Joint mobility in people with hiatus hernia.

OBJECTIVE: To assess joint mobility in people with hiatus hernia. METHODS: A comparative control study was made on 100 patients attending an endoscopic unit. Fifty patients with hiatus hernia were compared with a control group matched for age, sex and body mass index without hiatus hernia. Mobility was scored on a scale of 0-9. RESULTS: There were 11 (22%) patients in the hiatus hernia group with hypermobile joint score 4-9 compared with three (6%) subjects in the control group (P<0.001), whilst the total mobility score among hypermobile patients was 59 in the hiatus hernia group compared with 13 in the control group (P<0.005). CONCLUSION: There is a positive correlation between the presence of hiatus hernia and joint mobility.

The glutathione defense system in the pathogenesis of rheumatoid arthritis.

In order to assess a possible role of the natural glutathione defense system in the pathogenesis of rheumatoid arthritis (RA), serum reduced glutathione levels (GSH), glutathione reductase (GSR), glutathione S-transferase (GST), glutathione peroxidase (GSH-Px) and alkaline phosphatase (ALP) activities, lipid peroxidation (MDA content) and indexes of inflammation were evaluated in 58 rheumatic patients. Rheumatoid athritis was associated with significant depletion (ca. 50%) in GSH levels compared with normal control subjects. Serum levels of the detoxifying enzymes GSR and GSH-Px decreased by ca. 50% and 45%, respectively, whereas a threefold increase in the activity of GST was observed. A 1.2-fold increase in ALP was observed in patients with RA. These effects were accompanied by a 3.1-fold increase in serum MDA content. The MDA content was higher in RA patients who were seropositive for rheumatoid factor as well as positive for C-reactive proteins. The erythrocyte sedimentation rate for all patients with RA was approximately 13.8-fold higher than for the control group, and was higher among RA patients who were positive for C-reactive proteins and exhibited seropositivity for rheumatoid factor. Patients with RA receiving gold therapy exhibited significantly lower MDA levels whereas all other factors that were measured were not effected. The results support a hypothesis that defense mechanisms against reactive oxygen species are impaired in RA.

Brucella arthritis among Iraqi patients.

The clinical features of acute Brucella arthritis were reported in a prospective study of 58 patients (29 male, 29 female). Polyarthritis occurred in 33, was migratory in ten, additive in 23 and symmetrical in ten. Monoarthritis of knee or hip joints occurred in ten patients, whilst the spine alone was involved in 15. Hip and spinal involvement was more destructive than peripheral joint involvement. Hotness, redness and joint effusions were not prominent features. Tissue-typing did not show any association with Brucella arthritis. Treatment with various antimicrobials was followed by recovery, but the relapse rate was lowest with combined tetracycline and streptomycin. Brucella arthritis is frequently seen in Iraq, and dairy products prepared locally from unpasteurized milk should be controlled by local health authorities.

Behçet's disease in Iraqi patients.

The clinical features of 60 patients (45 male, 15 female) with Behçet's disease (BD) are reported in this prospective study. Ninety seven per cent had mouth ulceration, 83% genital ulceration, 75% skin lesions, 48% ocular involvement, 48% synovitis, 17% thrombophlebitis, and 22% of the male patients had epidiymitis, while constitutional symptoms were reported by 63%. The arthritis was intermittent, self limiting, and non-destructive, involving large joints, mainly the knees and ankles. The pathergy test was positive in 37 of 52 patients with BD, and negative in all 120 healthy controls and in 20 healthy volunteers who possessed the HLA-B51 antigen. HLA-B51 was present in 32 of 52 (62%) patients with BD compared with 51 of 175 (29%) unrelated normal controls. Both the pathergy and HLA-B51 tests were negative in four of 52 patients with BD. Behçet's disease is not uncommon in Iraq. Practising physicians, dermatologists, and ophthalmologists must be more aware of its existence.

Joint mobility among university students in Iraq.

The prevalence of joint hypermobility among 1774 university students, aged 20-24 years, in Iraq has been determined from a survey made in 1981. The degree of joint hypermobility was scored on a scale between 0 and 9 using the method described by Beighton in his modification of the Carter and Wilkinson scoring system. Joint hypermobility, defined as a score of 4 out of 9 or greater was found in 25.4% of males and 38.5% of females. The presence of joint complaints, ligamentous sprains, flat feet, Raynaud's phenomenon, easy bruising, high palate and varicose veins correlated well with joint hypermobility and were seen significantly more frequently in students scoring 7 out of 9 or more than in students scoring 3 out of 9 or less. The right (usually dominant) side was significantly less mobile than the left side, whatever the hypermobility score. Physique as expressed by body weight and height did not show any relation to joint mobility.

Clinical features of first attack of rheumatic fever in adults.

The clinical features of the first attack acute rheumatic fever in 32 adults are described in a prospective study. Classical migratory polyarthritis occurred in 11 patients whilst the arthritis in the remaining 21 was additive in type, rapidly becoming symmetrical. The lower limb joints were involved more frequently than those of the upper limb. Mild transient carditis was present in only one patient. All patients showed evidence of antecedent streptococcal infection but none had chorea, subcutaneous nodules or erythema marginatum. The disease ran a benign course so that the sensitivity of the modified Jones criteria for adult rheumatic fever needs re-evaluation. Rheumatic fever is still a significant health problem in Iraq and should always be considered in the differential diagnosis of acute polyarthritis in adults.

Joint hypermobility in women with genital prolapse.

To assess the relation between joint mobility and genital prolapse, joint mobility in 76 women with genital prolapse was compared with that in an age and parity matched control group without prolapse. Mobility was scored on a scale of 0-9. The number of patients with hypermobile joints and the total mobility scores were higher in the genital prolapse group (p less than 0.005), which also had more joint complaints and twice the prevalence of backache when compared with the control group.

Rheumatoid arthritis in population samples in Iraq.

A prevalence survey for rheumatoid arthritis was carried out during the summer of 1975 in persons aged 16 years and over in areas of Iraq representative of differences in geography and ethnicity. Definite rheumatoid arthritis was observed in 1% of the 6999 individuals studied, but differences in occurrence rates in relation to various associated characteristics were not detected. It is concluded that present rheumatological services in Iraq have not developed in response to the magnitude of the existing burden. Morning stiffness was reported fairly frequently by individuals without rheumatoid arthritis, but the significance of this observation is not easy to determine. Raynaud's phenomenon was also recorded, but comparative evaluation of the findings is not possible.

Reumatoid arthritis in Iraq.

Altogether 198 patients (149 female and 49 male) with rheumatoid arthritis, 133 classical and 65 definite by A.R.A. diagnostic criteria, have been studied in Baghdad. The disease pattern and the joint distribution are similar to those in Europe but the disease appears to be generally less destructive; hands are involved more often than the feet, and rheumatoid nodules, severe systemic upset and extra-articular manifestations appear to be less common.