Role of opticare eye drop delivery system in patients with rheumatoid arthritis.

OBJECTIVE: To investigate the prevalence of keratoconjunctivitis sicca in 340 patients with rheumatoid arthritis undergoing outpatient followup, and to assess their ability to use artificial tears, and the role of an aid to dispensing drops, the Opticare. METHODS: Initial questionnaire given to 340 patients based on preliminary criteria for classification of Sjögren's syndrome. Thirty symptomatic patients were invited to undergo objective and subjective assessment of the ability to instill artificial tears with and without the Opticare. RESULTS: One hundred twenty-seven (37%) patients had had symptoms lasting at least 3 months at some time, and 85 (25%) were currently symptomatic. Many patients found difficulty using artificial tears due to problems aiming and squeezing the bottles as a result of impaired upper limb function. The Opticare statistically significantly improved the ability to squeeze out drops and get them in the eye. CONCLUSION: The Opticare device allows patients with functional impairment of the upper limb to instill artificial tears, resulting in less wastage of tears and increased independence and compliance.

Radiological outcome in ankylosing spondylitis: use of the Stoke Ankylosing Spondylitis Spine Score (SASSS).

We investigated the role of the Stoke Ankylosing Spondylitis Spine Score (SASSS) in a longitudinal cohort study of 53 patients with AS, assessed 9 yr apart, and its relation to clinical, functional and laboratory measures of disease activity and outcome. We also examined the long-term predictive value of quantitative sacroiliac scintigraphy (QSS). SASSS correlated closely with clinical measures, including occiput-wall distance (OWD) (P < 0.001) and modified Schober (P < 0.001). QSS was significantly correlated with final X-ray score (P < 0.05). SASSS changed significantly (P < 0.001) over the study period; two patterns of change in spine score were discernible, one with little change in radiological score and the other showing marked progression. The SASSS is a useful, valid score, which correlates with clinical outcomes measures and which has identified specific patterns of radiographic progression in AS.

Smoking and outcome in ankylosing spondylitis.

In view of the recognised influence of smoking on the disease course of psoriasis and ulcerative colitis, and the association of these diseases with seronegative spondyloarthritis, we investigated a possible effect on outcome in ankylosing spondylitis. Thirtyone non-smokers, 12 exsmokers, and 10 smokers, with definite ankylosing spondylitis of a median duration of 20 years, were studied using clinical values (modified Schober, finger floor distance, total spinal movement), radiological (lumbar spine x-ray score), functional index, and laboratory assessment (ESR, CRP, Igs). There were statistically significant differences in the outcome between smokers and non-smokers for finger floor distance (p < 0.01), Schober test (p < 0.01), total spinal movement (p < 0.001), occiput-wall distance (p < 0.01), functional index (p < 0.01), stiffness (p < 0.01), and spine x-ray scores (p < 0.02). There was no statistically significant difference between the groups with regard to disease duration or age at onset. We conclude that smoking is associated with poor long term outcome in patients with ankylosing spondylitis.

Painful knees associated with a septic focus.

The association between gastrointestinal disorders and arthritis is well recognized. We describe a 54-yr-old man who presented with a seronegative oligoarthritis in whom the clinical picture was consistent with a hypertrophic osteoarthropathy. An occult septic focus was identified when a barium enema demonstrated a diverticular abscess, treatment of which led to a complete resolution of symptoms.

Role of prophylactic antibiotics in the prevention of late infection of prosthetic joints. Results of a questionnaire and review of the literature.

A postal survey has revealed wide variation in attitudes towards the need for prophylactic antibiotics in patients with implants who develop intercurrent infections, or who undergo surgical procedures. The available evidence is insufficient to reach any firm conclusions, however any patient who has an implant should receive swift treatment for intercurrent infections.

Prevention and management of steroid-induced osteoporosis.

Glucocorticoids were first used therapeutically in the late 1940s. While they have revolutionised the treatment of many diseases, they also have many side effects, including osteoporosis. Although osteoporosis has been recognised as an important complication since the first use of steroids, we are still a long way from understanding the pathophysiology of steroid-induced osteoporosis.

Career grade posts: do they work? Experience of a rheumatology rotation.

I describe the design and implementation of a new rotation for career grade registrars in rheumatology, and discuss what this implies for both trainers and trainees involved in such rotations. Some problems have occurred in relation to the geography of the rotation and in the choice of research projects undertaken during the rotation. I suggest possible solutions for these problems.