Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain.

OBJECTIVES: To determine the prevalence of pain arising from the zygapophysial joint in patients with chronic low back pain and to determine whether any clinical features could distinguish patients with and without such pain. METHODS: Sixty three patients with chronic low back pain were studied prospectively. All patients underwent a detailed history and physical examination as well as a series of intra-articular zygapophysial joint injections of 0.5% bupivacaine starting at the symptomatic level to a maximum of three levels or until the pain was abolished. They also received injections of normal saline into paraspinal muscles to act as controls. RESULTS: All patients proceeded with the injections. Twenty (32%; 95% confidence interval (CI) 20 to 44%) obtained greater than 50% relief of their pain following the administration of saline. Fifty seven patients completed the study; 23 of them (40%; 95% CI 27 to 53%) failed to obtain relief following the injection of saline but obtained relief following one or more intra-articular injections of local anaesthetic. None of the historical features or clinical tests could discriminate those patients with and those without zygapophysial joint pain. CONCLUSION: Pain originating from the zygapophysial joint is not uncommon, but this study failed to find any clinical predictors in patients with such pain.

The cycling of combination antirheumatic drug therapy in rheumatoid arthritis.

In this open pilot study a combination of hydroxychloroquine, prednisolone and alternating months of treatment with sulphasalazine or oral weekly pulse methotrexate has been investigated in 16 patients with rheumatoid arthritis (RA) refractory to a total of 67 disease suppressive medications. Results at 3 months indicated significant improvements in visual analogue score for pain, joint count, Ritchie index, scale of disability related to activities of daily living, ESR, rheumatoid factor and C-reactive protein. This degree of improvement, however, was not maintained 6 and 12 months after commencement of treatment. Pain score, Ritchie index and ESR were the only parameters demonstrating significant improvement at 12 months. Therapy was terminated in eight patients, half due to lack of efficacy and half because of side effects.

The effect of smoking on the distribution of gold in blood.

The uptake of gold by the red blood cells (RBC) of patients treated with aurothiomalate (GSTM) was greatly potentiated by smoking. The ratios of gold concentrations in RBC to the concentrations in plasma were 0.35 +/- 0.07 (mean +/- SE, n = 14) in smokers and 0.028 +/- 0.003 (n = 23) in non-smokers. Gold uptake by RBC in vitro was also greater in smokers than in blood from non-smokers. Thiocyanate appears to be a major factor which enhances the uptake of gold by RBC. The toxicity of GSTM was not altered by smoking but side effects occurred earlier in smokers.

Penicillamine-induced "Goodpasture's syndrome": successful treatment of a fulminant case.

Goodpasture's syndrome is a recognised but rare complication of penicillamine therapy. Return of useful renal function has no been recorded with this complication. A patient is presented in whom aggressive management with plasmapheresis, haemodialysis and immunosuppression in the acute stage resulted in rapid control of pulmonary haemorrhage and return of useful renal function without the need for long-term haemodialysis. Immunofluorescence and electron microscopic studies of renal tissue together with the demonstration of circulating immune complexes, established the immune complex pathogenesis of this patient's disease. Microhaematuria is emphasised as an important warning sign of this complication.