THE PHYSIOLOGICAL COST OF GAIT (PCG): A NEW TECHNIQUE FOR EVALUATING NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN RHEUMATOID ARTHRITIS

The physiological cost of gait (PCG) provides a technique forreproducibly quantifying the physical disabilities occasionedby inflammatory joint disease. The preferred walking speed (PWS)and the physiological cost index (PCI) related to achievingthat PWS are shown to be abnormal in rheumatoid arthritis (RA)and objective improvement can be demonstrated with naproxenand indomethacin, two commonly-used nonsteroidal anti-inflammatorydrugs (NSAIDs). Twenty patients with active RA were studied by double-blindcross-over technique and 16 completed the two-month study. ReliablePCG data obtained in 13 patients showed statistically significantimprovement in PWS and PCI with NSAID therapy. Improvement wasnot correlated with conventional clinical measures of jointinflammation such as pain score, articular index, haemoglobinor ESR but the trends were similar. PCG may offer a reproducible,objective method of quantifying disability and response to treatment. KEY WORDS: Rheumatoid arthritis, NSAID evaluation, Physiological testing     

Bacterial endocarditis in a child presenting with acute arterial ischemic stroke: should thrombolytic therapy be absolutely contraindicated?

Thrombolysis is considered to be contraindicated in acute ischemic stroke secondary to infective endocarditis (IE). We report a 12-year-old female who presented with acute dense right hemiparesis and aphasia. Cranial magnetic resonance imaging and angiography showed multiple diffusion-restricted lesions in the left hemisphere and absence of flow in the left internal carotid artery. She was treated with intra-arterial tissue plasminogen activator within 6 hours of her presentation. Subsequently she was diagnosed with pneumococcal endocarditis and underwent debridement of vegetations and patch repair of the mitral valve. The patient did not have hemorrhagic complications following thrombolytic therapy or surgery. Pathological analysis of the mitral valve vegetations revealed mostly fibrin thrombus. Follow-up imaging showed complete recanalization of the left internal carotid artery, and the patient had a remarkable neurological recovery. This is the first case report of successful intra-arterial thrombolytic therapy in childhood IE-related stroke. We believe that thrombolytic therapy contributed to a favorable outcome in our patient and may be safe in selected patients with childhood IE-related acute ischemic stroke.