ASSESSMENT OF FLEXOR TENOSYNOVITIS IN RHEUMATOID ARTHRITIS

Assessment of the effect of therapy—physical, surgical,or local corticosteroid Injections—in the management ofrheumatoid flexor tenosynovitis has proved difficult. This paperdescribes a simple, accurate and reproducible method of documentationusing a photocopying technique. Its application to a study ofthe role of hydrocortisone injections in the management of flexortenosynovitis is presented.     

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.     

IDIOPATHIC PROTRUSIO ACETABULI IN JUVENILES

Eight children, aged 9 to 15, referred to a juvenile rheumatologyservice on account of un-diagnosed hip pain, were ultimatelyfound to have idiopathic protrusio acetabuli (IPA). Qinicaland radiographic findings were generally asymmetrical on presentation.Subsequent radiographs tended to lag behind a rapid deteriorationin six patients, four of whom required bilateral total hip replacementduring adolescence. Pain on full flexion and moderate adductorspasm in the contra-lateral hip proved a useful early sign forpredicting bilateral disease. Six of eight patients were hypermobile.In three of five families investigated, symptom-free IPA wasrevealed in one or more first degree relatives. Histology earlyin the course in two cases showed a non-diagnostic inflammatoryreaction in the sub-synovium.     

LEUCOGYROPHANA PINASTRI, A WOOD DECAY FUNGUS AS A PROBABLE CAUSEOF AN EXTRINSIC ALLERGIC ALVEOLITIS SYNDROME

Two patients were suspected of having extrinsic allergic alveolitis due to exposure to an agent in their home environment. On inspection of their houses, fungal decay was evident in the floorboards, and fungal spores were found deposited on many surfaces. The decay fungus was later identified as Leucogyrophana pinastri. Using an extract of the fruiting bodies and mycelium of this fungus, precipitating antibodies were identified in the sera of both patients. Based on the known exposure by the two patients to these small spores, the absence of a likely alternative allergen, the similarity between these two cases, and the positive precipitin test results, L pinastri was considered to be the most likely cause of extrinsic allergic alveolitis in our cases.