O FitzGerald

Publications (89)366.74 Total impact

• Source

  Available from: arthritis-research.com

  Article: Peripheral corticotropin releasing hormone signaling is mediated by Type 1alpha receptors in early human inflammatory arthritis

  A McEvoy, B Bresnihan, O FitzGerald, E Murphy
  Arthritis Research & Therapy 04/2012; 3:1-1. · 4.45 Impact Factor
• Article: Joint tenderness and swelling in biologic-treated inflammatory arthritis patients - a tricky trade off?

  L C Harty, C T Ng, C Fearon, C A Murray, O Fitzgerald, D J Veale
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  ABSTRACT: To compare the pattern of joint responses in patients with rheumatoid arthritis and psoriatic arthritis treated with TNF inhibitor (TNFi) therapy. A total of 182 PsA/Rheumatoid arthritis (RA) patients attending the rheumatology unit of a tertiary referral centre in Ireland were recruited and prospectively followed up by the attendant rheumatologists. Clinical progress of the patients was noted at baseline and 6 months after starting TNFi therapy. A total of 114 RA and 68 PsA patients were assessed; 20% of the patients had one of either tender joints or swollen joints after 6 months of therapy. Rheumatoid arthritis patients had a significantly higher proportion of non-tender swollen joints compared with PsA patients, whereas PsA patients had a higher proportion of tender non-swollen joints (p < 0.05). Residual joint swelling was found more commonly in RA patients than in PsA patients following TNFi therapy, whereas residual tender joints occurred more frequently in PsA; this may reflect enthesiopathy or periostitis.
  International Journal of Clinical Practice 02/2012; 66(2):128-31. · 2.41 Impact Factor
• Source

  Available from: Chin Teck Ng

  Article: Synovial tissue hypoxia and inflammation in vivo.

  C T Ng, M Biniecka, A Kennedy, J McCormick, O Fitzgerald, B Bresnihan, D Buggy, C T Taylor, J O'Sullivan, U Fearon, D J Veale
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  ABSTRACT: Hypoxia is a microenvironmental feature in the inflamed joint, which promotes survival advantage for cells. The aim of this study was to examine the relationship of partial oxygen pressure in the synovial tissue (tPO(2)) in patients with inflammatory arthritis with macroscopic/microscopic inflammation and local levels of proinflammatory mediators. Patients with inflammatory arthritis underwent full clinical assessment and video arthroscopy to quantify macroscopic synovitis and measure synovial tPO(2) under direct visualisation. Cell specific markers (CD3 (T cells), CD68 (macrophages), Ki67 (cell proliferation) and terminal deoxynucleotidyl transferase dUTP nick end labelling (cell apoptosis)) were quantified by immunohistology. In vitro migration was assessed in primary and normal synoviocytes (synovial fibroblast cells (SFCs)) using a wound repair scratch assay. Levels of tumour necrosis factor alpha (TNFalpha), interleukin 1beta (IL1beta), interferon gamma (IFNgamma), IL6, macrophage inflammatory protein 3alpha (MIP3alpha) and IL8 were quantified, in matched serum and synovial fluid, by multiplex cytokine assay and ELISA. The tPO(2) was 22.5 (range 3.2-54.1) mm Hg and correlated inversely with macroscopic synovitis (r=-0.421, p=0.02), sublining CD3 cells (-0.611, p<0.01) and sublining CD68 cells (r=-0.615, p<0.001). No relationship with cell proliferation or apoptosis was found. Primary and normal SFCs exposed to 1% and 3% oxygen (reflecting the median tPO(2) in vivo) induced cell migration. This was coupled with significantly higher levels of synovial fluid tumour necrosis factor alpha (TNFalpha), IL1beta, IFNgamma and MIP3alpha in patients with tPO(2) <20 mm Hg (all p values <0.05). This is the first study to show a direct in vivo correlation between synovial tPO(2), inflammation and cell migration, thus it is proposed that hypoxia is a possible primary driver of inflammatory processes in the arthritic joint.
  Annals of the rheumatic diseases 07/2010; 69(7):1389-95. · 8.11 Impact Factor
• Article: Unregulated prescribing of anti-tumour necrosis factor agents does not mean inappropriate prescribing.

  C T Ng, B J Radovits, W Kievit, J Fransen, P L C M van Riel, O FitzGerald, D J Veale, B Bresnihan
  Annals of the rheumatic diseases 01/2010; 69(1):313-4. · 8.11 Impact Factor
• Article: An audit of hospital based outpatient infusions and a pilot program of community-based monoclonal antibody infusions.

  J-P Doran, S Alraqi, I Callanan, O FitzGerald, B Bresnihan, D J Veale
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  ABSTRACT: Infliximab, a chimeric monoclonal antibody to tumour necrosis factor alpha, is administered as an intravenous infusion requiring a costly hospital day case or inpatient admission. An audit of all current therapies given by intravenous infusions in an outpatient setting in St Vincent's University Hospital (SVUH) was undertaken. Furthermore, in conjunction with TCP homecare, we established in a general practise health clinic, the first Irish community infusion centre for the administration of infliximab in August 2006. All outpatient departments indicated that they would favour a centralized hospital infusion unit. There were no adverse events and the mean global satisfaction improved in the community infliximab infusion pilot programme of seven patients. This study suggests efficiencies in providing centralized infusion facilities, while the community based infusion of infliximab is feasible and safe in this small cohort and identifies the community infusion unit as a viable and cost efficient alternative for administration of infliximab.
  Irish Journal of Medical Science 02/2009; 178(4):497-501. · 0.58 Impact Factor
• Article: Consistency in assessing the Disease Activity Score-28 in routine clinical practice.

  C A E Walsh, R H Mullan, P B Minnock, C Slattery, O FitzGerald, B Bresnihan
  Annals of the rheumatic diseases 02/2008; 67(1):135-6. · 8.11 Impact Factor
• Article: Quality of life and economic impact of switching from established infliximab therapy to adalimumab in patients with rheumatoid arthritis.

  C A E Walsh, P Minnock, C Slattery, N Kennedy, F Pang, D J Veale, B Bresnihan, O FitzGerald
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  ABSTRACT: To evaluate the quality of life and economic impact of switching therapy from infliximab to adalimumab in patients with rheumatoid arthritis (RA). In this open-label study, patients demonstrating a clinical response to infliximab were switched to treatment with adalimumab and followed for 16 weeks. Both generic (Health Assessment Questionnaire and Short Form 36 Physical Component Summary and Mental Component Summary) and specific (Rheumatoid Arthritis Quality of Life questionnaire) assessment instruments of physical function and of quality of life were employed. An economic analysis of treatment-related costs was also performed. Disease activity was assessed by the composite 28-joint count Disease Activity Score (DAS28). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as acute phase markers. Nineteen patients were enrolled and completed the study. No changes in functional and quality-of-life measures were observed. One-year extrapolation data showed potential reductions in costs following switching to adalimumab that could be attributed primarily to reductions in patient- and staff-related costs. Safety and tolerability were similar for both treatments. Although there was a significant reduction in DAS28 (P < 0.005) and CRP (P < 0.001) after switching to adalimumab, there were no significant changes in individual DAS28 components, including swollen and tender joint counts and ESR. A switch from infliximab to adalimumab in patients with RA who have responded to infliximab is a feasible, well-tolerated treatment option, with the potential for direct and indirect economic advantages.
  Rheumatology 07/2007; 46(7):1148-52. · 4.06 Impact Factor
• Article: Inpatient and outpatient rehabilitation for patients with rheumatoid arthritis: a clinical and economic assessment

  N Kennedy, E Stokes, E O'Shea, T Brendan Murphy, B Bresnihan, O FitzGerald
  Journal of Medical Economics 01/2007; 10(4):515-528.
• Article: Downregulation of the inhibitor of apoptosis protein survivin in keratinocytes and endothelial cells in psoriasis skin following infliximab therapy.

  T Markham, C Mathews, S Rogers, R Mullan, B Bresnihan, O Fitzgerald, D J Veale, U Fearon
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  ABSTRACT: Survivin, an inhibitor of apoptosis protein (IAP), has been implicated in endothelial cell stability, through inhibition of apoptosis and in cell proliferation. To evaluate the effect of antitumour necrosis factor (TNF)-alpha therapy on survivin expression in psoriasis skin at 0, 2 and 12 weeks after infliximab therapy. Skin biopsies were obtained from 16 patients; 11 also had arthritis with active skin/joint disease. Clinical scores [Psoriasis Area and Severity Index (PASI), involved body surface area (BSA), Disease Activity Score (DAS28) and Health Assessment Questionnaire] were recorded. Inflammatory infiltration and survivin protein expression were examined and graded by immunohistochemical staining, and mRNA levels were determined by real-time polymerase chain reaction. Survivin mRNA and protein were demonstrated in all baseline lesional biopsies. Survivin mRNA and protein expression was significantly greater in lesional compared with nonlesional baseline skin (P < 0.05). Differential cellular localization of survivin was demonstrated with cytoplasmic survivin protein expression localized to the perivascular/endothelial regions and strong nuclear staining localized in the basal layer of the epidermis. Infliximab produced a dramatic clinical response in skin and joints (P < 0.05), paralleled by significant reduction in the inflammatory infiltrate and survivin protein expression (P < 0.05) which was reflected at the mRNA level where expression was significantly reduced by week 12 (P < 0.01). Survivin protein levels before and after treatment significantly correlated with PASI (r = 0.478, P < 0.05) and BSA scores (r = 0.528, P < 0.024). PASI strongly correlated with BSA (r = 0.949, P < 0.0001) and DAS28 (r = 0.717, P < 0.002) scores. Survivin correlates with disease activity in patients with psoriasis and is significantly downregulated following anti-TNF-alpha treatment. Understanding the role of IAPs in cell survival/antiapoptosis and proliferation mechanisms may provide important insights into downstream therapeutic targeting in inflammation.
  British Journal of Dermatology 12/2006; 155(6):1191-6. · 3.67 Impact Factor
• Article: Seropositive erosive rheumatoid arthritis (RA).

  C Matthews, O Fitzgerald
  Rheumatology 10/2006; 45(9):1100. · 4.06 Impact Factor
• Article: Standardisation of synovial tissue infiltrate analysis: how far have we come? How much further do we need to go?

  M D Smith, D Baeten, A-K Ulfgren, I B McInnes, O Fitzgerald, B Bresnihan, P P Tak, D Veale
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  ABSTRACT: Changes in cellular infiltrate and expression of cytokines, chemokines, and cell adhesion molecules as a result of therapeutic interventions in rheumatoid arthritis can be demonstrated in the synovial membrane. However, before synovial tissue analysis can be used as an outcome measure in such studies, standardisation of the site and method of synovial tissue acquisition, methods of tissue processing, and appropriate methods of detection and measurement of cell lineage specific markers and relevant biological proteins is needed.
  Annals of the Rheumatic Diseases 02/2006; 65(1):93-100. · 8.73 Impact Factor
• Source

  Available from: nih.gov

  Article: Synovial tissue inflammation in early and late osteoarthritis.

  M J Benito, D J Veale, O FitzGerald, W B van den Berg, B Bresnihan
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  ABSTRACT: To compare selected immunohistological features of inflammation in synovial tissue from patients with early and late osteoarthritis (OA). Synovial tissue samples were obtained from 10 patients with knee pain, normal radiographs, and arthroscopic manifestations of OA (early OA), and from 15 patients with OA undergoing knee joint arthroplasty (late OA). Conventional immunohistochemical techniques were used to measure microscopic manifestations of inflammation. The inflammatory cell infiltrate, blood vessel formation, and angiogenic factors, NF-kappaB activation, expression of tumour necrosis factor alpha (TNFalpha) and interleukin 1beta (IL1beta), and the presence of cyclo-oxygenase (COX)-1 and COX-2 were quantified. Fibroblast-like synoviocytes (FLS) were isolated from early and late OA tissue samples to compare in vitro production of prostaglandin E2 (PGE2) Synovial tissue from patients with early OA demonstrated significantly greater CD4+ (p = 0.017) and CD68+ (p<0.001) cell infiltration, blood vessel formation (p = 0.01), vascular endothelial growth factor (p = 0.001), and intercellular adhesion molecule-1 expression (p<0.001). Numbers of cells producing TNFalpha and IL1beta were also significantly greater in early OA (p<0.001). Manifestations of inflammation in early OA were associated with increased expression of the NF-kappaB1 (p<0.001) and RelA (p = 0.015) subunits, and with increased COX-2 expression (p = 0.04). Cytokine-induced PGE2 production by cultured FLS was similar in both groups. Increased mononuclear cell infiltration and overexpression of mediators of inflammation were seen in early OA, compared with late OA. Isolated FLS were functionally similar in both groups, consistent with microenvironmental differences in the synovial tissue during different phases of OA. These observations may have important therapeutic implications for some patients during the early evolution of OA.
  Annals of the Rheumatic Diseases 10/2005; 64(9):1263-7. · 8.73 Impact Factor
• Source

  Available from: nih.gov

  Article: Immunopathology of psoriasis and psoriatic arthritis.

  D J Veale, C Ritchlin, O FitzGerald
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  ABSTRACT: Psoriatic arthritis (PsA) is characterised by several unique clinical features that differentiate it from rheumatoid arthritis (RA). Attempts to identify immunopathological mechanisms, some shared with psoriasis, that underlie these differences from RA have been most challenging. Recent research studies, however, highlight novel findings in PsA at the molecular, cellular, and tissue levels that form the basis for a new understanding of this relatively common form of inflammatory arthritis. In particular, the availability of new, biological antitumour necrosis factor alpha therapies have allowed further insight into the immunopathology of psoriasis and PsA. This brief review focuses on immunohistological studies in psoriatic skin, PsA synovium, and bone to demonstrate how these data advance our knowledge of disease pathogenesis.
  Annals of the Rheumatic Diseases 04/2005; 64 Suppl 2:ii26-9. · 8.73 Impact Factor
• Source

  Available from: nih.gov

  Article: Synovial tissue interleukin-18 expression and the response to treatment in patients with inflammatory arthritis.

  T Rooney, E Murphy, M Benito, P Roux-Lombard, O FitzGerald, J-M Dayer, B Bresnihan
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  ABSTRACT: To measure synovial tissue interleukin-18 (IL-18) expression in patients with inflammatory arthritis, and to identify associations with serum levels, disease activity, and response to treatment. Synovial tissue biopsies and serum samples were obtained from patients with early, active, rheumatoid arthritis (RA) (n = 12), undifferentiated seronegative arthritis (SnA) (n = 9), psoriatic arthritis (PsA) (n = 5), and reactive arthritis (ReA) (n = 2) before and one year after introduction of disease modifying antirheumatic drug (DMARD) treatment. Osteoarthritis (OA) tissues were compared. Tissue IL-18 expression was determined after immunohistochemical staining using a semiquantitative scale. Serum IL-18 was measured by enzyme linked immunosorbent assay. Before treatment was started, tissue IL-18 expression was increased in each diagnostic group compared with OA (p<0.05). Tissue IL-18 expression was correlated with serum C reactive protein levels (r = 0.53, p = 0.003) but not with serum IL-18. After DMARD treatment, 12 patients (five RA, four SnA, three PsA) were re-evaluated. Decreases in tissue IL-18 expression were observed in eight, although the trend did not reach significance (p = 0.068). Changes in tissue IL-18 expression were correlated with changes in serum IL-18 (r = 0.62, p = 0.041) and C reactive protein (r = 0.72, p = 0.009). Synovial tissue IL-18 expression was correlated with disease activity in inflammatory arthritis. After treatment, tissue levels changed in parallel with changes in serum IL-18 and with changes in the acute phase response. These observations support a role for IL-18 in the pathophysiology of inflammatory arthritis.
  Annals of the Rheumatic Diseases 12/2004; 63(11):1393-8. · 8.73 Impact Factor
• Article: Suprascapular nerve block in chronic shoulder pain: are the radiologists better?

  E M Shanahan, M D Smith, M Wetherall, C W Lott, J Slavotinek, O FitzGerald, M J Ahern
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  ABSTRACT: Suprascapular nerve block is a safe and effective treatment for chronic shoulder pain in arthritis, which can be performed either by direct imaging (CT guided) or in the clinic using anatomical landmarks to determine needle placement. To compare a CT guided versus an anatomical landmark approach in a randomised, single blind trial examining the efficacy of suprascapular nerve block for shoulder pain in patients with degenerative joint/rotator cuff disease. 67 patients with chronic shoulder pain from degenerative disease participated in the trial. 77 shoulders were randomised. The group randomised to receive the block through the anatomical landmark approach received a single suprascapular nerve block. Those in the CT guided group received an injection of methylprednisolone acetate and a smaller volume of bupivacaine around the suprascapular nerve. The patients were followed up for 12 weeks by a "blinded" observer and reviewed at weeks 1, 4, and 12 after the injection. Significant improvements were seen in all pain scores and disability in the shoulders receiving both types of nerve block, with no significant differences in the improvement in pain and disability between the two approaches at any time. Improvements in pain and disability scores were clinically and statistically significant. No significant adverse effects occurred in either group. Patient satisfaction scores for pain relief using either approach were high. The CT guided control and landmark approaches to performing suprascapular nerve blocks result in similar significant and prolonged pain and disability reductions; both approaches are safe.
  Annals of the Rheumatic Diseases 10/2004; 63(9):1035-40. · 8.73 Impact Factor
• Article: A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience.

  D Kane, L Stafford, B Bresnihan, O FitzGerald
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  ABSTRACT: To determine the clinical presentation and clinical and radiological outcome of early psoriatic arthritis (PsA) at 1 and 2 yr. Patients with PsA were assessed at the St. Vincent's University Hospital Early Synovitis Clinic. Standardized clinical and laboratory assessment was performed at presentation and 1- and 2-yr follow-up. Radiographs of the hands and feet were evaluated in chronological order by two trained observers using the Sharp method modified to include the distal interphalangeal (DIP) joints. A total of 129 (12.7%) of 1018 patients were diagnosed with PsA [mean age at onset of arthritis was 40.4 yr (range 11-76); mean duration of disease was 9.9 months (range 0.3-48); 52 oligoarticular, 77 polyarticular]. Means and standard deviations of indices of disease activity at presentation were: 10-cm visual analogue scale = 4.8 +/- 2.7, HAQ score = 0.71 +/- 0.64, ACR functional class III/IV = 41 (35%), Ritchie Articular Index = 5.6 +/- 6, swollen joint count = 6.9 +/- 8, erythrocyte sedimentation rate = 24 +/- 26.4 mm/h, C-reactive protein = 27.6 +/- 58.5 mg/l. At presentation, 49 (38%) patients had peripheral enthesopathy, 13 patients (10%) had inflammatory spine pain and 50 (39%) patients had DIP involvement. A total of 119 had psoriasis at the time of presentation [plaque psoriasis in 112 (94%), mean age of psoriasis onset was 29.8 +/- 16.2 yr, nail dystrophy present in 78 patients (67%)]. At 1 yr of follow-up, 119 (92%) patients were reassessed and 70 (59%) were taking a disease-modifying anti-rheumatic drug (DMARD). At 2 yr, 97 (75%) patients were reassessed and 54 (56%) were taking a DMARD. Despite considerable improvement in inflammation and function scores, only 31 (26%) patients were in remission at 1 yr with 20 (21%) in remission at 2 yr. There was a low rate of DMARD-free remission [14 (12%) at 1 yr and 11 (11%) at 2 yr]. Radiographs of hands and feet were obtained for 117 (91%) patients at presentation and 86 (67%) patients at a median follow-up of 24 months (range 11-56); 47% of patients had joint erosions in hands or feet at follow-up with a mean Sharp erosion score of 3 (0) +/- 5.2 (range 0-25) and a mean Sharp narrowing score of 3.2 (0) +/- 7.5 (range 0-48). This study confirms that PsA is a chronic, progressive disease in the majority of patients. Despite clinical improvement with current DMARD treatment, PsA results in radiological damage in up to 47% of patients at a median interval of 2 yr.
  Rheumatology 01/2004; 42(12):1460-8. · 4.06 Impact Factor
• Article: A classification study of clinical subsets in an inception cohort of early psoriatic peripheral arthritis--'DIP or not DIP revisited'.

  D Kane, L Stafford, B Bresnihan, O FitzGerald
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  ABSTRACT: Multiple psoriatic arthritis (PsA) classification criteria exist, but these are based on established PsA when pre-existing joint damage and the effect of medication may confound their validity. This study examined the application of the Veale classification criteria in early PsA to determine the effect of disease progression and treatment on classification and to determine the effect of the number of involved joints and the presence of distal interphalangeal (DIP) joint involvement at initial presentation on clinical and radiological outcome. A total of 129 patients presenting with PsA to an Irish early synovitis clinic were assessed at presentation and at 1- and 2-yr follow-up. The Veale criteria were used for PsA classification and the Sharp score of hands and feet was used to quantify radiological outcome. At presentation, 52 (40%) had oligoarticular PsA and 77 (60%) had polyarticular PsA. Patients with polyarticular PsA were administered disease-modifying anti-rheumatic drugs (DMARDs) more frequently than patients with oligoarticular PsA and this resulted in a significant number of polyarticular PsA patients being reclassified as oligoarticular PsA at 1- [27/70 (39%)] and 2-yr [26/53 (49%)] follow-up. Fewer patients initially classified with oligoarticular PsA were reclassified as polyarticular PsA. More patients with oligoarticular PsA at baseline were in DMARD-free remission and there was less radiological damage at 2-yr follow-up. DIP disease was associated with other classic seronegative disease features-enthesopathy and nail dystrophy-but did not influence clinical or radiological outcome and the separation of DIP disease as a distinct subgroup in classification criteria was not supported. Synovitis-acne-pustulosis-hyperostosis (SAPHO) syndrome was not observed as a separate subgroup. This study confirms that the application of classification criteria of PsA based on the pattern and number of involved joints may be confounded in established PsA by the effects of DMARDs. The application of classification criteria based on disease pattern prior to treatment may be more useful in studies of pathogenesis and long-term outcome in PsA.
  Rheumatology 01/2004; 42(12):1469-76. · 4.06 Impact Factor
• Article: Expression of the pro-inflammatory protein S100A12 (EN-RAGE) in rheumatoid and psoriatic arthritis.

  D Foell, D Kane, B Bresnihan, T Vogl, W Nacken, C Sorg, O Fitzgerald, J Roth
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  ABSTRACT: Infiltration of synovial tissue by neutrophils is crucial in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and seronegative arthritis (SA). Altered vascular function and endothelial activation are important in PsA. S100A12 (EN-RAGE) is secreted by activated granulocytes and binds to the receptor for advanced glycation end products, which induces nuclear factor (NF)-kappaB-dependent activation of endothelium. Immunohistochemical studies were performed to detect synovial S100A12 expression. We analysed serum and synovial fluid of 42 patients for S100A12 levels. S100A12 was strongly expressed in inflamed synovial tissue whereas it was nearly undetectable in synovia of controls or patients after successful treatment. Serum levels of S100A12 correlated with disease activity. Local expression of S100A12 in inflamed tissue suggests a role in synovitis, especially in PsA. High serum concentrations of S100A12 in patients with active arthritis compared with healthy controls or patients in remission point to its usefulness as a serum marker.
  Rheumatology 12/2003; 42(11):1383-9. · 4.06 Impact Factor
• Article: Increased bone resorption and failure to respond to antiresorptive therapy in progressive dystrophic calcification.

  E Murphy, R Freaney, B Bresnihan, M McKenna, O FitzGerald
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  ABSTRACT: The aim of this study was to evaluate strategies to halt the progression of severe dystrophic calcification in a patient with progressive systemic sclerosis (PSS) and to monitor serial changes in biochemical markers of bone resorption and indices of calcium (Ca) metabolism in response to therapy. The relationship of bone turnover to the extent of dystrophic calcification was also investigated in a number of additional patients with varying degrees of calcinosis. Serial markers of bone turnover and indices of Ca metabolism were measured over a 3-year period in one patient with PSS and severe dystrophic calcification. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry (DXA). Bone turnover in this patient and two additional patients with PSS or dermatomyositis (DM) and severe dystrophic calcification (Group A, n = 3) was compared with that in patients with connective tissue disease with little or no evidence of dystrophic calcification (Group B, n = 13). Serial data on one patient with severe progressive calcinosis showed increased bone resorption markers, which remained high over a 3-year period despite antiresorptive therapy. BMD was low. Patients with PSS/DM with severe dystrophic calcification had higher bone resorption than those with minimal or no evidence of calcification. Mean serum ionized Ca and urinary Ca excretion were both lower in those with severe calcinosis. Bone resorption was increased in patients with connective tissue disease and severe dystrophic calcification. Several antiresorptive agents were shown to be ineffective in limiting either bone turnover or clinical progression in one patient.
  Calcified Tissue International 12/2003; 73(5):433-40. · 2.38 Impact Factor
• Article: Topical corticosteroid treatment: systemic side-effects.

  D Kane, L Barnes, O Fitzgerald
  British Journal of Dermatology 09/2003; 149(2):417. · 3.67 Impact Factor