TENOGRAPHY OF THE RHEUMATOID HAND

Rheumatoid tenosynovitis is common and is often treated by localsteroid injections. Sodium diatrizoate (Hypaque) has been addedto the hydrocortisone acetate injected to demonstrate the natureof the rheumatoid involvement and the distribution of injectedsteroids. ^*Abridgement of paper read at the Annual Meeting of the BritishAssociation of Physical Medicine and Rheumatology, London, April16, 1970.     

THE EFFECT OF HYPERPARATHYROIDISM ON THE COURSE OF RHEUMATOID ARTHRITIS

Rheumatoid arthritis and primary hyperparathyroidism have beendiagnosed in three patients. This is likely to represent thecoincidence of two common diseases but the clinical featuresare discussed with particular reference to the presence andwithdrawal of raised levels of circulating parathyroid hormone(PTH). It is argued that raised levels of PTH potentiate theeffects of the rheumatoid disease on bone and joints. Othermusculoskeletal features of hyperparathyroidism and the actionsof PTH on bone are reviewed. KEY WORDS: Hyperparathyroidism, Rheumatoid arthritis     

THE EFFECT OF RHEUMATOID ARTHRITIS ON THE SOCIAL SITUATION OF HOUSEWIVES

Thirty-seven housewives treated in hospital for rheumatoid arthritiswere investigated with particular reference to their husbands‘reactions. Although most patients had ’accepted‘the disease, many were distressed by both the physical aspectsof it (tiredness, pain and limitation of activities) and bythe psychological aspects (guilt, fear of being a burden, andnot understanding the disease). In 70% it was felt that theirhusbands understood the disease, but half the patients had difficultiesin coping with the anxiety of their husbands. Those whose arthritishad developed before marriage fared better in terms of fearof losing their independence, understanding the disease, guiltfeelings, adjustment to the disease, their husbands’ understandingand friction in the home. Patients with milder disease weremore anxious, but experienced the greater understanding of theirhusbands. Help was required in enabling the patients to cope with theirfears, to manage practically, and to deal with the anxiety oftheir husbands. Help in coping with the fears and in allayingthe anxiety of their husbands was most required in those withmild disease and those in whom it had progressed to become sociallydisabling, but without confining the patients to their homes. ^*Paper read at the Annual General Meeting of the British Associationfor Rheumatology and Rehabilitation, London, March 1976, byDr. John Lambert.     

THE DISTRIBUTION OF RADIOLOGICAL JOINT DAMAGE IN THE RHEUMATOID HAND

We report a detailed study of the relative distribution of jointdamage, as assessed by erosion and joint space scores, in theproximal interphalangeal (PIP) and metacarpophalangeal (MCP)joints of the rheumatoid hand. Hand radiographs of 30 patientswith erosive rheumatoid arthritis were studied. There was significantly more damage in the dominant hand. Thelittle-finger PIP joints were more damaged and the thumb interphalangeal(IP) joints less damaged than the other PIP joints. The indexand middle finger MCP joints were more damaged than the otherMCP joints. There was a significant negative correlation betweenthe erosion scores of the PIP and MCP joints of each individualdigit, when digits with only minimal damage were excluded. These findings support the concept that joint damage in therheumatoid hand is greater in those joints that are subjectedto greater mechanical stresses, and that in any digital raythe damage is concentrated at either the PIP or MCP joint. ^*Paper read at the Annual Provincial Meeting of the BritishAssociation for Rheumatology and Rehabilitation, the Royal Societyof Medicine, Section of Rheumatology and Rehabilitation andthe Irish Society for Rheumatology and Rehabilitation, Portsmouth,12 and 13 October 1978.     

THE EFFECT OF EXERCISE ON ANKYLOSING SPONDYLITIS -- A PRELIMINARY STUDY

The Polhemus Navigation Sciences 3Space Isotrak system was usedto measure the range of lumbar spinal motion of 57 patientswith ankylosing spondylitis. Forty-three of these attended voluntaryexercise sessions for an average of one and a half hours perweek while 14 did not participate in any formal exercise groups.Exercising patients fell into two groups: those attending moderateand those attending vigorous exercise sessions. Results forexercising patients obtained immediately pre- and post- a singleexercise session showed a small but significant increase inextension for the vigorous exercise group but no significantchanges in any other movement for either of the groups. In agroup of 44 patients (33 exercising, 11 non-exercising) whowere followed-up over a 2 to 6 month period, slight loss offlexion (5.5°) and lateral bend (3°) was observed butthere was no change in range of extension. KEY WORDS: Exercise, Ankylosing spondylitis, Range of motion, isotrak     

THE OCCURRENCE AND SIGNIFICANCE OF HAND DEFORMITIES IN EARLY RHEUMATOID ARTHRITIS

One hundred rheumatoid arthritis patients (38 men, 62 women),with mean age of 53 years and mean disease duration of 11.5months, were followed. Standardized clinical, biochemical, andradiographic evaluation was performed regularly. After 2 yearsthe prevalence of ulnar deviation, buttonhole deformity, andswan neck deformity was 13%, 16%, and 8%, respectively. Altogether,31 patients had developed one or more deformities. There wasno difference in age or gender distribution and no predominanceof the dominant hand. Each patient with a deformity was matchedaccording to age, sex, and disease duration with another earlyRA patient without deformity. The deformity group had more activedisease, less grip strength, more disability, and markedly moresevere radiographic changes. When studied retrospectively ata time point 3 months prior to the detection of deformity, synovitisof relevant joints was as common in the group who developeddeformities as in the control group. This suggests that jointinflammation may contribute to the genesis of deformity butadditional factors are needed. Hand deformities were found tobe common in early RA. KEY WORDS: Early RA, Ulnar deviation, Swan neck deformity, Buttonhole deformity, Radiology, Hand disability     

EFFECT OF AGE ON THE EFFICACY AND TOLERANCE OF METHOTREXATE IN RHEUMATOID ARTHRITIS

The objective of this study was to assess the influence of ageon the efficacy and toxicity of methotrexate in rheumatoid arthritis.Four hundred and sixty-nine patients were separated accordingto the age of onset of methotrexate treatment; before 65 yr(group l, n = 416) and after 65 yr (group 2, n = 53). No differencewas found in the evolution of clinical and biological parametersbetween the two groups. The number of patients in remissionat the end of the study was equal. The frequency and type ofside-effects were similar. No significant difference was foundin the frequency and reasons for methotrexate withdrawal. Wenoted a trend towards lower therapeutic maintenance of methotrexatewhen prescribed after the age of 65 yr (P = 0.07, actuarialmethod). In conclusion, the age at initiation of methotrexatetreatment probably did not influence its efficacy and toxicityin rheumatoid arthritis. KEY WORDS: Methotrexate, Age, Efficacy, Tolerance, Rheumatoid arthritis     

A PRELIMINARY STUDY ON THE EFFECT OF ALPHA-INTERFERON TREATMENT ON THE JOINT INFLAMMATION AND SERUM CALCIUM IN RHEUMATOID ARTHRITIS

A 12-week, double-blind controlled study comparing low dose     

EFFECT OF HYDROCORTISONE ON LONG-TERM HUMAN MARROW CULTURES

In human long-term marrow cultures a relatively high concentration of hydrocortisone (10⁻⁶ M or more) is necessary for the development and subsequent maintenance of some cellular components in the adherent cell layer. However, such concentrations of hydrocortisone seem to be inhibitory for the production of granulocyte/macrophage progenitor cells (GM-CFC). In further attempts to improve these cultures, therefore, it is important to maintain a balance between a concentration of hydrocortisone which is necessary for the development of a competent adherent layer and the concentration which is inhibitory to the production of GM-CFC.     

THE EFFECT OF SOMATOSTATIN ON METABOLIC AND HORMONAL CHANGES DURING AND AFTER EXERCISE

The effect of intravenous somatostatin on blood levels of metabolites and hormones has been examined in normal subjects who performed a 30-minute period of bicycle exercises at 70% maximal exercise capacity. The results have been compared with control studies in the same subjects. Measurements were made of blood levels of lactate, glucose, free fatty acids, glycerol, acetoacetate, 3-hydroxybutyrate, insulin, glucagon, growth hormone (hGH) and prolactin. Growth hormone and glucagon release were suppressed during exercise with somatostatin and there was a subsequent elevation during recovery. There was slight post-exercise depression of insulin, but no alteration of plasma prolactin secretion. Blood glucose was reduced during exercise with somatostatin and increased during recovery. The elevation of ketone bodies after exercise was greater in the investigation with somatostatin, but there were no significant changes in other metabolites. Somatostatin, although causing inhibition of hGH release, appeared to have no significant effect upon fatty acid mobilization during exercise.     

A PROGRAMME TO ENCOURAGE PARTICIPATION OF HAEMODIALYSIS PATIENTS IN AN EXERCISE REGIMEN

Recent research has reinforced the idea that haemodialysis (HD) patients should exercise to maintain their physical functioning and improve their quality of life. Some effective exercise programmes are available for HD patients. However, these programmes are not always completed by the patients who enrol in them, and therefore, these patients do not maintain long‐term physical activity. In this study, a support programme based on the concepts of self‐monitoring, verbal reinforcement and motivation was developed to encourage continued participation of HD patients in an exercise regimen. Intervention group participants were provided a support programme in addition to the exercise programme, whereas nonintervention group participants were only provided the exercise programme. The two groups were compared for 12 weeks. The intervention group participants showed a significantly higher rate of continuation of independent exercise than the nonintervention group participants.     

THE EFFECT OF SHORT- AND LONG-TERM CORTICOSTEROID TREATMENT ON SLEEP-ASSOCIATED GROWTH HORMONE SECRETION

Eight healthy medical studients and four renal transplant patients had blood sampled two or three times hourly throughout EEG monitored nocturnal sleep. This was carried out on the healthy subjects for a total of 12 nights without medication (control nights asleep), a total of 12 nights following 40 mg of flucortolone the previous morning, and a total of 6 nights with similar blood sampling when sleep was prevented (control nights awake). Four renal transplant patients who were receiving long-term therapy with prednisolone were similarly studied (total of 7 nights asleep). Circulating corticosteroid and growth hormone (GH) levels were determined. A peak of GH was seen during the first 2 h of sleep on the control nights when slow-wave sleep predominated. The GH peak was absent on the control nights awake. The pattern of plasma corticosteroid levels was identical during control nights asleep and awake. Both single-dose and chronic corticosteroid administration inhibited the GH peak associated with slow-wave sleep. Chronic corticosteroid therapy, but no single-dose administration in the morning, suppressed the circadian rise of plasma corticosteroids which normally occurs late in sleep.     

THE EFFECT OF LONG-TERM DIPHENYLHYDANTOIN THERAPY ON GLUCOSE TOLERANCE AND INSULIN SECRETION: A CONTROLLED TRIAL

The influence of long-term administration of diphenylhydantoin (DPH) on glucose tolerance and insulin secretion was studied in a random controlled trial in non-epileptic patients receiving the drug for 2 years following recovery from myocardial infarction. While receiving DPH, insulin response to glucose was less than that in the control group, both in absolute terms and when related to the blood glucose level. Despite this, glucose tolerance did not differ from the control group. One month after cessation of DPH, the plasma insulin response had returned to the levels found in the control group, and glucose tolerance had improved to be significantly better than that found in the control group. Thus, the tendency of DPH to impair the insulin response to glucose has been confirmed in this controlled study. However, this does not result in significantly impaired glucose tolerance; it is suggested that the decreased insulin secretion is accompanied by improved insulin sensitivity.     

甲苯达唑药盐防治钩虫病的远期效果观察

本文报道广西上林县用甲苯达唑药盐，分０．６％、０．３％、０．１５％三个浓度分别供Ⅰ、Ⅱ、Ⅲ组居民作生活盐食用，每人服药盐５００ｇ，约服用３０ｄ，每人服用甲苯达唑总量Ⅰ、Ⅱ和Ⅲ组分别为３ｇ、１．５ｇ和０．７５ｇ，每年进行一次，共三次，以防治钩虫病。结果三组居民钩虫感染率从服药盐前的７１．１％、５７．９％和６１．６％均降至０。停止服药后，经４～５年的远期效果考核，三个组的居民钩虫感染率和土壤钩蚴阳性率均为０。     

氟卡尼与奎尼丁对阵发性心房颤动的远期疗效比较

以氟卡尼治疗阵发性心房颤动(简称房颤)26例,并与24例服奎尼丁者对比。平均随访1年发现,氟卡尼1个月、6个月及1年的有效率分别为46.2%,65.6%和65.6%。而奎尼丁组的有效率则分别为41.7%、50.0%和33.3%。本观察表明,氟卡尼是预防阵发性房颤的有效药物,其1年有效率高于奎尼丁。