Salicylate toxicity in elderly patients with rheumatoid arthritis.

Using the American Rheumatism Association Medical Information System, we studied the effect of age upon salicylate toxicity in elderly patients with rheumatoid arthritis. Data were gathered from 545 patients by self-reported questionnaires for the 6 months and also the 7 days before the visit of interest. With one week data and weight adjusted doses in 253 patients in whom data were available, age related differences in lower gastrointestinal symptoms (p = 0.05) and tinnitus (p = 0.01) were found, despite the fact that elderly patients (E) took less salicylate than younger ones (y)--E [39.1 +/- 2.4 (SD) mg/kg/day] vs Y [49.8 +/- 3.89 mg/kg/day] (p = 0.02). Our data indicate a difference in salicylate dynamics among the elderly (i.e., increased toxicity in the face of decreased salicylate doses).

Reiter's syndrome: chronicity of symptoms and employment.

To assess the chronicity of symptoms and long term prospects for employment in patients with Reiter's syndrome, a follow-up study of 111 patients was performed. Ninety-eight patients were available for follow-up; these had a mean disease duration of 7.9 years (range two months to 39 years). At follow-up, 55 patients had symptomatic joints and 26 objective evidence of synovitis, but only seven had chronic joint deformity. Seven patients fulfilled criteria for ankylosing spondylitis. Ninety-three patients were in functional class I or II, 86 patients were working, 26 had changed employment, and 11 were unemployed because of the disease. No prognostic features of value were identified. The tissue antigen HLA B27 was associated significantly with anterior uveitis and radiological sacroiliitis.

Clinical features of meningococcal arthritis: a report of four cases.

Four patients with Neisseria meningitidis infection complicated by arthritis are described. Three patients had an acute polyarthritis which responded quickly to antimicrobial therapy. A fourth patient developed a prolonged arthritis which occurred after the initial infection had been successfully treated. Tenosynovitis occurred as a complication in one case. Attention is drawn to possible confusion with gonococcal infection, and postulated pathological mechanisms are discussed.

The functional significance of sacroiliitis and ankylosing spondylitis in Reiter's syndrome.

The frequent development of sacroiliitis and ankylosing spondylitis (AS) in patients suffering from Reiter's Syndrome (RS) has been stressed by a number of authors. This study was designed to ascertain the frequency of these problems in our RS patients, whether they were related to other clinical features of RS and what was the extent of the resulting disability. Fifty-five patients (50 men and 5 women) with RS with a mean duration of 9.3 years were assessed radiologically to determine the prevalence of sacroiliitis and thoracolumbar syndesmophyte formation. These radiological findings were correlated with HLA-B27, clinical features and functional status. Sacroiliitis was found in 22 patients (40%) but was mild in severity, frequently asymmetrical and very rarely associated with syndesmophyte formation. Sacroiliitis occurred significantly more commonly in patients with iritis and/or a prolonged disease duration (p less than 0.05) but although it was also found more frequently in HLA-B27 positive patients this was not significant (0.1 greater than p greater than 0.05). Some restriction in back movement was observed in 31 patients (56.3%) but only two patients satisfied New York criteria for AS and just one was functionally impaired by his back disease. Although the frequent finding of sacroiliitis in RS may provide an interesting insight into the interrelationship between RS and AS, our study shows that this sacroiliitis is commonly asymptomatic and does not provide a problem in management.

Use of the HLA B27 test in Auckland.

An assessment was made of the probability of HLA B27 associated disease in 74 patients who had recently been tested. Six patients had definite, 31 possible, and 37 very unlikely HLA B27 associated disease. Thirteen patients were HLA B27 positive. Fourteen tests were ordered by rheumatologists (43% HLA B27 + ve) and 60 by other doctors (12% HLA B27 + ve) p less than 0.01. Non-rheumatologists ordered an excessive number of tests in patients with a low probability of HLA B27 associated disease.

Employment in ankylosing spondylitis.

All patients with ankylosing spondylitis attending our rheumatology clinics were reviewed to assess the effect of their disease on employment. Back movement was measured in three planes, chest expansion determined, and peripheral joint involvement was noted to see whether these correlated with work capability. Sixty patients were reviewed (47 men, 13 women; mean disease duration 24.3 years). Nine were unemployed, but only four of these attributed this condition to ankylosing spondylitis. Although all four had severe neck, back, and hip involvement, this did not differentiate them from other patients who were fully employed. There was no relationship between disease duration and employment. The prospect for continued employment in ankylosing spondylitis is good even when the disease is long standing and severe.

Ethnic difference in the prevalence of systemic lupus erythematosus.

A retrospective study of systemic lupus erythematosus (SLE) was carried out in Auckland, New Zealand, for the years 1975 to 1980 inclusive. One hundred and fifty-one patients were found of which 106 fulfilled the American Rheumatism Association criteria. There were 15 deaths. Age-adjusted prevalence rates per 100 000 were estimated for all cases at the end of 1980 as follows: white 14.6, Polynesian 50.63, and other 19.11. There was a preponderance of females in each ethnic group, average 87% of all cases. Age-adjustment mortality rates per million patient years were: white 2.5 and Polynesians 13.0. Survival curves for both ethnic groups were similar. The prevalence rate in New Zealand Polynesian is significantly higher than in white counterparts which confirms the observation that the disease is commoner in the pigmented races.

Perna canaliculus in the treatment of rheumatoid arthritis.

Freeze-dried extracts of the New Zealand green lipped mussel, Perna canaliculus, have been promoted extensively as a treatment for rheumatoid arthritis for some years though there have been few published trials of its effectiveness. Our study was designed to test the ability of the mussel extract to relieve the symptoms of rheumatoid arthritis as both a supplement and an alternative to orthodox anti-inflammatory medication.

Ribonucleoprotein antibodies, polyarthritis and metastatic squamous cell carcinoma of the bronchus.

A 62-year-old woman presented with seronegative polyarthritis four months before she was found to have squamous cell carcinoma of the bronchus with widespread metastases. Unexpectedly, high titre speckled antinuclear antibodies with antibody to ribonucleoprotein were found.

Immunological mechanism for spontaneous abortion in systemic lupus erythematosus.

The incidence of lymphocytotoxic antibodies in patients with systemic lupus erythematosus (S.L.E.) was significantly lower during pregnancies ending in normal live births than in pregnancies ending in spontaneous abortions (P less than 0.005). It was possible to absorb the lymphocytotoxic antibodies from S.L.E. sera with purified trophoblast antigens. The presence of a trophoblast-reactive lymphocytotoxic antibody which fails to disappear during pregnancies which end in abortion suggests an immunological mechanism for spontaneous abortion in S.L.E.

Intravenous diazoxide in treatment of hypertension associated with recent myocardial infarction.

Twenty patients with blood pressure over 180/110 mm Hg one hour after admission to a coronary care unit with recent acute myocardial infarction were given intravenous diazoxide in a bolus of 300 mg. The average blood pressure before diazoxide was 194/122 mm Hg. Blood pressure fell considerably in all patients, though six patients required two injections. The average fall was 58 mm Hg systolic and 40 mm Hg diastolic. No patient became severely hypotensive. The heart rate increased by an average of 10 beats/min. In nine patients the electrocardiographic changes immediately after the administration of diazoxide suggested an increase in myocardial injury. Though none of the patients seemed to deteriorate clinically from the diazoxide the electrocardiographic changes suggested that the use of intravenous diazoxide to lower blood pressure in patients with acute myocardial infarction might possibly be deleterious.

The physician-specialist in Western Samoa.

An analysis of the work content of the physician-specialist at Apia General Hospital, Western Samoa, over a 12-month period in 1973-74 is described. Respiratory infections, rheumatic heart disease, hypertension, diabetes, peptic ulcer, and various forms of liver disease were encountered most commonly.