NSAID-induced gastrointestinal damage. Epidemiology, risk and prevention, with an evaluation of the role of misoprostol. An Asia-Pacific perspective and consensus.

The problem of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity was reviewed by members of the Asia Pacific League of Associations for Rheumatology (APLAR) in a consensus conference in September 1992. This paper by the participants presents the consensus conclusions incorporating knowledge from recent publications. There had been a high level of concern that much of the toxicity had resulted from extensive and indiscriminate prescribing of NSAIDs. The implementation of evidence-based guidelines was considered likely to be able to effect a substantial reduction in toxicity without significant loss of overall therapeutic benefit. The evidence from which such guidelines could be developed is critically appraised.

Naproxen in the treatment of rheumatoid arthritis.

Naproxen, a new nonsteroidal anti-inflammatory analgesic drug was found to be better than placebo and as effective as indomethacin in the treatment of rheumatoid arthritis. The drug was well tolerated, and appears to be a useful alternative to more established medication such as aspirin.

Genetic predisposition to two rheumatic diseases.

The co-existence of ankylosing spondylitis and rheumatoid arthritis is uncommon and usually occurs in a male with a long history of back pain followed by the appearance of clinical features of ankylosing spondylitis, while features of rheumatoid arthritis develop in the third or fourth decade of life. Recently, histocompatibility (HLA) antigens have partially elucidated the genetic factors predisposing to both diseases. We report a patient with ankylosing spondylitis and rheumatoid arthritis who had the associated HLA genes.

Body image in rheumatoid arthritis: the relevance of hand appearance to desire for surgery.

To investigate the importance of body image concerns relating to hand appearance in rheumatoid arthritis, a questionnaire was devised and administered to 80 female out-patients. Subjective judgements of hand attractiveness, feelings about hands, and behaviours relating to hand adornment and concealment were sought. Objective ratings of hand attractiveness were obtained from photographs taken at this time of the women's hands. Factor analysis indicated four principal orthogonal factors describe these body image items. Evaluative and affective elements were found to be independent of each other. The hypothesis that body image, thus rated, is relevant to desire for reparative hand surgery was tested using a two-stage general linear modelling procedure. Body image concerns, particularly negative feelings about hands, emerged as significant predictors of desire for surgery, and remained significant after the removal of variance accounted for by duration of arthritis, age, grip strength and objectively rated hand attractiveness. It is suggested that in rheumatoid arthritis, self-perception of hands and the associated emotional response, may be a covert agenda in women's decision to have surgery, and need specific clinical consideration.

Metastatic malignancy associated with reflex sympathetic dystrophy.

A patient who presented with reflex sympathetic dystrophy of the foot is described. Biopsy confirmed metastases of the small bones which at postmortem proved to be from carcinoma of the lung.