Sequelae of moderate finger frostbite as assessed by subjective sensations, clinical signs, and thermophysiological responses.

The aim of the study was to investigate prevalence and qualities of sequelae following moderate finger frostbite. The study material comprised 30 subjects, who had suffered second-degree frostbite (73% contact frostbite) 4-11 years before this study. In clinical tests 66% of the subjects had an elevated tendency for vasospasm, yet only 20% suffered from white fingers. However, no marked traces of frostbite-related alterations were observed in systemic cardiovascular reflex tests or in X-ray examinations of the frostbite area. Subjective assessments revealed a high prevalence of sequelae (63%), although the primary frostbite was moderate and local. The sequelae in the frostbite area included hypersensitivity to cold (53%), numbness of fingers (40%), and declined sensitivity of touch (33%). Also working ability was lowered due to frostbite sequelae (13%). In cold air provocation tests, the skin temperature of the frostbitten areas decreased more quickly and reached lower values than in healthy control subjects. In conclusion the suffered frostbite was associated with an increased tendency for vasospasm. Subjective sensations of the frostbitten area were associated with thermophysiological changes. The sequelae were reported to worsen in the cold environment thus emphasizing the probable occupational limitations of even moderate cold injury.

Bone mineral density evaluated by dual-energy X-ray absorptiometry after one-year treatment with calcitriol started in the predialysis phase of chronic renal failure.

Thirteen patients in the predialysis phase of chronic renal failure (CRF) were treated with calcitriol (0.25 micrograms/day) and 12 with placebo. After 1 year of study, an increase in bone mineral density in the calcitriol group measured by dual-energy X-ray absorptiometry was seen for the femoral neck and lumbar spine when compared to the placebo group (p < 0.001 and p < 0.01, respectively). We conclude that a steady low dose of calcitriol started in the predialysis phase of CRF is beneficial to the patients with CRF. This may be partly due to suppression of secondary hyperparathyroidism.

Joint impairment is strongly correlated with disability measured by self-report questionnaires. Functional status assessment of individuals with rheumatoid arthritis in a population based series.

OBJECTIVE: To determine how well self-report functional ability reflects the impairment due to the arthritic process in rheumatoid arthritis (RA) and how much it is affected by other factors of health status. METHODS: We examined the relationships between self-report measures such as the Health Assessment Questionnaire (HAQ) and Arthritis Impact Measurement Scales (AIMS) and measures of impairment such as the Keitel function test (KFT), which is intended to reflect the degree of functional limitation of the joints, grip strength and radiological destruction as well as anxiety and depression in a population-based series of RA. RESULTS: First, the HAQ and AIMS had a high correlation coefficient (r = 0.89, p < 0.0001). Second, the above measures of impairment were more significant predictors of self-report functional measures than, for example, mental health perceptions. The AIMS scales also correlated well with the corresponding physical function of the KFT. CONCLUSION: Patients' self-report functional ability in RA reflects their physical impairment due to the arthritic joint disease and is less influenced by other factors such as emotional adjustment.

Increased type I collagen degradation correlates with disease severity in rheumatoid arthritis.

OBJECTIVES: To assess the extent and clinical significance of type I collagen degradation in rheumatoid arthritis (RA). METHODS: Serum samples from 90 consecutive patients with RA from a cross-sectional population based study and 90 age- and sex-matched controls were analysed with the new assay of cross-linked carboxyterminal telopeptide of type I collagen (ICTP). RESULTS: Patients with RA had significantly higher concentrations of ICTP than the controls. ICTP correlated strongly with measures of impairment in RA, such as the erosive state of joint disease (ES) (r = 0.57, p < 0.001) and Keitel function test (KFT) (r = 0.49, p < 0.001), and more weakly with various disease activity markers. When erythrocyte sedimentation rate (ESR), ES or KFT were used as indicators of disease severity among the patients with disease duration over five years, ICTP distinguished the more serious RA from milder cases. CONCLUSIONS: Elevated serum concentrations of ICTP are common in RA and are associated with signs of aggressive disease.

Low incidence of osteoporosis in a two year follow-up of early community based patients with rheumatoid arthritis.

52 patients with early rheumatoid arthritis (RA) were followed with regular measurements of bone mineral density (BMD) and serum markers of type I collagen metabolism in order to determine whether they develop osteoporosis during the first two years of the disease course and if the changes in type I collagen metabolites reflect the alterations in BMD. The mean percentage BMD change over the first year of follow-up was -0.91 for lumbar spine (LS) and -0.76 for femoral neck (FN); the corresponding figures from 0 to 24 months was -1.3 and -0.8, respectively. During the follow-up, only five patients developed osteoporosis by the Z-score definition (<-1). If defined by T-score (<-2.5) none of the patients developed osteoporosis. The BMD change correlated neither with the clinical parameters of disease activity nor with the markers of collagen metabolism. However, the BMD change in FN was associated with the cumulative corticosteroid dose (r=-0.31, p <0.05, 95% CI -0.54 to -0.04). Reasons for the lack of accelerated bone loss in our series are open to various interpretations. This series was community based and most of the patients had mild RA. The patients were also actively treated and their physical function did not deteriorate.

A controlled study of bone mineral density in patients with inflammatory bowel disease.

To assess the prevalence of and risk factors for low bone mineral density in inflammatory bowel disease (IBD), 152 IBD patients and 73 healthy controls were studied. Sixty seven patients had ulcerative colitis, 78 had Crohn's disease (52 of them (66.7%) had ileal disease), and seven had indeterminate colitis. Bone mineral density values (g/cm2) measured by dual energy x ray absorbtiometry at the spine (L2-L4), the femoral neck, Ward's triangle, and the trochanter were 1.177, 0.948, 0.850, and 0.838 in the patients and 1.228 (p = 0.034), 1.001 (p = 0.009), 0.889 (NS), and 0.888 (p = 0.012) in the control group, respectively. The type or extent of the disease or previous small bowel resection did not have any significant effect on the bone mineral density values. There was a weak, but statistically significant negative correlation between bone mineral density and the total lifetime corticosteroid dose (in the lumbar spine r = -0.164, p = 0.04, the femoral neck r = -0.185, p = 0.02, Ward's triangle r = -0.167, p = 0.04, and the trochanter r = -0.237, p = 0.003). The patients whose lifetime corticosteroid dose (prednisone/prednisolone) was more than 10 g had especially low bone mineral density (p < 0.05 compared with the groups with no or less than 5 g of corticosteroid). The patients who had never taken peroral corticosteroids did not have decreased bone mineral density. In conclusion, IBD patients have significantly lower bone mineral density values than healthy controls, but the difference is not so great as has been reported previously. Low bone mineral density values in these patients are related to high lifetime corticosteroid doses.