fractions. With 650 pairs of data being correlated, the best correlation coefficients were obtained between total lipids and triglycerides (r = 0.67), total lipids and cholesterol (r = 0.63), free glycerol and free fatty acids (r = 0.55), total lipids and free fatty acids (r = 0.54), and triglycerides and free fatty acids (r = 0.50). Although all correlation coefficients were highly significant statistically (P less than 0.001), the very large standard errors precluded using any of these relationships to make clinical predictions. Problems and limitations of currently available techniques are discussed in order to provide a lead for further research.

Plasma lipid patterns (total lipids, free glycerol, triglycerides, free fatty acids, and cholesterol) were studied in 10 very low-birthweight neonates assigned alternately to continuous drip versus every 2-hr bolus feedings with a formula containing 50% of its fat as medium-chain triglycerides. In the group of neonates fed continuously, plasma lipids did not vary significantly during the 4-day study. In the bolus-fed group, free fatty acid concentrations peaked 30 min after feeding; the other fractions did not vary significantly during 2 hr after feeding. Mean plasma concentrations of total lipids and triglycerides were higher in the continuous than in the bolus-fed neonates; concentrations of the other fractions were similar. Compared to plasma concentrations measured in a group of 4-day-old very low-birthweight neonates before any exposure to exogenous fat, continuously fed neonates had higher total lipid, triglyceride, free fatty acid, and cholesterol concentrations; bolus-fed neonates only had significantly higher triglyceride levels. These data emphasize the need to obtain information on plasma lipid patterns that is specific for gestational maturity, postnatal age, and method and type of feeding.

• Fluid and energy intakes and plasma concentrations of various lipid fractions were studied in 45 newborn infants, weighing between 820 and 1550 g, randomly assigned to one of three regimens for infusion of a fat emulsion: group 1, stepwise increase in daily dosage (1 to 4 g/kg) at a steady rate over 24 hours; group 2, stepwise increase in daily dosage (1 to 4 g/kg) at a steady rate over 16 hours, followed by a rest period of eight hours; and group 3, full dosage (4 g/kg) at a steady rate over 24 hours. At a given daily rate of infusion, mean plasma concentrations of the various lipid fractions tended to be higher in group 2 than in either group 1 or group 3. Plasma lipid concentrations correlated best with the hourly rate of lipid infusion, regardless of whether the infusion was continuous over 24 hours or intermittent. ( AJDC 1988;142:145-152)