Table 4.
Natural experiment of eradication failure, and effect of anti-nuclear antibody (ANA) status, on within-subject time-trends in outcome criteria for idiopathic parkinsonism, in first year post-active treatment
| Estimated change/yearabMean (95% CI) |
Estimated change/yearabMean (95% CI) |
|||||
|---|---|---|---|---|---|---|
| Outcome variable | Evidence failed eradicationc22 assessments(n = 4) | Remainder 153 assessments (n = 26) | p-value | Remainder ANA +ve 25 assessments (n = 6) | Remainder ANA −ve 128 assessments (n = 20) | p-value |
| Brady/hypokinesiad | ||||||
| Mean stride length (mm) | −158 (−273, −43) | 52 (17, 87) | .001 | −105 (−196, −14) | 68 (33, 102) | .001 |
| Mean free-walking speed (mm/second) | −97 (−271, 76) | 72 (19, 124) | .046 | −64 (−206, 79) | 85 (31, 139) | .045 |
| Rigidity (Nm × 10−3) | ||||||
| Mean torque to extend | 374 (76, 672) | 160 (61, 258) | .1 | −113 (−346, 121) | 191 (92, 291) | .01 |
| Mean torque to flex | −41 (−283, 201) | −2 (−83, 80) | .7 | −140 (−333, 53) | 16 (−68, 101) | .1 |
| Tremor | ||||||
| Mean tremor seated (mm)e | −8 (−24, 8) | −3 (−8, 2) | .7 | 5 (−8, 18) | −4 (−8, 2) | .2 |
| Mean tremor stance/walk (%) | 4 (−11, 19) | 2 (−3, 7) | .7 | −15 (−26, −3) | 4 (−1, 8) | .003f |
| Postural abnormality (%)g | ||||||
| Mean body sway | 0 (−42, 78) | 5 (−12, 24) | .9 | −9 (−46, 44) | 6 (−11, 26) | .5 |
| Ratio mean sway: eyes open/closed | −12 (−28, 8) | −1 (−7, 6) | .2 | −16 (−29, 0) | 1 (−5, 8) | .04 |
Median follow-up after known eradication failure was 268 (range 78–416) days, and, in remainder 544 (inter-quartile range 245, 1059).
Psychometric function was unaffected by either eradication failure or ANA status. Mean arterial pressure was unaffected, but pulse lower with eradication failure (−11 (95% CI −20, −1) vs 1 (0, 3) supine; −9 (−19, 1) vs 1 (0, 3)/minute/year standing over 3 minutes: p = .01 and .048 respectively). Weight loss was greater with failure (−0.3 (−1.3, 0.1) vs 0.6 (−0.2, 1.4) kg, p = .03). ANA status had no significant effect on these outcomes in remainder.
Criterion: UBT (n = 1), histology and culture (1), molecular detection only (2). UBT available in all 30 following an active treatment, 26/30 having a repeat endoscopy at a median of 346 (inter-quartile range 31, 387) days. Classification and grading of gastritis improved (even in those with evidence of eradication failure) or returned to normal, in all but one. The exception had a minor degree of chronic antral gastritis, with Helicobacter-like organisms before eradication, without organisms after.
Subjective brady/hypokinesia video rating deteriorated with eradication failure (−13 (95% CI −25, −0.3) vs 1 (−3, 5), p = .02). It was unaffected by ANA status in remainder.
Tremor under stress unaffected by eradication failure or ANA status.
After excluding those with tremor ratings of ≥90/100 on stance/walk, size effect: −40 (−74, −6) for ANA positive (n = 2 with eight observations), 7 (−5, 20) for ANA negative (n = 7 with 48 observations), p = .004.
Ambulatory foot separation tended to be narrower with eradication failure (−28 (−51, −4) vs −7 (−14, 0.5) mm, p = .07), ANA status having no significant effect in remainder.