Comorbidity clusters in generalized osteoarthritis among female patients: A cross-sectional study.

OBJECTIVES: To investigate the prevalence of comorbidities among female patients with generalized osteoarthritis (GOA) in comparison to an age- and sex matched control group. To identify clusters of comorbidities in both groups. METHODS: An observational, cross-sectional study was conducted. Consecutive female patients with hand and knee osteoarthritis according to the American College of Rheumatology (ACR) classification criteria were invited to participate in the study. A control group of participants without musculoskeletal symptoms, history or evidence of osteoarthritis or inflammatory rheumatic disease were also included. Cardiovascular, obstructive pulmonary, gastrointestinal, endocrine, neurological, malignant diseases and depression were recorded in both groups. In both study groups comorbidity cluster and factor analysis was performed. RESULTS: The study population included 200 GOA and 200 control participants. The following comorbidities were observed adjusted to Bonferroni correction with a significantly higher prevalence among individuals with GOA: hypertension, uterine leiomyoma, gastroesophageal reflux disease, diverticulosis, upper gastrointestinal tract ulcers, depression, diseases with vertigo (benign paroxysmal positional vertigo and vertebrobasilar insufficiency) and surgery due to otoclerosis. In the GOA group 5 clusters were identified with different comorbidity patterns. CONCLUSION: We report a high comorbidity rate in GOA. Cluster analysis allowed us to identify different comorbidity subsets for vascular, gastrointestinal and malignant gynaecological disorders. Further research is required to understand the links between GOA and non-musculoskeletal comorbidities.

Nocturnal pain correlates with effusions in diseased hips.

Thirty-five of 50 patients with different hip joint disease had sonographic evidence of joint effusion. Arthrocentesis confirmed effusions in 30 of these 35 patients. Thirty-two of the 35 patients had nocturnal pain. Both nocturnal pain and sonographic evidence of effusion decreased after aspiration (15 patients) and aspiration and injection of corticosteroids (15 patients). In a further group of 61 patients who subsequently had Charnley arthroplasties, 35 had positive sonograms before operation. Of these, 25 had effusions confirmed at operation, the remaining 10 having synovitis and capsule thickening. Again a correlation was found with nocturnal pain. The sensitivity of sonography in detecting hip joint effusion was 92% with a specificity of 70%. Nocturnal pain had a lower sensitivity, 85%, but higher specificity, 94%.

Ultrasonography after hip arthroplasty.

Ultrasonography was performed in 55 patients who had total Charnley hip arthroplasties. Effusions were identified in 19 patients and confirmed in all but 3 by arthrocentesis or at surgery. Aspirations were performed in 5 and demonstrated infection in 2. It is concluded that ultrasound is a valuable noninvasive method for assessing painful hip arthroplasty. It can demonstrate the presence of effusion, which should be aspirated to exclude infection.

A simple method for measuring lateral flexion of the dorsolumbar spine.

A simple method for measurement of spinal dorsolumbar lateral flexion is described. Measurements performed on 200 healthy 19-year-old men showed that normal lateral flexion was about 10% of body height. The method which requires only a measuring tape correlates well with that recorded by the more sophisticated inclinometer.

Punched-card aid in rheumatological diagnosis.

A punched-card diagnostic system is described for use in rheumatological practice. The system is based on pattern recognition and provides a list of both common and rare possible diseases. The system is simple and can be manufactured cheaply, and may be of particular use to family doctors in remote areas of practice. The system has also potential as an educational tool for both undergraduate and postgraduate students of medicine.

Diagnosis of rheumatic disease: a plea for contemplation of the future.

In clinical practice the definition of diagnosis is far from clear, since different levels of diagnosis are employed from the symptomatic to the pathological and aetiological. The recent development of computer data bases has important implications for the future, but will require a great deal of thought regarding the nature and quality of the data to be used. Evolution of diagnosis has occurred gradually during the history of medicine. As we see it, computer-assisted data handling will have a profound effect on diagnosis and classification of disease. To meet this challenge we require to define our terms regarding diagnosis of rheumatic disorders. In this paper we comment on the state of the art of diagnosis and classification of rheumatic diseases, and then propose changes to meet the needs of future developments.

Calcium pyrophosphate crystals in intermittent hydrarthrosis.

A 49-year-old female presented with intermittent hydrarthrosis affecting the right knee. Numerous calcium pyrophosphate crystals were demonstrated in synovial fluid aspirated from the knee.