Musculoskeletal manifestations in hyperlipidaemia: a controlled study.

Eighty eight patients with hyperlipidaemia (81 white patients from South Africa and seven patients of mixed race from the West Cape area) were studied. Forty eight had adult familial hypercholesterolaemia, 16 had juvenile familial hypercholesterolaemia, and 24 had mixed hyperlipidaemia (increased cholesterol and triglycerides). They were interviewed and examined and their musculoskeletal manifestations compared with 88 controls with normal lipid profiles, and matched for age, sex, and race for each group of patients. The following manifestations were significantly increased in the patients: (a) tendon xanthomas particularly of the tendo Achillis in patients with adult familial hypercholesterolaemia and mixed hyperlipidaemia; (b) tendo Achillis tendinitis in patients with adult familial hypercholesterolaemia and mixed hyperlipidaemia; and (c) oligoarthritis in patients with mixed hyperlipidaemia but not in those with adult familial hypercholesterolaemia. Migratory polyarthritis and transient tendo Achillis pain were rare. Thirty eight per cent of patients with juvenile familial hypercholesterolaemia had musculoskeletal system manifestations none of which was significantly increased compared with controls. There was a significant association between tendon xanthomas and tendo Achillis tendinitis. There was a significant difference in pretreatment cholesterol levels in the patients with adult familial hypercholesterolaemia and musculoskeletal system manifestations compared with those without and in all three groups combined. The study confirms an association between hyperlipidaemia and tendon xanthomas, tendo Achillis tendinitis, and to a lesser extent oligoarthritis but not migratory polyarthritis or transient tendo Achillis pain as reported in other studies. It also shows that musculoskeletal system manifestations antedated the diagnosis of hyperlipidaemia in 24/39 (62%) patients and that the manifestations improved or resolved completely in 19/30 (63%) patients after receiving lipid lowering treatment. It is therefore important to recognise the association between musculoskeletal system manifestations and hyperlipidaemia for diagnostic and therapeutic reasons.

Articular mobility in systemic lupus erythematosus (SLE).

The study was prompted by the suggestion that inflammatory polyarthritis and corticosteroids increase articular mobility. Ninety female patients with systemic lupus erythematosus (SLE) of whom 85 had polyarthritis and at least 75 of whom had received corticosteroid therapy were studied and compared to an equal number of carefully matched controls. The difference between the number of hypermobile patients [6 (7%)] and controls [5 (6%)] was not significant. There was also no significant difference when either the pooled mobility scores or the pooled hand scores of the patients and controls were compared. No significant association between articular mobility and either age at onset of disease, duration of disease or corticosteroid therapy was demonstrated. There was a significant association between deformity and duration of disease (p = 0.04) but not with mobility score. We conclude that SLE patients do not have a hypermobile tendency and therefore that neither SLE nor corticosteroids predispose to increased articular mobility. There is also no association between articular mobility and deformity.

Thallium poisoning. A case report.

A 21-year-old Black male with painful neuropathy, abdominal pain, tachycardia and encephalopathy developed striking scalp alopecia 1 week after admission. Thallium poisoning was suspected and confirmed by urinalysis. The clinical course, investigations and management are presented.

Preliminary studies with azapropazone in gout and hyperuricaemia.

Eight patients with acute gouty arthritis were treated with high dose oral azapropazone 600 mg qds in an open study in order to evaluate its therapeutic potential in acute gout. The drug appeared to be as effective as previous agents used in the management of individual patient's acute gout with resolution of pain in 2-21 days, and it had a potent hypouricaemic and uricosuric effect. The uricosuric effect of azapropazone 300 mg qds and phenylbutazone 100 mg tds was compared in a seven day cross-over study in seven asymptomatic patients with gout and hyperuricaemia. Azapropazone had a more rapid uricosuric effect than phenylbutazone. There was a statistically significant fall in serum uric acid and rise in uric acid clearance 24 hours after starting azapropazone and 72 hours following phenylbutazone.

Gold therapy in rheumatoid arthritis.

During the period 1971-1979, 114 patients with rheumatoid arthritis attending the arthritis clinics at Groote Schuur Hospital and Princess Alice Orthopaedic Hospital were treated with gold sodium aurothiomalate (Myocrisin). Data obtained from 104 completed protocols showed that 70 patients (67,3%) benefited from chrysotherapy. Forty of these patients went into complete remission. Therapy was discontinued in 58 patients, side-effects accounting for this in 33 cases (31,8%). Adverse reactions included skin rashes in 41 (39%) and renal complications in 16 (14%); 7 (6%) developed haematological complications, which resulted in death in 2 cases. HLA tissue typing in 37 patients with side-effects showed no increase in the HLA Dw2 or HLA Dw3 antigen. There was, however, a significant increase in the HLA DRw4 antigen in both Whites and Coloureds (P less than or equal to 0,008 and P less than or equal to 0,001 respectively).