Rheumatology and Rehabilitation

Online ISSN: 0300-3396
Publications
Article
SUMMARY A prospective study was undertaken of 102 patients initially diagnosed as having polymyalgia rheumatica/temporal arteritis. The mean period of follow-up was 5.2 years. The delay between onset of symptoms and referral for specialist opinion was 6.2 months. The proportion of patients referred with the correct diagnosis by the general practitioner increased from 4% to 10% over a 10-year period from 1964 to 1974. Seventy-four per cent of patients presented with limitation of shoulder movement. During follow-up, 12% of patients developed myocardial infarction and aorto-fernoral occlusive disease occurred in 6%. One patient became blind due to central artery occlusion. Steroid therapy had to be continued for at least five years in 84% of cases.
 
Article
SUMMARY During the mobilization of stiff hands after Colles' fractures the additional effects of Movelat cream and its base cream were compared with each other. The areas of comparison were ranges of active and passive palmar flexion of the wrist and pumping power of the hand. No statistically significant differences (P <0.05) could be observed in the recovery of the three parameters mentioned between the Movelat cream or its base cream treatment groups.
 
Article
The pattern of chest expansion and spinal mobility (anterior flexion, lateral flexion, and extension) has been studied in 106 patients with ankylosing spondylitis. New objective clinical methods were used to measure spinal mobility; the measurements from patients were compared with those obtained from 237 normal controls. Traditional subjective observation that chest and spinal mobility are limited in ankylosing spondylitis has been confirmed objectively after correcting the data for age and sex. No difference in pattern of chest and spinal mobility was noted between patients with uncomplicated spondylitis and those with spondylitis associated with psoriasis, ulcerative colitis, Crohn's disease, and Reiter's disease. On a clinical basis four patterns of spondylitis were delineated: pain free and normal chest and spinal mobility (8.6%); painful but normal mobility (14.1%); painful and restricted mobility (66.3%); and relatively pain free but completely limited mobility (10.8%). The scatter of chest and spinal mobility in patients was considerable, and extensive overlap into the normal range occurred. The degree of overlap, and therefore the high yield of false negative results, weaken the value of clinical measurements as accurate indices of ankylosing spondylitis. Contrasted with normal controls, a correlation study in patients with spondylitis revealed close relationships between chest expansion and all three planes of spinal mobility, and between individual planes of spinal mobility. It is suggested, therefore, that for epidemiological studies of ankylosing spondylitis, measurement of only one of these parameters should be sufficient. In order to secure the best clinical differentiation between spondylitis and disorders of the lumbar disc, lateral spinal flexion is probably the measurement of choice. In addition to their value in differential diagnosis, chest and spinal mobility are also useful in the assessment of progress and therapy.
 
Article
A painful heel syndrome (plantar fasciitis and/or Achilles tendinitis) was found in 33 among 150 patients suffering from a seronegative spondarthritis. The clinical and radiological manifestations of this syndrome were similar in the nosological entities included in the seronegative spondarthritis group. HLA-B27 antigen was found in 91% of the patients, radiological sacroliitis in 64% and an asymmetric peripheral arthritis in all cases. By contrast, Achilles tendinitis was not encountered in 220 cases of rheumatoid arthritis; plantar fasciitis was exceptional in the same cases.
 
Article
A case is reported of a hyperviscosity-like syndrome in a 53-year-old male suffering from rheumatoid arthritis. The clinical presentation was an acute abdomen, peripheral neuritis, otovestibular areflexy, and central retinal vein thrombosis (papilloedema and retinopathy with venous engorgement, haemorrhages and exudates). Plasma viscosity was normal and whole blood viscosity, measured with an Oswald viscometer, was slightly elevated. The patient had markedly elevated rheumatoid factor titre and fibrinogen level. Histologically, there were no signs of arteritis in the mesentery. Intermittent plasma-exchange resulted in general improvement and no new vascular accidents after 2.5 years.
 
Article
A short-term double-bind cross-over trial of prenazone 600 mg daily and phenylbutazone 300 mg daily was carried out in twenty out-patients with rheumatoid arthritis. Ten patients preferred prenazone, and eight preferred phenylbutazone. No significant difference in analgesic and antiinflammatory potency was demonstrated under the conditions of the trial, and no serious adverse effects, either clinical or laboratory, were encountered. These findings support other claims that prenazone may be a useful alternative in the treatment of rheumatoid arthritis.
 
Article
SUMMARY Seventy-one of 78 patients presenting to routine rheumatology clinics with seronegative arthritis were found to possess the histocompatibility antigen HL-A 27. Four principal components to their arthritis emerged, namely: spondylitis, sacroiliitis, peripheral polyarthritis, oligoarthritis (involvement of one or two large joints). It is suggested that each of these may be influenced by separate genetic determinants. The various combinations in which these occur warrant a unified nomenclature. A small subgroup of patients with HL-A 27-associated arthritis is described in whom the diseases may be especially benign.
 
Article
The standard 8BL Ministry chair is a chair which is suitable for use in smaller flats and houses, and for transport in three wheeler Ministry cars. Until now its use by double amputees has been contra indicated by its tendency to tip backwards when going up slopes or when propelled forwards rapidly from the stationary position. Displacing the rear wheels 3 in backwards has certainly counteracted this tendency, but has added an extra 3 in to the overall length of the chair, and has thus increased the floor space needed for its operation. A method has recently been developed at Mary Marlborough Lodge whereby the overall length of the chair is unchanged, but the centre of gravity of the chair/patient combination has been displaced forwards, so diminishing its tendency to fall backwards.
 
Article
Yttrium-90 synovectomy resulted in complete resolution of chronic knee synovitis in 40% of a group of 15 patients. These patients would have otherwise required surgical synovectomy. The number of chromosomal aberrations detected in 30 patients after yttrium-90 synovectomy showed a statistically significant increase over the pre-treatment analysis, and, following treatment, chromosomal damage was noted in nine patients who had no damage before treatment. The risk arising from this chromosomal damage is uncertain but, while the long-term implications of the chromosomal aberrations are investigated in those who have already been treated, this therapy should be reserved for the older patient.
 
Article
SUMMARY Chromosomal damage to circulating lymphocytes occurs following injection of intra-articular radio-isotopes. Differences in the degree of chromosomal damage have been shown with various colloidal forms of yttrium 90, and the severity of these changes has been shown to correlate with the degree of leakage of radio-isotope to the draining lymph node rather than with whole-body irradiation. The long-term significance of these changes is not yet known, but it is clearly prudent to use the colloidal form least associated with chromosomal damage.
 
Article
Chromosome studies were performed on 30 patients undergoing 90Y synovectomy before and after therapy. It was observed that overall there was a small but significant rise from 0.33% to 0.87% in the frequency of cells with specific chromosome aberrations following treatment. These findings agree well with those of other surveys. Analysis of individual results show that, of the 30 patients, only 10 showed chromosome damage that could be attributed unequivocally to the 90Y therapy.
 
Article
The long-term effect of (90)Y was studied in 33 knees from 28 patients with rheumatoid arthritis, all with chronic knee effusions. Patients were allocated on a random basis to receive intra-articular injection of either 5 mCi (90)Y or non-radioactive yttrium. All patients were assessed before and after injection (the assessor being unaware of the type of treatment given), by use of arthroscopy, synovial biopsy, radiological assessment, clinical indices of joint size and range of movement, and the global evaluation of patient and observer. A striking finding was the variable nature of the clinical results, excellent degrees of improvement being found in patients who had received (90)Y or non-radioactive yttrium. Overall, there was no significant difference in clinical indices between the two treatment groups. Knee circumference fell to a greater extent in the (90)Y-treated group, but this did not achieve significance in the numbers studied, and improvement in range of movement occurred in both treatment groups. In terms of patients' overall assessment, more patients were pleased with (90)Y than what may be called the placebo group. The changes were very variable, as were histological alterations, with the exception of vascular endothelial proliferation, which was seen in half the patients given (90)Y and attributed to radiation damage. Improvement was seen in both groups of patients when large quantities of loose intra-articular fibrin were removed at pre-injection arthroscopic assessment, compared with patients in whom chunks of fibrin were not found. The joint washing which accompanies arthroscopy appears to be beneficial. A significant incidence of anterior instability of the knee occurred at a mean time of 21 months after injection in those knees treated with the radioactive isotope, which raises the possibility that yttrium may have a harmful effect. It is felt that the exact place of radioactive yttrium remains to be clearly defined.
 
Article
Quantitative sacro-iliac (SI) joint scanning with methylene diphosphonate labelled with technetium-99 (99TcMDP) was performed in 25 control patients, in 16 patients with definite ankylosing spondylitis, in 23 patients with mechanical low back pain, and in 12 patients with seronegative arthritis. The mean radio-isotope index in the control group was 1.2 +/- 0.15. The highest value was 1.5. Values in excess of 1.5 were seen in patients with clinically active ankylosing spondylitis but not those with inactive disease. Three of the 12 seronegative arthritis patients (without clinical or radiological evidence of sacro-iliitis) had elevated values: all of these were positive for HL-A B27. An important finding was that six of the 23 patients with mechanical or non-specific low back pain had values above 1.5, unassociated with B27. These data emphasize the need for caution in the interpretation of abnormal sacro-iliac scans. Radio-isotope bone scanning can provide a qualitative and quantitative assessment of inflammatory activity in joints with minimal radiation exposure. Various authors have shown its value in providing early evidence of sacro-iliitis (Russell et al., 1975; Namey et al., 1977). In this study, methylene diphosphonate labelled with technetium-99 (99TcMMDP) has been used to produce quantitative sacro-iliac scans in order to evaluate sacro-iliac disease in four groups of patients presenting with or without low back pain.
 
Article
SUMMARY Too much of the information required for rigorous assessment of the diagnostic value of a positive HL-A 27 test is not available. Certainly there would seem to be no case for population screening, not least because effective prophylaxis is not possible. At present sacroiliac radio-graphs have greater value in the clinical situation, and it seems unlikely that the contribution they make to diagnosis will be challenged. The absence of the HL-A 27 antigen may have some value as an exclusion test, but careful prospective studies are required, as well as a more detailed cost-benefit appraisal of this test.
 
Article
SUMMARY Sixty-four patients with advanced multiple sclerosis were assessed on intellectual and memory tests. They were rated by occupational therapists on an Activities of Daily Living scale according to their abilities, and by relatives on the same scale, according to what they actually did. Results indicated that the multiple sclerosis patients had intellectual and memory deficits. A few discrepancies occurred between patients' abilities as rated by an occupational therapist and what they actually did as rated by a relative. These discrepancies were not significantly related to memory impairment.
 
Article
The mean plasma total tryptophan concentration of 13 long-standing rheumatoid arthritis patients was found to be lower than that of seven nonrheumatoid control subjects, but the plasma nicotinic acid concentration was unchanged. In the rheumatoid patients the urinary excretion of the tryptophan metabolites, kynurenine, xanthurenic acid and 3-hydroxyanthranilic acid, was increased several fold, but the excretion of N-methylnicotinamide was normal. These findings are discussed in relationship to the dietary intakes of tryptophan, nicotinic acid and pyridoxine, the effect of antirheumatoid drugs on plasma tryptophan and liver tryptophan pyrrolase, and the requirement of rheumatoid patients for pyridoxine.
 
Article
Reference is made to legislation concerned with the introduction of the New Zealand Accident Compensation Scheme in 1974. The author’s experience of the Scheme is based on an exchange visit in 1975. The basic principles are community responsibility and universal entitlement to compensation. Earnings-related benefits are paid to the injured person, and flat-rate payments to non-earners. The Scheme is administered by a three-man Commission with wide responsibilities for accident prevention, rehabilitation services, administration of funds, records, public relations, and an independent Appeals Authority. There have been far reaching consequences on medical practice. The Commission construe the phrase ‘Personal Injury by Accident’ as damage to the human system which is not designed by the person injured: the implications of such a definition are briefly discussed. The administrative costs of any similar Scheme in the United Kingdom would be enormous and it is doubtful whether the benefits would justify the cost.
 
Article
SUMMARY The opportunity was taken during an interview survey of impaired people, based on a group general-medical practice, to check the impaired person‘s statement about the nature of the underlying medical condition against the general practitioner’s assessment based on his notes and recollections. It was possible to check 311 statements, and 294(94%) were corroborated by the general practitioner. Specific diagnoses were established for 191 cases, of which 154 had been given accurately by the impaired people. There was a marked lack of specific diagnoses in three groups of disorders, the deaf and hard of hearing, the blind and partially sighted, and musculoskeletal disorders. The findings are in agreement with previous studies and whilst they may not be surprising, they are reassuring in view of the large number of interview surveys of impaired and handicapped people that have been and are being carried out.
 
Article
SUMMARY Eight children, aged 9 to 15, referred to a juvenile rheumatology service on account of un-diagnosed hip pain, were ultimately found to have idiopathic protrusio acetabuli (IPA). Qinical and radiographic findings were generally asymmetrical on presentation. Subsequent radiographs tended to lag behind a rapid deterioration in six patients, four of whom required bilateral total hip replacement during adolescence. Pain on full flexion and moderate adductor spasm in the contra-lateral hip proved a useful early sign for predicting bilateral disease. Six of eight patients were hypermobile. In three of five families investigated, symptom-free IPA was revealed in one or more first degree relatives. Histology early in the course in two cases showed a non-diagnostic inflammatory reaction in the sub-synovium.
 
Article
Twenty-seven synovitic knees, of 24 patients, were subjected to aspiration followed by the injection of 50 mg. hydrocortisone acetate alone, 50 mg. hydrocortisone acetate plus 9 ml. normal saline, or 10 ml. normal saline. Though undoubtedly superior to normal saline alone, no significant difference from the effect of hydrocortisone acetate has been demonstrated by the addition of normal saline. It is concluded that aspiration followed by the injection of undiluted steroid is probably at least as beneficial as the same injection plus diluent.
 
Article
Twenty four cases of rheumatoid arthritis with digestive disorders have been treated with methylprednisolone (Depa Medrone) and then triamcinolone acetonide (Kenalog) in equal dosage or double the dosage. It was found that the time interval between injections, on average, using the same dose, could be increased from 4.5 to 8.6 days (p < 0.001). It was also found that after a series of triamcinolone acetonide injections the time between the injections could gradually be increased and hence the dose reduced. No appreciable gastric symptoms arose. Steroid complications were of the frequency and degree expected, except for two patients who developed symptoms suggestive of mild myopathy. During the process of increasing the time interval between injections two patients had symptoms of adrenal insufficiency. One of these died, and at autopsy the myocardium showed a patchy early necrosis though to be due to the period of hypotension. There were also widespread amyloid changes in the walls of the smaller arteries and the vasa recta of the kidneys, but surprisinly not affecting the glomerular tufts or tubular basement membrane.
 
Article
N-acetyl-beta-D-glucosaminidase activity in the synovial fluid of different articular diseases was studied and statistical investigations were carried out after logarithmic transformation of the data. The enzyme activity in the synovial fluid of rheumatoid arthritis is increased when compared with osteoarthrosis and traumatic effusions. The enzyme activity in traumatic effusions is also increased in comparison with osteoarthrosis. A linear relation was found between the enzyme activity in cell-free fluid and the polymorphonuclear leucocyte (PMN) count in rheumatoid arthritis osteoarthrosis and in miscellaneous synovitis. The activity per PMN cell was determined and found to be relatively constant in the synovial fluid of inflammatory diseases (rheumatoid arthritis, chondrocalcinosis, miscellaneous synovitis). The N-acetyl-beta-D-glucosaminidase activity per PMN cell in serum was found to be significantly lower than in synovial fluid.
 
Article
Urine levels of the lysosomal enzyme beta-N-acetylglucosaminidase have been measured in patients with arthritic disorders; significantly higher levels were found in patients with rheumatoid arthritis (mean: 332.9 nmol/h/mg creat.) than in those with degenerative joint disease (mean: 86.31 nmol/h/mg creat.; P less than 0.001). Analysis of the results shows that salicylates were responsible for some of this difference, but suggests that rheumatoid disease itself may cause renal damage.
 
Article
A multicentre double-blind comparison of choline magnesium trisalicylate (CMT) and acetylsalicylic acid (ACSA) compared the two medications for seven weeks in rheumatoid arthritis patients. Investigators measured the number of painful and swollen joints and the duration of morning stiffness, and assessed the overall condition of each patient. Both medications were highly effective in significantly reducing the severity of symptoms flaring after interruption of prior therapy. CMT achieved a greater reduction in the number of swollen joints than did ACSA (P less than 0.05). The incidence of adverse side-effects per patient was significantly less with CMT (P less than 0.05) (ACSA 32.1%; CMT, 16.3%. A larger percentage of ACSA patients (50.8%) reported adverse side-effects than did CMT patients 28.4%) (P less than 0.02).
 
Article
A quantitative comparison of gastro-intestinal microbleeding induced by acetylsalicylic acid (ASA), 3.6 g daily, ketoprofen (KETO), 200 mg daily and placebo (P) was undertaken in 12 normal volunteers using a double-blind factorial design with repeated measures. We conclude that KETO induces less gastro-intestinal bleeding than ASA but more than placebo and that there is a significant residual bleeding under placebo following ASA.
 
Article
A double-blind placebo-controlled trial was carried out in 30 out-patients with osteoarthritis of knee and hip. The therapeutic value of flactafenine 1.2 g daily, a new oral non-narcotic analgesic agent, was compared with that of enteric-coated acetylsalicylic acid (ACSA) (Rougier Inc.--enteric-coated acetylsalicylic acid, tablets of 650 mg) 2.6 g daily. Every patient successively received the three medications for six weeks according to a Latin-square design. An objective index of improvement of hips and knees was developed and applied to this study. In both objective and subjective assessments of the disease, floctafenine was found to be approximately equivalent to or superior to ACSA and superior to placebo. Both drugs were clinically well tolerated. A consistant but slight decrease in both haemoglobin and red-blood-cell count under floctafenine and ASA was found to be statistically but not clinically significant.
 
Article
Our observations, as well as similarities between penicillamine and Myocrisin in clinical action and side effects in RA make it not unreasonable to think that thiomalate may have a penicillamine-like effect. Only a controlled clinical trial with thiomalate in RA can provide an answer to this question.
 
Article
Evidence for the stabilizing effect of ketoprofen on the lysosomal membrane is presented. Ketoprofen was as potent as indomethacin in stabilizing lysosomes subjected to changes in osmotic pressure. This effect was more marked in rats with adjuvant arthritis than in normal animals.
 
Article
A dominant feature of rheumatoid synovitis is the relentless persistence of the chronic inflammatory response. It is postulated that the macrophage plays a key role in chronic inflammation. Chronicity of inflammation may be maintained by persistent migration of monocytes, proliferation of cells at the site of inflammation or persistence of long lived cells at the site. Gold, penicillamine and the immunosuppressive drugs produce a slow improvement in the signs and symptoms of rheumatoid arthritis. The action of these drugs is accompanied by effects on extra articular features of the disease so that it is clear that their effect is more fundamental. Immunosuppressives could reasonably be expected to act on the efferent loop of the response, suppressing the function of sensitized lymphocytes or impairing the process of sensitization. Thoracic duct drainage probably removes T cells which carry the bad news to the inflammatory site. Hypotheses should not be taken too seriously, must change constantly and are intended to stimulate and direct further research. The immunostimulant theory is but the latest of many proposed modes of action of penicillamine and may be as transient as most of its predecessors. The fundamental action of 'specific' drugs may however provide a useful tool for studying the pathogenesis of rheumatoid arthritis.
 
Article
SUMMARY Single doses of a new nonsteroidal anti-inflammatory drug, isoxepac (200 mg) have been shown to have comparable analgesic activity to single doses of aspirin (800 mg)
 
Article
SUMMARY In patients with rheumatoid arthritis neither indomethacin nor aspirin influenced the levels of the erythrocyte sedimentation rate (e.s.r.) or serum acute-phase proteins (fibrinogen, hapto-globin, C-reactive protein and alpha1 acid-glycoprotein). Treatment with D-penicillamine, sodium aurothiomalate, or alclofenac produced a significant reduction both in acute-phase protein levels and in e.s.r. Each of the drugs displaced L-tryptophan from plasma proteins in vivo but withdrawal of indomethacin and aspirin was followed immediately by excessive binding of this amino acid to circulating proteins: this phenomenon was not observed when alclofenac, sodium aurothiomalate or D-penicillamine were withdrawn. It has been demonstrated that disease activity in rheumatoid arthritis is reflected in acute-phase protein concentrations and in the extent to which L-tryptophan is bound to plasma protein. It is suggested that drugs which profoundly affect these parameters provide not only symptomatic relief but also possible beneficial effects upon the disease process itself.
 
Article
Episodes of acute pseudogout following parathyroidectomy are rare, and only a few reports have appeared in the literature. 62-year-old 62-tear-old woman was evaluated for hypercalcaemia discovered on routine blood analysis. She had never been subject to any arthritic discomfort. Serum calcium 3.3-3.5 mmol/l (13.2-14.0 mg/100 ml), bicarbonate 20 mEq/l and chloride 106 mEq/l. Sodium, potassium and uric acid levels were normal. Hyperparathyroidism was diagnosed, and a 12 g parathyroid adenoma successfully removed. On the fourth post-operative day, the serum calcium was 2.1 mmol/l (8.4 mg/100 ml). On the following day she complained of severe pain in both knees and developed a frank arthritis. The patient's temperature was 38.5°C. Radiography showed chondrocalcinosis in both knees. The serum calcium was 2.25 mmol/l (9.0 mg/100 ml), phosphorus 1.1 mmol/l (2.7 mg/100 ml), bicarbonate 26 mEq/l and chloride 98 mEq/l. Serum sodium, potassium and uric acid were normal. The synovial fluid aspirate was turbid, sterile and contained weakly positively birefringent intraleucocytic crystals. The synovial fluid calcium level was 1.28 mmol/l (5.l mg/100 ml). Dramatic clinical improvement followed the intra-articular injection of methyl prednisolone.
 
Article
In an epidemiological study of acute herniated lumbar intervertebral discs in the New Haven, Connecticut (U.S.A.), area, it was found that this condition was most likely to be diagnosed among persons in the age group 30-39 years, and that the most important risk factors among the variable considered in this study were driving of motor vehicles at or away from work, sedentary occupations, suburban residence, and previous full-term pregnancies. Variables for which there was some suggestion of an association but for which the evidence was inconclusive were the male sex, high social class among females, chronic cough and chronic bronchitis, participation in baseball, golf and bowling, the spring and fall seasons, and possibly lack of physical activity other than at work. No increase in risk for this condition was related to race, social class in males, smoking habits, participation in sports other than baseball, golf and bowling, weight or body bulk, recent episodes of emotional stress, pregnancies which were not full-term, and jobs involving lifting, pushing, pulling, or carrying.
 
Article
Of 100 consecutive patients admitted as emergencies to three acute general medical wards in a district general hospital, 43 had an associated rheumatological problem which in 32 patients was a source of complaint and in 19 of these either caused the admission, contributed to it or modified arrangements for treatment, nursing, rehabilitation or discharge.
 
Article
SUMMARY One hundred and fourteen patients suffering from musculoskeletal disorders were entered into a double-blind, parallel comparison of naproxen sodium (825 mg daily) and indomethacin (75 mg daily). The two treatment groups were found to be matched for age, sex, history of disorder and severity of symptoms at the start of the study. At the seven-day follow-up both groups of patients showed statistically significant reductions from baseline in pain and limitation of movement. Patients' daily records showed a steady decline of symptom severity throughout the seven days. There were no significant differences between the effects of the two drugs. The numbers of patients with side-effects and the total number of complaints in the two treatment groups were not significantly different but there were significantly more patients complaining of headache (P = 0.018) and diarrhoea (P = 0.034) in the indomethacin group. Nine patients withdrew from the study—three patients taking naproxen sodium and six taking indomethacin—all because of side-effects.
 
Article
SUMMARY Four cases are reported, three of tennis elbow and one of golfer's elbow, which were characterized by the dramatic onset and severity of the pain and in which there was radiological evidence of calcium deposition within the soft tissues in the vicinity of the tendon origins.
 
Article
A double-blind therapeutic trial carried out by the sequential method has demonstrated clearly a significant difference in efficacy between ketoprofen (given rectally at a dosage of 200 mg daily) and a placebo in a group of patients suffering from osteoarthritis of the hip or knee. The interest in this type of study lies in the fact that it will often given the answer to a simple question using a relatively small number of patients.
 
Article
The effects of ketoprofen suppositories were studied in an open trial in 50 patients with various rheumatic disorders. A beneficial effect was obtained in many patients and this lasted for about 8 hours after administration. Mild local irritation was the commonest side-effect but seldom led to withdrawal of treatment.
 
Article
A double-blind cross-over study is being undertaken in fifty patients with "definite" rheumatoid arthritis, comparing ketoprofen (2-(3-phenylbenzoyl proprionic acid) 75 mg daily orally and 100 mg suppository at night with indomethacin in the same dosage. A pilot study of twenty-four patients has been completed, fifteen having finished the trial. The objective assessment of grip strength and articular index were comparable with the two drugs, but subjective assessment showed that relief of early morning stiffness was better with indomethacin, although pain relief was no different. Evidence so far available shows that ketoprofen is a useful anti-inflammatory analgesic drug which is well tolerated and that the use of a suppository may be helpful in a few patients who find the oral route unacceptable. A larger study is necessary to evaluate finally the use of a combined administration.
 
Article
The results of a clinical study of ketoprofen suppositories suggest that the drug is effective when given in this way. It is suggested that, in the treatment of inflammatory rheumatic disorders, advantage should be taken of the longer duration of action of ketoprofen suppositories to prescribe their administration early in the morning and before retiring. Local intolerance occurred in only 4 of 52 patients.
 
Article
The ranges of spinal movement in 390 healthy children aged from 10 to 15 years have been recorded. These measurements are in two planes, anterior and lateral; they are quick and easy to perform and require no special equipment, just a tape measure. Many conditions occurring in childhood can lead to limitation of spinal movement: these include juvenile ankylosing spondylitis, spondylolisthesis, Scheuermann's vertebral osteochondritis, discitis and vertebral fractures, the latter being not uncommon in children receiving prolonged corticosteroid therapy. The purpose of the present paper is to define the normal range for anterior and lateral spinal flexion in adolescents and to correlate these with sex, age, height and weight.
 
Article
A double-blind trial of prednisolone in patients with rheumatoid arthritis using doses of zero, 3 mg and 5 mg is reported. Patients on a dose of 3 mg derived little sustained benefit but subjects on the higher dose showed some improvement which did not last more than two years. Mild suppression of the hypothalamo-pituitary-adrenal axis occurred in both steroid-treated groups.
 
Top-cited authors
Edward Huskisson
  • King Edward VII's Hospital
Rodney Grahame
  • University College London
Paul Dieppe
  • University of Exeter
Paul A Bacon
  • University of Birmingham
E.F.J. Ring
  • University of South Wales