The association of pain and stiffness with fatigue in incident polymyalgia rheumatica: baseline results from the polymyalgia rheumatica cohort study.

We aimed to examine the association between pain, stiffness and fatigue in newly diagnosed polymyalgia rheumatica (PMR) patients using baseline data from a prospective cohort study. Fatigue is a known, but often ignored symptom of PMR. Newly diagnosed PMR patients were recruited from general practice and mailed a baseline questionnaire. This included a numerical rating scale for pain and stiffness severity, manikins identifying locations of pain and stiffness and the FACIT-Fatigue questionnaire. A total of 652 PMR patients responded (88.5%). The mean age of responders was 72.6 years (SD 9.0) and the majority were female (62.0%). Manikin data demonstrated that bilateral shoulder and hip pain and stiffness were common. The mean fatigue score (FACIT) was 33.9 (SD 12.4). Adjusted regression analysis demonstrated that a higher number of pain sites (23-44 sites) and higher pain and stiffness severity were associated with greater levels of fatigue. In newly diagnosed PMR patients, fatigue was associated with PMR symptom severity.

Association between characteristics of pain and stiffness and the functional status of patients with incident polymyalgia rheumatica from primary care.

This paper aims to examine the relationship between different characteristics of pain and stiffness and the functional status of patients with newly diagnosed polymyalgia rheumatica (PMR). Baseline analysis of an inception cohort study was conducted. Patients aged ≥18 years, with a new diagnosis of PMR were recruited from 382 English general practices. Participants were mailed a baseline questionnaire, including separate pain and stiffness manikins and numerical rating scales (NRS), a question on their ability to raise their arms above their head and the modified Health Assessment Questionnaire (mHAQ) to examine participants' functional status. Linear regression analysis, reported as regression co-efficients (95% confidence intervals (95% CI)), was used to assess the association of pain and stiffness with function, initially unadjusted and then adjusted for age, gender, deprivation status, smoking status, BMI, anxiety and depression. Six hundred fifty two patients responded to the baseline survey (88.5%). The majority (88.2%) reported no, or mild impairment in their functional status. Adjusted linear regression analysis demonstrated that high (NRS ≥8) pain (0.20 (95% CI 0.10-0.28)) or stiffness (0.18 (0.09-0.26)) ratings, an increasing number of sites of pain (0.18 (0.06-0.29)) or stiffness (0.19 (0.08-0.31)) and shoulder pain (0.18 (0.05-0.31)), stiffness (0.10 (0.01-0.20)) and difficulty raising arms above one's head (0.19 (0.10-0.28)) were all associated with increased functional impairment. The majority of newly diagnosed PMR patients reported no or minimal functional difficulty. However, those who experience severe or widespread pain or stiffness often have significant functional limitation in performing their daily activities and may be a subset worthy of additional focus in primary care.

Chemiluminometric determination of ascorbic acid in pharmaceutical formulations exploiting photo-activation of GSH-capped CdTe quantum dots.

An automated multi-pumping flow system is proposed for the chemiluminometric determination of ascorbic acid in pharmaceutical formulations, relying on the ability of semiconductor nanocrystals to generate short-lived reactive species upon photo-irradiation. A photo-unit based on visible-light-emitting diodes is used to photo-excite cadmium telluride (CdTe) quantum dots capped with glutathione, leading to the generation of radicals that react with luminol under alkaline conditions, yielding the chemiluminescence. Ascorbic acid acts as a radical scavenger, preventing the oxidation of luminol, thus ensuring a concentration-dependent chemiluminescence quenching. After system optimization, a linear working range of 5.0 × 10(-7) to 5.0 × 10(-6) mol/L ascorbic acid (r = 0.9967, n = 5) was attained, with a detection limit of 3.05 × 10(-7) mol/L and a sampling rate of 200/h. The flow system was applied to the analysis of pharmaceutical formulations and the results were in good agreement with those obtained by the reference titrimetric procedure (RD < ± 4.3%, n = 7).

Influence of chronic diseases on long-term change in physical health: a consultation-survey linkage cohort study in general practice.

PURPOSE: To investigate the influence of disease severity within cardiovascular disease (CVD) and musculoskeletal (MSK) disorder spectrums on physical health change over 3 years. METHODS: Consultation records of 4,672 patients aged 50 years and above from six general practices were linked to their baseline and 3-year Short-Form-12 (SF-12) physical component summary (PCS) scores. Associations between exclusive diagnostic categories and comorbid counts with physical health change over 3 years were examined. RESULTS: There were 1,371 (29.3%) CVD and 1,972 (42.2%) MSK consulters. Adjusted additional change in PCS scores relative to hypertension ranged from -0.43 (95% confidence interval -2.5, 1.7) for atrial fibrillation to -2.09 (-4.2, 0.0) for heart failure. In the MSK spectrum, changes relative to soft tissue disorder ranged from -0.63 (-3.0, 1.8) for soft tissue pain to -1.09 (-4.1, 2.0) for inflammatory polyarthropathy. A trend in association between increasing disease severity and deterioration in physical health was only observed within the CVD spectrum, and this trend was retained in those with CVD and higher levels of comorbidity. CONCLUSIONS: CVD severity with higher levels of comorbidity was associated with greater relative deterioration in long-term physical health. Such findings were not found for the MSK cohorts, suggesting the differing health impact of different chronic diseases.

Isoniazid-induced fever.

A 56-year-old man was started on therapy with isoniazid after exhibiting a positive reaction to an intradermal injection of intermediate-strength purified protein derivative of tuberculin. After the first dose and each of the following three doses, nausea, vomiting, chills, and an elevated body temperature ranging from 38 degrees C (100.4 degrees F) to 40 degrees C (104. degrees F) occurred. There was no evidence of a hypersensitivity reaction to isoniazid, such as cutaneous rash, eosinophilia, elevated concentration of IgE, and abnormal results on tests of hepatic function. Following discontinuance of therapy with isoniazid, the temperature returned to normal. This experience illustrates the potential of isoniazid to cause febrile reactions, a situation that could be misdiagnosed as an infectious process.