Stimulated eccrine gland function in primary Sjögren's syndrome

Sweat secretion rate, stimulated by iontophoresis of pilocarpine, was measured in 22 patients with primary Sjögren's syndrome and 22 age- and sex-matched normal control subjects. There was no significant difference in measured sweat rates (P = 0.45). We conclude that the complaint of dryness of the skin in patients with Sjögren's syndrome is not due to decreased eccrine gland secretion.

A study of headaches and migraine in Sjögren's syndrome and other rheumatic disorders

Migraine occurs with increased frequency in patients with systemic lupus erythematosus and in subjects suffering from Raynaud's phenomenon without any underlying connective tissue disorders. A possible link between migraine and Raynaud's phenomenon has been suggested. Two rheumatic conditions where Raynaud's phenomenon occurs very commonly are scleroderma and primary Sjögren's syndrome. It is possible that migraine is also common in these disorders but has been unrecognised. Therefore, the prevalence of migraine was assessed by a questionnaire in 191 subjects suffering from various connective tissue disorders and control subjects. Migraine was diagnosed in 16/35 (46%) patients with primary Sjögren's syndrome, 31/97 (32%) patients with scleroderma, 4/33 (12%) patients with rheumatoid arthritis/Sjögren's syndrome compared with 3/26 (11%) control subjects. A family history of headaches was more common in the patient groups than controls. There was a significant association between occurrence of Raynaud's phenomenon and migraine. Small vessel pathology may underlie both migraine and Raynaud's phenomenon in these connective tissue disorders--as has been suggested in systemic lupus erythematosus. The findings stress the need to ask specifically about complaints of headaches/migraines in patients with scleroderma and primary Sjögren's syndrome for the appropriate total management of these patients.

Alpha 1 antitrypsin (PI) phenotypes in two rheumatic diseases: a reappraisal of the association of PI subtypes in rheumatoid arthritis

alpha 1 Antitrypsin phenotypes were determined by isoelectric focusing in 225 adult white patients with rheumatoid arthritis (RA), 60 patients with severe rheumatoid arthritis (grade III and IV), 17 sibling pairs--HLA identical but discordant for rheumatoid arthritis, and 122 random patients with Sjögren's syndrome. No significant increase in non-M phenotypes was found in either of the groups of patients with RA, but the association between M subvariants was striking. There was a significant increase in M1M2 phenotype and M2 allotype in both the RA and severe RA groups. This increase in M1M2 was also supported by DR4 positive patients with RA compared with DR4 positive siblings without RA. No apparent association of variant phenotype was found in four subgroups of patients with Sjögren's syndrome.

Genetic markers in Sjögren's syndrome: the question of its genetic heterogeneity

Genetic factors may be implicated in the causation of Sjögren's syndrome (SS) as shown by familial clustering of the disease and certain HLA associations. Non-HLA genetic markers in SS have not previously been studied in detail. In this study of 122 unrelated patients with various categories of SS and 104 control subjects, 29 genetic markers were studied (11 blood groups, 5 serum proteins and 13 red-cell enzymes). Almost all systems showed a considerable range of gene frequency among the various subgroups of patients with SS but only a few attained statistical significance (C3 and GPT). Multivariate (kinship) analysis, however, showed clear distinction between the subgroups of SS, suggesting that they are genetically distinct entities.

Multicentre double-blind comparison of sustained action formulations of tiaprofenic acid and indomethacin in osteoarthritis

In a randomised double-blind, multicentre, crossover study, the short term efficacy and tolerance of a sustained action preparation of tiaprofenic acid 600 mg once daily was compared with sustained release indomethacin 75 mg once daily in 98 patients with osteoarthritis. After a minimum washout period of 3 days, patients were randomly allocated to receive each treatment in turn for a period of 4 weeks. There were no significant differences between the 2 treatments in the clinical assessments of pain level, duration of morning stiffness, articular index and functional impairment performed at the end of each treatment period. High pain levels on movement were reduced by both treatments, and reduction was also seen in night pain, where initial levels were lower. There was no significant difference between the number of patients who reported side effects on the 2 treatments. 37 patients (39%) reported 49 side effects while taking sustained release tiaprofenic acid, and 35 patients (37%) reported 53 side effects while taking sustained release indomethacin. Daily diary cards showed that both treatments provided improvements in duration of morning stiffness and in pain relief. Thus sustained action tiaprofenic acid and sustained release indomethacin were shown to be equally well tolerated and efficacious.

Association of limited joint mobility with Dupuytren's contracture in diabetes mellitus

Limited joint mobility is a relatively recent addition to the list of other well known rheumatic disorders that may be associated with diabetes mellitus. In our study of 109 patients with diabetes, a higher prevalence of Dupuytren's contracture was found compared to nondiabetic subjects, but the difference was not statistically significant (p less than 0.1). An association between limited joint mobility and Dupuytren's contracture was shown. Patients with diabetes with Dupuytren's contracture showed no difference compared to those without Dupuytren's contracture with regard to sex, insulin dosage, metabolic control and presence of shoulder capsulitis. Limited joint mobility and Dupuytren's contracture may be associated with retinopathy.

Use of simple analgesics in the treatment of ankylosing spondylitis

The role played by simple analgesics in the treatment of ankylosing spondylitis (AS) is not clear. A questionnaire survey of AS patients and rheumatologists revealed that a majority (78%) of patients took NSAIDs and a substantial proportion (34%) took simple analgesics. A majority of rheumatologists (65%) considered simple analgesics worth prescribing for AS patients. Rheumatologists tended to prescribe NSAIDs more often initially than simple analgesics while the reverse was true for general practitioners. Over half the patients (57%) considered pain relief as their first priority for drug treatment. Other objectives such as prevention of deformities and relief of stiffness were less important. A sizeable proportion of patients (15%) bought over-the-counter drugs. Prescribing habits of doctors can be improved by listing over-the-counter drugs in the British National Formulary and Data Sheet Compendium.

Salivary amylase and pancreatic enzymes in Sjögren's syndrome

Concentrations of immunoreactive trypsin (IRT) and pancreatic and salivary amylase activities were measured in 22 patients with primary Sjögren's syndrome (SS) and in 13 patients with secondary SS. Nineteen of the 22 patients with primary SS had above-normal IRT, and six had above-normal pancreatic isoamylase activity. Six of the 13 patients with secondary SS had above-normal IRT; none had above-normal isoamylase activities. Serum IRT and pancreatic isoamylase were correlated significantly (r = 0.7; p less than 0.0001). Above-normal values for IRT and pancreatic isoamylase were more frequent in patients who had SS for longer than 10 years, but were not related to the presence of salivary gland autoantibodies or to salivary isoamylase activity. We conclude that the concentration and activity of pancreatic enzymes are frequently abnormal in SS; that the abnormality is greater and more frequent in patients with primary SS; and that it increases with the duration of the disease.

Salivary amylase and pancreatic enzymes in Sjögren's syndrome

Concentrations of immunoreactive trypsin (IRT) and pancreatic and salivary amylase activities were measured in 22 patients with primary Sjögren's syndrome (SS) and in 13 patients with secondary SS. Nineteen of the 22 patients with primary SS had above-normal IRT, and six had above-normal pancreatic isoamylase activity. Six of the 13 patients with secondary SS had above-normal IRT; none had above-normal isoamylase activities. Serum IRT and pancreatic isoamylase were correlated significantly (r = 0.7; p less than 0.0001). Above-normal values for IRT and pancreatic isoamylase were more frequent in patients who had SS for longer than 10 years, but were not related to the presence of salivary gland autoantibodies or to salivary isoamylase activity. We conclude that the concentration and activity of pancreatic enzymes are frequently abnormal in SS; that the abnormality is greater and more frequent in patients with primary SS; and that it increases with the duration of the disease.

Bf and C3 polymorphisms in rheumatoid arthritis

Properdin factor B (Bf) and complement C3 polymorphisms were studied in 225 unrelated rheumatoid arthritis (RA) patients from North-East England. Patients were subdivided on the presence or absence of significant titres of rheumatoid factor and antinuclear factor. No association with the C3 system was detected. For the Bf system, a significant excess of Bf SS and deficiency of Bf FS phenotypes was observed in seropositive RA patients lacking antinuclear antibodies. This finding suggests that auto-antibody-defined subgroups of RA may be genetically heterogeneous with respect to Bf and confirms the status of Bf SS phenotype as a marker for RA susceptibility and/or severity.

Genetic structure of the population with rheumatoid arthritis in north east England: a genetic approach to define different subtypes

Clinically and immunologically rheumatoid arthritis (RA) is possibly a heterogeneous disorder. Despite numerous efforts clearer definition of this heterogeneity has been of limited success. Measurements of rheumatoid factor (RF) and antinuclear antibodies (ANA) by conventional methods define subpopulations of patients with RA and in a few recent studies an association of human leucocyte antigens (HLA) undoubtedly indicates the immunogenetic differences in the susceptibility of RA patients with different status of autoantibodies. The studies on a few isolated non-HLA genetic markers in RA are controversial. To understand the role of genetic factors in susceptibility 24 single gene characters other than HLA were investigated in 225 patients with RA classified by humoral status (presence or absence of RF and ANA) into three groups and in 104 healthy control individuals from the north east of England. Locus by locus comparison suggested associations of MN, Lewis, and Bf system with RF positive patients. Although the associations with MN and Lewis blood groups require further investigations, the involvement of the Bf locus is in agreement with the immunological component of the disease suggested by HLA associations and it could be due to the phenomenon of linkage disequilibrium. Measures of genetic distance applied to the subpopulations of patients with RA, divided according to the presence or absence of humoral factors, suggest that RF+ ANA+, RF- ANA-, and RF+ ANA- subgroups are distinct genetic diseases, each affecting a different subsection of the population which is genetically distinct. Such genetic heterogeneity may suggest a different pathogenetic mechanism for each of these subpopulations of rheumatoid arthritis.

A controlled trial of continuous lumbar traction in the treatment of back pain and sciatica

A controlled trial of continuous lumbar traction in the treatment of back pain and sciatica showed similar improvements in both the treated group (weighted traction) and the control group (simulated traction). The findings of this study question the justification of admitting patients with back pain into hospitals for purposes of traction alone.

Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus

Limited joint mobility and shoulder capsulitis were evaluated in 109 consecutive diabetic patients attending an out-patient diabetic clinic. Forty-nine had insulin-dependent diabetes mellitus (IDDM) and 60 had non-insulin-dependent diabetes mellitus (NIDDM). Seventy-five normal subjects were also examined. Limitation of joint mobility was detected in 24 (49%) patients with IDDM and in 31 (52%) patients with NIDDM but in only 17 (20%) normal subjects (p less than 0.001). There were no significant differences between diabetic patients with and without joint limitation with regard to age, sex, type of DM, mean daily insulin dosage and overall diabetic control as assessed by estimation of glycosylated haemoglobin concentration. However, patients with impaired joint mobility had a longer duration of diabetes (p = 0.01) and a significantly increased frequency of retinopathy compared to patients without joint limitation (p less than 0.05). Normal subjects with restricted joint mobility were older than those without restriction (p = 0.05). Shoulder capsulitis was present in 19% of patients with diabetes mellitus and 5% of normal subjects. However, there was no significant association between limited joint mobility and shoulder capsulitis in the diabetics.