Palindromic rheumatism. Clinical and serum complement study.

A review of 39 patients diagnosed as suffering from palindromic rheumatism showed that 17 cases had evolved into typical rheumatoid arthritis (RA), while 22 had remained palindromic. The pattern of palindromic attacks in the two groups gave no grounds for regarding palindromic rheumatism as a separate condition from RA with palindromic onset. At the first attendance minor clinical or radiological changes, raised erythrocyte sedimentation rate, and positive serology were more common along those patients who were about to develop the picture of RA. Rheumatoid disease developing in patients with a palindromic onset was at least as severe as that among other patients with RA. 5 patients gave a history suggestive of fluid retention during the palindromic episodes, suggesting that attacks might be related to circulating immune complexes and altered vascular permeability. However, samples of blood obtained from 6 patients both during and between attacks showed no reduction in any of a variety of complement components tested.     

Comparison of the effects of alclofenac, flurbiprofen, and prednisolone on acute inflammatory response in the rat.

The fluid and cellular phases of the inflammatory response were measured using a technique employing subcutaneous implantation of polyurethane foam cubes impregnated with heat-killed Mycobacterium tuberculosis. Fluribiprofen and prednisolone were equipotent and were capable of almost completely suppressing fluid and cellular responses, while alclofenac was less potent at nontoxic dose levels. Study of the patterns of cellular exudation by image analysing computer showed that alcofenac appears unique in that it produces a well-defined cell-free zone between the edge of the implanted cubes and a band of neutrophil polymorphs within the cubes.     

Strain rate and mineral content in fracture models of bone

I reanalysed data from my previous work to determine the extent to which a model for the loading-rate dependence of the fracture of cortical bone, put forward by Carter and Caler, fits this independently derived data set. In particular, the extent to which the generality of the model is vitiated by its ignoring the effect of mineralisation on strength was tested. The model was rather strongly corroborated. In addition, the reanalysed data show that yield strain is strongly strain-rate dependent, but that Young's modulus is rather unvarying over physiological strain rates. The implications of this for hypotheses concerning fracture of bone are discussed.     

Serum cytidine deaminase levels after withdrawal of non-steroidal anti-inflammatory treatment in rheumatoid arthritis.

Increases in joint inflammation in nine patients with rheumatoid arthritis were provoked by withdrawal of their non-steroidal anti-inflammatory drugs. Pain score, duration of morning stiffness, Ritchie articular index score, and the number of analgesic tablets consumed reached peaks after five, three, five, and five days respectively compared with values during six days of normal treatment. Changes in serum cytidine deaminase (believed to reflect polymorph turnover in inflamed joints) showed a different pattern, with a sharp peak after two days and a subsequent trough. Possible mechanisms for these differences are discussed.     

Ultrasound has no anti-inflammatory effect.

The use of therapeutic ultrasound within the Health Service is widespread and growing. The most common indication is to reduce inflammation. We have tested the influence of ultrasound on a model of acute inflammation in the rat, and we have found a complete absence of any anti-inflammatory action.     

Sideroblastic anaemia with iron overload presenting as an arthropathy.

We report on 2 patients with sideroblastic anaemia an secondary iron overload whose presenting symptom was an arthropathy of small an large joints. One patient had marked spinal symptoms which were severe enough to suggest ankylosing spondylitis, and the pattern of arthritis in the other resembled seronegative rheumatoid arthritis. We believe these to be the first cases described of an arthropathy associated with iron overload secondary to sideroblastic anaemia.     

Total hip replacement in a patient with systemic mastocytosis: a case report

Systemic mastocytosis is a rare condition that often involves the bone marrow. We report the case of a patient with systemic mastocytosis who underwent total hip replacement. Technical difficulties encountered during the procedure included a narrow medullary canal and abnormally hard bone, later confirmed by laboratory measurements. Follow-up at five years showed a good clinical and radiological outcome.