In a previous study, Ahles et al. [1] compared the MMPI results of primary fibromyalgia, rheumato... more In a previous study, Ahles et al. [1] compared the MMPI results of primary fibromyalgia, rheumatoid arthritis and non-pain control participants. The purpose of the present study was to reanalyze the original data using the contemporary norms of Colligan et al. [5]. The reanalysis revealed that the pattern of group differences remained the same; however, the number of primary fibromyalgia patients classified as 'psychologically disturbed' was appreciably reduced. These data have clinical relevance in that the incidence of psychopathology in chronic pain patients may be overestimated because of the use of outdated norms. Additionally the data have theoretical relevance in that a large number of patients who present with pain in the absence of a known organic pathology do not present evidence of psychopathology.
The American Journal of the Medical Sciences, Dec 1, 1971
Page 1. Clinical correlation analysis of 137 patients with Raynaud's phenomenon ... more Page 1. Clinical correlation analysis of 137 patients with Raynaud's phenomenon EDWARD E. VELAYOS HARRY ROBINSON FE U. PORCIUNCULA ALFONSE T. MASI Abstract: The clinical records of 137 hospitalized patients with Raynaud's phenomenon were reviewed and ...
This is the second part of an integrated review of disseminated gonococcal infection (DGI) and go... more This is the second part of an integrated review of disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA). It covers clinical manifestations, spectrum of GCA, diagnosis and treatment. These disorders are important since DGI may be the most frequent form of acute arthritis in sexually active younger females, and other selected groups. Although the spectrum of disease is varied, it may be classified into stages and clinical subgroups. N. gonorrhoeae strains causing DGI in the U.S. have been highly sensitive to penicillin. Such findings require revision in beliefs that high-dose intravenous penicillin is needed for effective initial therapy of GCA. Recommended treatment protocols for localized gonorrhea and DGI are reviewed as well as the occurrence and implications for treatment of penicillinase-producing N. gonorrhoeae (PPNG) infection in the U.S.
The early course of newly diagnosed RA among young adult patients (16-44 yr) is described from re... more The early course of newly diagnosed RA among young adult patients (16-44 yr) is described from results of an ongoing study with a mean follow-up of 3.4 yr. Study diagnosis was based on the judgement of experienced rheumatologists, and data on several hundred variables were obtained on entry and annually for the purpose of defining patterns of onset and course of disease. Race and sex factors, as well as certain entry manifestations, e.g., RF, were found to correlate with onset and course patterns. Females, and especially white females, had significantly greater numbers of swollen upper extremity joints than males at entry and at last observation, with increased likelihood of developing bone erosions. At entry, RF positive patients differed only on few articular manifestations from RF negative patients, but had a higher frequency of positive ANA at entry and more subcutaneous nodules and bone erosions during follow-up. Seropositive white females at entry had significantly more swollen upper joints than their seronegative counterparts, but with no difference found at last follow-up. White females of each serogroup had more joint involvement at last examination than patients of other race-sex groups. Males had more acute onset, especially under age 30, with significantly greater improvement in arthritis and in ESR than did females. The majority (55%) of patients entered as seropositive, converted to seronegative during follow-up, and no correlation of either joint swelling or erosions was noted with this phenomenon. At last visit, RF positively did not correlate with bone erosions, but patients developing bone erosions had higher frequency of ANA and higher mean serum complement levels at last examination. The following entry factors were found to correlate significantly with a better outcome: maleness, acute onset under age 30, less swollen upper joints, and negative RF. Type of drug therapy tended to reflect severity of arthritis, rather than vice versa, and functional capacity improved significantly from entry to last evaluation in both males and females, even though the latter had stable or progressive arthritis. Further study is necessary over long intervals and in wider age range to more adequately interpret the biologic implications of findings of this ongoing study. A better understanding of the pathogenesis of RA may be derived from critical studies of the contribution of host factors, e.g., sex, and other variables predisposing to the development of RF positivity (and ANA), subcutaneous nodules, and bone erosions, particularly in systematic ongoing studies of patients with early diagnosed disease.
Objectives: To identify sex effects and preclinical serum biomarker associations with both incide... more Objectives: To identify sex effects and preclinical serum biomarker associations with both incident rheumatoid arthritis (RA) and its subsequent mortality, using a 41-year, community-based, case-control cohort. Methods: After cohort entry in 1974, incident RA cases (n=54) had clinical onsets between 1977 and 1994. Cohort control (CN) subjects were individually matched on entry to cases (4 CN:1 RA, n=216). All subjects were followed for survival from 1995 through 2015. Ranks (1-5) of preclinical z-scores within each set of 1 RA and 4 matched CN were analysed for associations with incident RA and mortality. Survival was evaluated using Cox proportional hazards models. Results: Preclinical serum IgG RF z-score ranks associated with incident RA in 90 males (18 RA, 72 CN). Cigarette smoking, androstenedione, pregnenolone, and sIL-2Rα ranks associated with incident RA in 180 females (36 RA, 144 CN). Total percentile mortality was greater (p=0.003) in RA (70.4) vs. CN (49.9) and equivalently increased in female RA (69.4) vs. CN (49.3) and in male RA (72.2) vs. CN (43.1) subjects. Percentile respiratory-related CODs were greater (p=0.009) only in the female RA cases (16.7) vs. CN (3.5). Ranks of preclinical hsCRP (p=0.028) and sIL-2Rα (p=0.030) independently associated with 140 total deaths, as did sTNF-R1 (p=0.003) and hsCRP (p=0.005) with 50 CVD deaths. Latter biomarker association were significant in females. Therapy responses in 1995 significantly associated with subsequent mortality. Conclusions: Sex effects were important in preclinical biomarker associations with incident RA, total and CVD mortality as well as occurrence of respiratory deaths.
The relationship between oral contraceptives and death from thromboembolism shown by studies of v... more The relationship between oral contraceptives and death from thromboembolism shown by studies of vital statistics, and the contribution of cigarette smoking to these deaths are reviewed. In 1968 a British study showed that a slight increase in deaths from thromboembolism had occurred in young women, proportional to the increase in use of the pill. A study on U.S. thromboembolism deaths in 1962-1966 similarly showed increasing mortality among women compared to men. Another analysis of U.S. data on deaths among women 15-44 years of age in 1966 provided estimates of relative risk of 3 to 9-fold for pill users, increasing with age. Data from women of 20-44 years from England, Wales and Northern Ireland in 1966 yielded a 7-fold risk for pill users compared with nonusers, and an excess death estimate of 3 per 100,000 for users. A U.S. study of data from 1956, 1961, and 1966 estimated the excess thromboembolism deaths at 3.6 per 100,000 pill users. Although British reports showed no increased risk of thromboembolism for those who smoked 15 or more cigarettes daily, a U.S. rebuttal claimed that these data could be rearranged to show increased risk for pill users who smoked heavily compared to nonsmoking nonusers. A U.S. retrospective study also originally published no relationship, but could be recalculated to show that smoking and pill use were associated in both the case and the control groups.
Los sintomas clinicos de la artritis reumatoide (AR) muestran una variacion circa-diana; la rigid... more Los sintomas clinicos de la artritis reumatoide (AR) muestran una variacion circa-diana; la rigidez y el dolor articulares son mas prominentes a primeras horas de la manana. Un funcionamiento anormal del eje hipotalamico-hipofisario-adrenal (cortisol) y de la glandula pineal (melatonina) parecen ser factores importantes en la perpetuacion de los sintomas clinicos circadianos de la AR. Asimismo, la produccion de citocinas proinflamatorias en humanos muestra un ritmo diurno, con niveles maximos durante la noche y primeras horas de la manana, cuando el cortisol plasmatico (antiinflamatorio) es minimo y la melatonina (proinfla-matoria) es maxima. Las hormonas sexuales tambien parecen intervenir en los ritmos circadianos de los sintomas de la AR. En los pacientes con AR se observa un aumento de la intensidad del dolor y alteraciones del sueno durante la fase luteinica, cuando los niveles de estrogeno (y de progesterona) son mayores que en la fase folicular. La presencia de ritmos circadianos en la reaccion inflamatoria sugiere importantes implicaciones sobre las actividades programadas de la vida diaria, sobre cuando realizar las valoraciones en los ensayos clinicos y posiblemente sobre el momento en el que tomar los farmacos antirreumaticos, como los corticosteroides y los antiinflamatorios no esteroideos.
This is the second part of an integrated review of disseminated gonococcal infection (DGI) and go... more This is the second part of an integrated review of disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA). It covers clinical manifestations, spectrum of GCA, diagnosis and treatment. These disorders are important since DGI may be the most frequent form of acute arthritis in sexually active younger females, and other selected groups. Although the spectrum of disease is varied, it may be classified into stages and clinical subgroups. N. gonorrhoeae strains causing DGI in the U.S. have been highly sensitive to penicillin. Such findings require revision in beliefs that high-dose intravenous penicillin is needed for effective initial therapy of GCA. Recommended treatment protocols for localized gonorrhea and DGI are reviewed as well as the occurrence and implications for treatment of penicillinase-producing N. gonorrhoeae (PPNG) infection in the U.S.
A patient with chronic discoid lupus erythematosus was admitted with fever, arthralia, pleuroperi... more A patient with chronic discoid lupus erythematosus was admitted with fever, arthralia, pleuropericarditis, and a history of leukopenia. He was initially believed to have systemic lupus erythematosus (SLE), but extensive evaluation showed negative immunologic studies and the presence of acid-fast organisms on pericardial biopsy specimens with cultures positive for Mycobacterium tuberculosis. Discoid lupus erythematosus patients with extracutaneous manifestations should be carefully studied for concurrent illness, especially when serologic evidence fo SLE is negative.
In a previous study, Ahles et al. [1] compared the MMPI results of primary fibromyalgia, rheumato... more In a previous study, Ahles et al. [1] compared the MMPI results of primary fibromyalgia, rheumatoid arthritis and non-pain control participants. The purpose of the present study was to reanalyze the original data using the contemporary norms of Colligan et al. [5]. The reanalysis revealed that the pattern of group differences remained the same; however, the number of primary fibromyalgia patients classified as 'psychologically disturbed' was appreciably reduced. These data have clinical relevance in that the incidence of psychopathology in chronic pain patients may be overestimated because of the use of outdated norms. Additionally the data have theoretical relevance in that a large number of patients who present with pain in the absence of a known organic pathology do not present evidence of psychopathology.
The American Journal of the Medical Sciences, Dec 1, 1971
Page 1. Clinical correlation analysis of 137 patients with Raynaud's phenomenon ... more Page 1. Clinical correlation analysis of 137 patients with Raynaud's phenomenon EDWARD E. VELAYOS HARRY ROBINSON FE U. PORCIUNCULA ALFONSE T. MASI Abstract: The clinical records of 137 hospitalized patients with Raynaud's phenomenon were reviewed and ...
This is the second part of an integrated review of disseminated gonococcal infection (DGI) and go... more This is the second part of an integrated review of disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA). It covers clinical manifestations, spectrum of GCA, diagnosis and treatment. These disorders are important since DGI may be the most frequent form of acute arthritis in sexually active younger females, and other selected groups. Although the spectrum of disease is varied, it may be classified into stages and clinical subgroups. N. gonorrhoeae strains causing DGI in the U.S. have been highly sensitive to penicillin. Such findings require revision in beliefs that high-dose intravenous penicillin is needed for effective initial therapy of GCA. Recommended treatment protocols for localized gonorrhea and DGI are reviewed as well as the occurrence and implications for treatment of penicillinase-producing N. gonorrhoeae (PPNG) infection in the U.S.
The early course of newly diagnosed RA among young adult patients (16-44 yr) is described from re... more The early course of newly diagnosed RA among young adult patients (16-44 yr) is described from results of an ongoing study with a mean follow-up of 3.4 yr. Study diagnosis was based on the judgement of experienced rheumatologists, and data on several hundred variables were obtained on entry and annually for the purpose of defining patterns of onset and course of disease. Race and sex factors, as well as certain entry manifestations, e.g., RF, were found to correlate with onset and course patterns. Females, and especially white females, had significantly greater numbers of swollen upper extremity joints than males at entry and at last observation, with increased likelihood of developing bone erosions. At entry, RF positive patients differed only on few articular manifestations from RF negative patients, but had a higher frequency of positive ANA at entry and more subcutaneous nodules and bone erosions during follow-up. Seropositive white females at entry had significantly more swollen upper joints than their seronegative counterparts, but with no difference found at last follow-up. White females of each serogroup had more joint involvement at last examination than patients of other race-sex groups. Males had more acute onset, especially under age 30, with significantly greater improvement in arthritis and in ESR than did females. The majority (55%) of patients entered as seropositive, converted to seronegative during follow-up, and no correlation of either joint swelling or erosions was noted with this phenomenon. At last visit, RF positively did not correlate with bone erosions, but patients developing bone erosions had higher frequency of ANA and higher mean serum complement levels at last examination. The following entry factors were found to correlate significantly with a better outcome: maleness, acute onset under age 30, less swollen upper joints, and negative RF. Type of drug therapy tended to reflect severity of arthritis, rather than vice versa, and functional capacity improved significantly from entry to last evaluation in both males and females, even though the latter had stable or progressive arthritis. Further study is necessary over long intervals and in wider age range to more adequately interpret the biologic implications of findings of this ongoing study. A better understanding of the pathogenesis of RA may be derived from critical studies of the contribution of host factors, e.g., sex, and other variables predisposing to the development of RF positivity (and ANA), subcutaneous nodules, and bone erosions, particularly in systematic ongoing studies of patients with early diagnosed disease.
Objectives: To identify sex effects and preclinical serum biomarker associations with both incide... more Objectives: To identify sex effects and preclinical serum biomarker associations with both incident rheumatoid arthritis (RA) and its subsequent mortality, using a 41-year, community-based, case-control cohort. Methods: After cohort entry in 1974, incident RA cases (n=54) had clinical onsets between 1977 and 1994. Cohort control (CN) subjects were individually matched on entry to cases (4 CN:1 RA, n=216). All subjects were followed for survival from 1995 through 2015. Ranks (1-5) of preclinical z-scores within each set of 1 RA and 4 matched CN were analysed for associations with incident RA and mortality. Survival was evaluated using Cox proportional hazards models. Results: Preclinical serum IgG RF z-score ranks associated with incident RA in 90 males (18 RA, 72 CN). Cigarette smoking, androstenedione, pregnenolone, and sIL-2Rα ranks associated with incident RA in 180 females (36 RA, 144 CN). Total percentile mortality was greater (p=0.003) in RA (70.4) vs. CN (49.9) and equivalently increased in female RA (69.4) vs. CN (49.3) and in male RA (72.2) vs. CN (43.1) subjects. Percentile respiratory-related CODs were greater (p=0.009) only in the female RA cases (16.7) vs. CN (3.5). Ranks of preclinical hsCRP (p=0.028) and sIL-2Rα (p=0.030) independently associated with 140 total deaths, as did sTNF-R1 (p=0.003) and hsCRP (p=0.005) with 50 CVD deaths. Latter biomarker association were significant in females. Therapy responses in 1995 significantly associated with subsequent mortality. Conclusions: Sex effects were important in preclinical biomarker associations with incident RA, total and CVD mortality as well as occurrence of respiratory deaths.
The relationship between oral contraceptives and death from thromboembolism shown by studies of v... more The relationship between oral contraceptives and death from thromboembolism shown by studies of vital statistics, and the contribution of cigarette smoking to these deaths are reviewed. In 1968 a British study showed that a slight increase in deaths from thromboembolism had occurred in young women, proportional to the increase in use of the pill. A study on U.S. thromboembolism deaths in 1962-1966 similarly showed increasing mortality among women compared to men. Another analysis of U.S. data on deaths among women 15-44 years of age in 1966 provided estimates of relative risk of 3 to 9-fold for pill users, increasing with age. Data from women of 20-44 years from England, Wales and Northern Ireland in 1966 yielded a 7-fold risk for pill users compared with nonusers, and an excess death estimate of 3 per 100,000 for users. A U.S. study of data from 1956, 1961, and 1966 estimated the excess thromboembolism deaths at 3.6 per 100,000 pill users. Although British reports showed no increased risk of thromboembolism for those who smoked 15 or more cigarettes daily, a U.S. rebuttal claimed that these data could be rearranged to show increased risk for pill users who smoked heavily compared to nonsmoking nonusers. A U.S. retrospective study also originally published no relationship, but could be recalculated to show that smoking and pill use were associated in both the case and the control groups.
Los sintomas clinicos de la artritis reumatoide (AR) muestran una variacion circa-diana; la rigid... more Los sintomas clinicos de la artritis reumatoide (AR) muestran una variacion circa-diana; la rigidez y el dolor articulares son mas prominentes a primeras horas de la manana. Un funcionamiento anormal del eje hipotalamico-hipofisario-adrenal (cortisol) y de la glandula pineal (melatonina) parecen ser factores importantes en la perpetuacion de los sintomas clinicos circadianos de la AR. Asimismo, la produccion de citocinas proinflamatorias en humanos muestra un ritmo diurno, con niveles maximos durante la noche y primeras horas de la manana, cuando el cortisol plasmatico (antiinflamatorio) es minimo y la melatonina (proinfla-matoria) es maxima. Las hormonas sexuales tambien parecen intervenir en los ritmos circadianos de los sintomas de la AR. En los pacientes con AR se observa un aumento de la intensidad del dolor y alteraciones del sueno durante la fase luteinica, cuando los niveles de estrogeno (y de progesterona) son mayores que en la fase folicular. La presencia de ritmos circadianos en la reaccion inflamatoria sugiere importantes implicaciones sobre las actividades programadas de la vida diaria, sobre cuando realizar las valoraciones en los ensayos clinicos y posiblemente sobre el momento en el que tomar los farmacos antirreumaticos, como los corticosteroides y los antiinflamatorios no esteroideos.
This is the second part of an integrated review of disseminated gonococcal infection (DGI) and go... more This is the second part of an integrated review of disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA). It covers clinical manifestations, spectrum of GCA, diagnosis and treatment. These disorders are important since DGI may be the most frequent form of acute arthritis in sexually active younger females, and other selected groups. Although the spectrum of disease is varied, it may be classified into stages and clinical subgroups. N. gonorrhoeae strains causing DGI in the U.S. have been highly sensitive to penicillin. Such findings require revision in beliefs that high-dose intravenous penicillin is needed for effective initial therapy of GCA. Recommended treatment protocols for localized gonorrhea and DGI are reviewed as well as the occurrence and implications for treatment of penicillinase-producing N. gonorrhoeae (PPNG) infection in the U.S.
A patient with chronic discoid lupus erythematosus was admitted with fever, arthralia, pleuroperi... more A patient with chronic discoid lupus erythematosus was admitted with fever, arthralia, pleuropericarditis, and a history of leukopenia. He was initially believed to have systemic lupus erythematosus (SLE), but extensive evaluation showed negative immunologic studies and the presence of acid-fast organisms on pericardial biopsy specimens with cultures positive for Mycobacterium tuberculosis. Discoid lupus erythematosus patients with extracutaneous manifestations should be carefully studied for concurrent illness, especially when serologic evidence fo SLE is negative.
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