Acute synovial rupture in Behçet's syndrome

A patient with Behçet's disease presented with an acute synovial rupture of the knee that was initially diagnosed as a deep venous thrombosis.

Acute knee joint rupture--a report of two unusual cases

An acute rupture of the knee joint is a well recognized and documented condition. The symptoms and signs it produces have been described as the pseudothrombophlebitis syndrome and its importance in the differential diagnosis of calf pain is being increasingly recognized. We report two cases where the symptomatology has been unusual and stress the need for considering this condition in other atypical cases of leg pain which may not strictly conform in presentation to the pseudothrombophlebitis syndrome.

Trochanteric bursitis--a frequent cause of 'hip' pain in rheumatoid arthritis

One hundred consecutive patients with rheumatoid arthritis (RA) were examined for the presence of trochanteric bursitis. This condition was found in 15. Ten patients responded to a single local injection of corticosteroid and the remaining 5 to a second injection. Trochanteric bursitis is an underdiagnosed, easily remediable cause of pain in RA. Specific examination for in presence should be a routine in all patients with RA, especially those with hip pain.

Measurement of stiffness in the metacarpophalangeal joint: the arthrograph

A new type of finger arthrograph is described that evaluates the stiffness parameters of the metacarpophalangeal joint of the index finger at 10 degrees increments of flexion and extension. Stiffness is evaluated in terms of the energy loss per cycle (of amplitude 4 degrees), at every 10 degrees interval from 4 degrees to 94 degrees of flexion and by the mid-position torque and the mean slope of the least-squares fitted line through the graph of resistive torque against angular displacement. The instrument is simple to use, quick and comfortable for the patient, and gives reproducible results.

Coexistent rheumatoid arthritis and tophaceous gout: a case report

Rheumatoid arthritis and gout are both common rheumatic diseases, but their coincidence is rare. We report the case of a 67-year-old Caucasian woman with rheumatoid arthritis who later developed tophaceous gout. The tophi disappeared with remarkable rapidity on treatment with allopurinol.

Stiffness in the metacarpo-phalangeal joints of young adults

A simple design of arthrograph is described and used to study the stiffness of the metacarpo-phalangeal joints of 55 subjects between the ages of 18 and 25. The apparatus and experimental technique produced results which were repeatable to within four percent. Results obtained when the tests were conducted at different angles of flexion showed that the direction of approach to the angle of flexion was important. For example, if the same angular position were approached first from a greater angle of flexion and then from a smaller angle of flexion, the resulting measured resistive torques were different. However, the two different values were repeatable and not dependent on the order of testing. Stress relaxation of the soft tissues surrounding the joint was observed while the variation in the equilibrium position (resting angle of flexion) was seen to be from 16 to 44 deg (mean 33.2). Stiffness was strongly correlated with subject mass and weakly correlated with wrist circumference. Women exhibited lower joint stiffness than mean but some of this difference may be due to their lower body mass.

Human joint performance and the roughness of articular cartilage

It is known that the surface of articular cartilage is rough and it has been suggested that this is likely to affect the lubrication of human joints. This paper describes the direct measurement of a cartilage surface with a stylus instrument. It is found that the height distribution is Gaussian with an inverse-square power spectrum. It is thus possible to calculate the elastic deflection of the surface under normal walking loads and it is shown that the mean separation of the cartilage surfaces in a human joint varies rather slowly with load. In one particular hip joint at heel strike the real area of contact was calculated to be about 1.3 cm2, the mean gap to be about 60 micrometers and the trapped volume to be about 80 percent of that when standing.

Night medication in rheumatoid arthritis. III. the use of sulindac

A double-blind controlled trial was carried out in 18 in-patients with classical or definite rheumatoid arthritis to assess the effectiveness of night-time medication with 100 mg indomethacin plus 10 mg diazepam, 200 mg sulindac, and 200 mg sulindac plus 10 mg diazepam in improving sleep and reducing night pain and the duration of morning stiffness. Patients received each treatment regimen for 1 night. The results from the 17 patients completing the full trial protocol indicated that indomethacin plus diazepam was the most effective of the three regimens, although the differences did not reach conventional statistical significance. It is suggested that in further such studies with sulindac a larger dose and a longer duration of treatment should be used.

Night medication in rheumatoid arthritis: II. Combined therapy with indomethacin and diazepam

Seventeen of eighteen patients hospitalized for active rheumatoid arthritis completed a three-day randomized, double-blind comparison of 100 mg indomethacin, 100 mg indomethacin with 10 mg diazepam and matching placebo as night medication. The results showed a consistent pattern in the four functions measured--pain, morning stiffness, sleep score and patient preference. In each, indomethacin proved superior to placebo and the combined therapy better than indomethacin alone. From this it has been concluded that the combination of indomethacin and diazepam should now be considered the treatment of choice for maximum control of night pain and morning stiffness in rheumatoid arthritis.

The effects of antacids on enteric-coated salicylate preparations

A volunteer study was undertaken in which the effect of the co-administration of therapeutic doses of aluminium hydroxide and magnesium trisilicate on the excretion of aspirin derived from enteric-coated preparations was studied. A significant alteration in the pattern of salicylate excretion was seen, but the mechanism of the interaction cannot be deduced from the present study. It was concluded that the interaction was of potential therapeutic importance, and further studies based on this pilot investigation have been initiated.

Night medication in rheumatoid arthritis

The efficacy of indomethacin 100 mg, diazepam 10 mg, and placebo in producing sleep, relieving night pain, and reducing the severity of morning stiffness, was compared in 18 patients in hospital with active classical or definite rheumatoid arthritis.There was no statistically significant difference in the preference of patients or sleep score among the three forms of treatment. Both indomethacin and diazepam were more effective than placebo in relieving night pain. Indomethacin decreased, but diazepam increased, morning stiffness in comparison to placebo. Neither active therapy produced significant side-effects.

Some studies of feprazone

Feprazone, 200 mg t.d.s., was compared with indomethacin, 25 mg t.d.s. rising to 50 mg t.d.s., in an eight-week double-blind cross-over study in twenty-three patients with active rheumatoid arthritis. Both therapies proved equally efficacious and acceptable. Measurement of the plasma levels of the two drugs showed no consistent correlation between efficacy and plasma concentrations.