Predicting prosthetic rehabilitation outcome in lower limb amputee patients with the functional independence measure.

OBJECTIVE: To determine the value of the Functional Independence Measure (FIM) score as a prognostic indicator for prosthetic use in the lower limb amputee patient. DESIGN: Cohort study of 41 patients with lower limb amputations. SETTING: University hospital rehabilitation unit. MAIN OUTCOME MEASURES: FIM motor subscore and Houghton Scale for prosthetic use. RESULTS: FIM score on admission did not correlate with prosthetic use as measured by the Houghton Scale; however, FIM motor subscore at discharge did. CONCLUSION: The admission FIM score is not useful in predicting successful prosthetic rehabilitation in lower extremity amputee patients. Only the motor subscore at discharge correlates with the use of prosthesis.

Physician perceptions of the value of physical modalities in the treatment of musculoskeletal disease.

We randomly surveyed 100 specialists in rehabilitation medicine and 100 rheumatologists concerning their perceptions of the value of 11 different physical modalities--cold, active and passive exercise, interferential current, laser, magnetotherapy, microwave, shortwave diathermy, traction, ultrasound and transcutaneous nerve stimulation in the treatment of seven different musculoskeletal conditions--acute arthritis, joint contracture, neck pain, back pain, tendinitis, reflex sympathetic dystrophy and frozen shoulder. There were significant differences in the perceived benefits of modalities which varied by modality and condition. Overall, rehabilitation medicine specialists regarded modalities to be helpful more often than rheumatologists (P < 0.001).

Osteopenia in patients with above knee amputation.

Using dual energy x-ray absorptiometry, we studied 16 male patients with unilateral above knee amputations (AKA) with a mean age of 48 years (range, 23 to 66 years) who were full-time prosthetic users for more than 5 years. All prostheses were ischial weight bearing. All 16 subjects were found to have normal bone density in their spines and in the normal femurs when compared to nonamputation controls. However, a significant decrease of mean femoral neck bone density was found on the amputated side (0.68g/cm2, range, 0.52 to 1.01) when compared to the normal side (1.01g/cm2, range, 0.75 to 1.20) (p < .05). The mean bone density percentage difference between the two sides was 28% (range, 4% to 48%). There was a significantly negative correlation between the patient's age at the time of amputation and the severity of osteopenia (-0.73; p < 0.05).

Absence of an association between HLA typing in cystic fibrosis arthritis and hypertrophic osteoarthropathy.

Fourteen patients with cystic fibrosis arthritis and eight patients with cystic fibrosis and hypertrophic osteoarthropathy were typed for HLA-A, B, C, DR, and DQ antigens and were compared with age and sex matched controls with cystic fibrosis. The diagnosis of cystic fibrosis arthritis and hypertrophic osteoarthropathy was confirmed by radiography and bone scanning. The prevalence of HLA-A, B, C, D, antigens in the cystic fibrosis group (44 patients) did not differ from that in the control group. A comparison between patients with cystic fibrosis arthritis or hypertrophic osteoarthropathy and their respective controls did not show any significant differences in HLA prevalence. It is concluded that HLA antigens may not be a factor in the susceptibility of patients with cystic fibrosis to cystic fibrosis arthritis or hypertrophic osteoarthropathy.

Basilar impression and osteogenesis imperfecta in a three-year-old girl: CT and MRI.

A 3-year-old girl with osteogenesis imperfecta developed symptomatic basilar impression. Her neurological symptoms were treated by foramen magnum decompression and laminectomy. This is an unusually young patient to have this condition.

Discoid meniscus presenting as juvenile rheumatoid arthritis.

Discoid meniscus is a mechanical lesion described as having little inflammatory reaction. We describe a child with lateral discoid meniscus misdiagnosed as juvenile rheumatoid arthritis (JRA). Synovitis responded to aspirin, but function gradually deteriorated with increasing flexion deformity until arthrotomy and meniscectomy. Histology showed intense inflammatory changes compatible with JRA. Clinical and laboratory clues to early diagnosis were the localized nature of the inflammation on physical examination, radiographs and bone scan.

Isolated vasculitis of the central nervous system in a patient with celiac disease.

A 51-year-old white man with celiac disease presented with seizures unresponsive to medical therapy. Investigations including brain biopsy revealed isolated vasculitis of the central nervous system. Treatment with prednisone and cyclophosphamide resulted in clinical and radiographic improvement. The relationship between celiac disease and vasculitis is discussed.

Arthritis associated with Haemophilus influenzae meningitis: septic or reactive?

We reviewed 165 pediatric cases of Haemophilus influenzae type b meningitis and found 11 (6.7%) with associated arthritis. Synovial fluid culture and Gram stain suggested that only three of these 11 cases were caused by a septic process. In all three children with septic arthritis, joint symptoms were present on admission or within 24 hours. In contrast, of the eight who had reactive arthritis, arthritis did not appear in six until after 1 week of antibiotic therapy. Patients with septic arthritis were older than patients with reactive arthritis (mean 31 months vs 17 months), had a longer duration of symptoms before the start of antibiotic therapy (mean 6.0 days vs 2.5 days), and were more likely to have a positive blood culture (67% vs 18%). It is probable that the majority of episodes of synovitis occurring after H. influenzae meningitis occur as a result of a reactive rather than a septic process. Treatment of reactive arthritis should be with anti-inflammatory agents rather than with multiple joint aspirations and prolonged antibiotic therapy.

Correlation of renal histology with outcome in children with lupus nephritis.

We assessed renal histological features in 20 children with diffuse proliferative lupus nephritis (DPLN) to determine whether they were useful in predicting clinical outcome. Renal biopsies were analyzed by assigning scores indicating an activity index (AI) and chronicity index (CI). Clinical assessment of renal function at biopsy and outcome were graded according to urinalysis, serum creatinine, need for dialysis and/or transplantation, and/or death from end-stage renal failure. Renal function at biopsy correlated significantly with AI and CI. Serum complement (C3 and C4) correlated significantly with CI but not with AI. The usefulness of the clinical grading system was confirmed in ten patients who underwent repeat biopsies. Of these, four converted from DPLN to mesangial or membranous lupus and showed improvement in their grade, while only one of the six with DPLN on both biopsies improved. After a mean follow-up of 4.0 years, 14 of the 20 patients showed clinical improvement, four were unchanged, and two were worse. CI predicted clinical outcome (P less than 0.01) but AI did not. Histologic scores of AI and CI obtained from renal biopsies showing DPLN may be useful in predicting therapeutic responses and designing prospective clinical trials to determine optimum management of children with DPLN.

Rheumatoid arthritis after Takayasu's arteritis.

The association of Takayasu's arteritis with other rheumatic disease is rare. We report a 37-year-old female who developed Takayasu's arteritis in her 20s and subsequently developed rheumatoid arthritis.

The musculoskeletal manifestations of cystic fibrosis.

Twenty-seven patients with CF and joint complaints were reviewed. Twelve patients had arthritis, 11 had HPO, and four had symptoms of mechanical neck and back pain. We have confirmed the association of CF with an episodic form of arthritis. For the first time, we have reported that a subgroup of these patients later develop persistent synovitis with progressive asymmetric, erosive disease. The etiology of CF arthritis is unclear, but may relate to chronic infection and immune complex mechanisms. CF arthritis can be contrasted with CF induced HPO, which is associated with worse lung disease, a male predominance, and an older mean age of onset of symptoms. Mechanical neck and back pain may relate to an associated scoliosis or kyphosis in CF.