THE PREVALENCE OF RHEUMATOID ARTHRITIS IN AFFLUENT AND POOR URBAN COMMUNITIES OF PAKISTAN

Using previously applied methods a survey of joint symptomswas undertaken among 4232 adults, evenly distributed betweenaffluent and poor areas of Karachi, Pakistan. Only six casesof definite rheumatoid arthritis (RA) (1958 ARA criteria) wereidentified in the 245 persons who complained of joint problemsof at least 4 weeks duration. The prevalence was 0.9 [confidenceinterval (CI) 0.21–3.61] and 1.98 (CI 0.55–5.1)per thousand in the poor and affluent districts, respectively.These were substantially less than prevalence rates reportedin the West but were similar to figures derived from other developingcountries. There was no obvious impact of current living standardson the findings. The relative paucity of older female subjectsin both the affluent and poor communities may account at leastin part for the low rates observed. The infrequency of rheumatoidnodules in Southern Asians with RA illustrates the difficultyof applying existing diagnostic criteria to this community. KEY WORDS: Rheumatoid arthritis, Pakistan, Prevalence, RA latex     

KNEE PAIN AND DISABILITY IN THE COMMUNITY

In order to investigate the strength of any relationship betweenknee pain and disability, a postal questionnaire was sent to2102 men and women aged over 55 registered at a general practicein Bristol. A response rate of 80·6% was achieved atsecond reminder. Knee pain was common particularly in women(27·6% overall). Disability was also more frequentlyreported in women (P<0·05) and rose with increasingage. Respondents with knee pain had significantly more disabilityrelating to upper as well as lower limb activities (P<0·05). KEY WORDS: Knee osteoarthritis, Disability, HAQ ^*Now Senior Registrar in Rheumatology, St Thomas' Hospital,Lambeth Palace Road, London SE1 7EH.     

DOUBLE OSTEOTOMY FOR THE RELIEF OF PAIN IN ARTHRITIS OF THE KNEE

Double osteotomy was performed on 67 patients for disablingpain in knees which had a good range of movement. Fifty-ninepatients (31 with rheumatoid arthritis and 28 with osteoarthrosis)were reviewed after a mean interval of two years. Three kneeswere subjected to secondary procedures because of persistentpain. Forty-one knees (63%) were causing slight or no pain atreview. The relief of pain was similar in the rheumatoid andosteoarthrosic knees. A subjective feeling of insecurity disappearedin most knees. Functional improvement was only modest. The meanrange of flexion was decreased by 13 degrees. The majority ofdeformities, some well marked, in the coronal and sagittal planeswere corrected. Complications were few. Possible mechanismsof pain relief in osteotomy are briefly discussed. Double osteotomyis of value in painful rheumatoid knees in which a useful rangeof flexion is retained. ^*Paper read at the Annual Meeting of the British Associationfor Rheumatology and Rehabilitation, London, April 1974. Senior Registrar in Orthopaedics Senior Registrar in Rheumatology     

PAIN IN THE NECK AND ARM

The clinical features of eight cases of carcinoma of the bronchuspresenting as pain in the neck and arm, arising from a populationof 320 000 in eight years, are described. The difficulties in establishing a diagnosis are discussed,and the implications for therapy and management are described.It would appear that carcinoma of the bronchus, whether local,as a Pancoast syndrome, or metastatic, is more common than isrealized. ^*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.     

NAPROXEN AND SULINDAC IN THE TREATMENT OF OSTEOARTHRITIS OF THE HIP AND KNEE

Thirty patients with osteoarthritis of the hip or knee wereentered into a double-blind, cross-over study of naproxen (750mg/day) and sulindac (400 mg/day) both given in twice-dailyregimens. Patients received each drug for four weeks. Both drugsproduced improvements in the patients' overall condition. Therewere no statistically significant differences between the effectsof the two drugs. There were few side-effects. Overall, bothdrugs proved beneficial and safe.     

PAIN RELIEF IN THE RHEUMATOID KNEE AFTER STEROID INJECTION A SINGLE-BLIND COMPARISON OF HYDROCORTISONE SUCCINATE, AND TRIAMCINOLONE ACETONIDE OR HEXACETONIDE

Since the introduction of intra-articular steroid therapy 40yr ago there have been many changes in the treatment of rheumatoidpatients. Previous studies suggest differing times of responsefor the same agents. This study reports the response, measuredby a five-point pain chart, of 300 patients with painful rheumatoidknees. Sixty received hydrocortisone succinate (HC), 150 receivedtriamcinolone acetonide (TA), and 120 triamcinolone hexacetonide(TH). Results demonstrated little effect with HC, but good responseswith TA and TH. More patients were rendered painfree for a longertime with TH; 18% at 12 weeks, as against 9% with TA (     

膝关节B超在膝关节病变中的临床意义

目的：为探讨膝关节Ｂ超对早期膝关节病变诊断及治疗的临床意义。方法：对正常人及ＯＡ、ＲＡ病人共计１３４个膝关节行Ｂ超检测。结果：①ＯＡ及ＲＡ组髌上囊积液及涔膜厚度明显高于正常人组；②两组股骨内髁外软骨厚度较正常组明显变薄，且ＯＡ组股骨内髁处骨质破坏明显高于外髁；③接受透明质酸钠治疗组，治疗后髌上囊积液减少或消失，滑膜厚度亦变薄，说明滑膜病变参与了ＯＡ的病理过程，滑膜厚度可作为微量病情活动的指数；④膝     

BONE BIOPSY IN THE INVESTIGATION OF BONE PAIN AND FRACTURES

Iliac-crest bone biopsies were performed on 20 consecutive patientspresenting to a rheumatology clinic with bone pain and/or pathologicalfracture on X-ray examination. Four patients had osteoarthrosis,ten patients rheumatoid arthritis and six patients back pain. Quantitative bone pathology showed seven patients to have osteomalacia,four patients osteoporosis, and two patients both osteomalaciaand osteoporosis. Blood chemistry was of little help in diagnosis though a veryhigh alkaline phosphatase was found in patients with Paget'sdisease and unsuspected bony metastases. Only one patient hadLooser's zones and eight patients with 'normal' or 'osteoporqtic'bone, density were shown to have histological osteomalacia.There was a strong association between steroid therapy, osteoporosisand pathological fracture, particularly in rheumatoid arthritis. Present address: Rheumatism Research Unit, 36 Clarendon Road,Leeds LS2 9PJ     

ULTRASOUND IN THE ASSESSMENT OF SYNOVIAL THICKENING IN THE HEMOPHILIC KNEE

Two patients with severe hemophilic arthropathy of the knee were studied using ultrasound. Post-operative confirmation of the ultrasound findings is presented. The possible role of ultrasound in the assessment and management of joint disease in hemophilia is discussed.     

TIAPROFENIC ACID (SURGAM) IN THE TREATMENT OF OSTEOARTHRITIS OF THE KNEE AND HIP

Tiaprofenic acid 200 mg three times a day was compared withindomethacin 25 mg three times a day in 36 patients sufferingfrom osteoarthritis of the knee and hip. In this double-blindcross-over study little significant difference in efficacy betweenthe. drugs was seen. Although no significant difference in adverseeffects was found, significantly fewer central nervous systemside-effects were associated with tiaprofenic acid treatment     

RADIOTHERAPY IN THE TREATMENT OF OSTEOARTHROSIS OF THE KNEE

The purpose of this trial was to evaluate the response of patientswith osteoarthrosis of the knee to deep X-ray therapy by comparisonwith the results obtained with standard physiotherapy. Patientsselected for inclusion were aged 60 years or more and were randomlyallocated blind to one of two treatment groups. Those givenradiotherapy received 800 rads over four weeks. Physiotherapycomprised short-wave diathermy combined with standardized exercises,the course also lasting four weeks. Assessments were made beforeand after treatment and then 10 and 24 weeks after the startof treatment. Note was made of subjective alleviation of painand stiffness; changes in analgesic consumption; changes inrange of knee flexion and an estimate of the volume of synovialeffusion. Functional grading was assessed according to the patients'ability to stand from the sitting position. Twenty-nine subjectsunderwent radiotherapy and 17 received physiotherapy. The resultsrevealed no significant differences between the treatment groups.     

NEW CONCEPTS OF CAUSE AND MANAGEMENT OF PAIN IN THE ELDERLY

Pain is a sensory and emotional experience and, as such, is always subjective. However, for many patients pain results from stimulation of nociceptors in the somatic structures. This nociceptive information is conveyed to the central nervous system by thinly myelinated and unmyelinated nerve fibres. Many unmyelinated fibres have polymodal nociceptors responsive to chemical as well as mechanical and thermal stimuli. These receptors also mediate neurogenic inflammation through the release of neuropeptides from the nerve terminals. The study of nociceptor and afferent nerve function in man, although in its infancy, suggests that it may be possible to assess the contribution of the peripheral nervous system to the total pain experience. One method Is to analyse the neurogenic inflammatory response of polymodal nociceptors in patients with different pain states. One hypothesis is that some treatment modalities may act to desensitize polymodal nociceptors. Some recent evidence for this view obtained in a sample of elderly patients with low back pain is presented.     

PAIN IN THE BACK AND LEG: A GENERAL PRACTICE SURVEY

Over a two-year period, the data on all patients in a generalpractice with back and leg pain were recorded in a standardizedway. Two broad categories were distinguished, those with low-backpain syndromes and those with back and leg pain syndromes. Withinthe former, four patterns of pain distribution could be identified,and the latter were sub-divided according to severity, history,and neurological involvement. History, clinical features, andoutcome correlated with these various types. The majority ofthese patients may be managed conservatively at home, only asmall proportion requiring referral for specialist advice ortreatment. It is suggested that the intervertebral disc canaccount for only a small proportion of these problems. ^* Based on a paper presented to a scientific meeting of theSociety for Back Pain Research at Bristol on 26th March 1976.