Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens.

Forty-two patients with frozen shoulder were followed up closely for eight months. They were all taught pendular exercises and randomly allocated to one of four treatment groups: (a) intraarticular steroids, (b) mobilisations , (c) ice therapy, (d) no treatment. This study has shown that there is little long-term advantage in any of the treatment regimens but that steroid injections may benefit pain and range of movement in the early stages of the condition.

Frozen shoulder: a long-term prospective study.

As the natural history of frozen shoulder is poorly documented, a prospective study of 40 patients followed up for 40-48 months (mean 44 months) is described. The range of movement was significantly less than age- and sex-matched controls. Objective restriction was severe in five patients and mild in a further 11. Patients were often unaware that shoulder range was impaired. Dominant arm involvement, manual labour, and mobilisation physiotherapy were associated with a less satisfactory outcome. We conclude that, while objective restriction persists, there is little functional impairment in the late stage of frozen shoulder.

Frozen shoulder: an arthrographic and radionuclear scan assessment.

The diagnostic criteria and nomenclature used to describe the painful stiff shoulder remain confused. Arthrographic features of capsulitis have come to be accepted as characteristic of the frozen shoulder. Increased technetium uptake has also been noted. Both features have been considered to have possible prognostic and therapeutic importance. During a therapeutic study of strictly defined clinical frozen shoulder 35 of 38 patients showed increased technetium diphosphonate uptake in the affected shoulder in comparison with the opposite side. Of 36 patients who had arthrography 15 showed evidence of capsulitis, 11 rupture of the rotator cuff, and five no abnormality. Five tests failed owing to technical difficulty. There was no association between the technetium uptake and the arthrographic features, and neither was useful in predicting the rate or extent of recovery. Frozen shoulder of traumatic onset behaved no differently from that which arose spontaneously. We do not therefore consider that arthrography or technetium diphosphonate scanning performed at presentation contributes to the assessment of the painful stiff shoulder.

Immunological studies in frozen shoulder.

This immunological study of 40 patients with frozen shoulder showed a pretreatment increase in immune complex levels, C-reactive protein, and decreased lymphocyte transformation to phytohemagglutinin and concanavalin A compared to a control group. Repeat estimations after 8 months showed that values tended to approach control levels.

Immunological studies in patients with rheumatoid arthritis receiving azathioprine and myocrisin in combination.

Thirty-one patients with classical or definite rheumatoid arthritis (RA), on treatment with azathioprine and sodium aurothiomalate in combination were studied. Absolute lymphocyte counts and IgA levels were reduced but this did not reach statistical significance. Lymphocyte transformation with phytohaemagglutinin (PHA) showed no significant difference from a control group. However, antibody dependent cell-mediated cytotoxicity was significantly impaired compared to rheumatoid controls (p less than 0.001). There was no relation to the degree of impairment of ADCC and the current dose of azathioprine nor to the total dose or duration of therapy. Inhibiting material to cell-mediated cytotoxicity was present in the sera of 23 patients but its presence showed no relation to the degree of cytotoxicity exhibited by cells in the same patient. Our studies of cellular cytotoxicity have revealed alterations in cellular function possibly attributable to azathioprine.

Lack of consistent peripheral blood lymphocyte transformation responses in polymyalgia rheumatica and giant cell arteritis.

The in vitro transformation response of peripheral blood lymphocytes to human arterial and muscle homogenates has been studied in patients with polymyalgia rheumatica (PMR), giant cell arteritis (GCA) and in unrelated controls. Homogenates that stimulated PMR/GCA cells also stimulated controls. There was no greater stimulation to human or bovine elastin than to artery and muscle homogenates. Our results do not confirm a lymphocyte abnormality in these diseases.

A comparative study of the long-term efficacy of flurbiprofen and indomethacin in the treatment of rheumatoid arthritis, with special reference to iron metabolism.

Preliminary results are reported for the first 23 rheumatoid arthritis patients entered in a long-term, double-blind trial to compare the efficacy of flurbiprofen and indomethacin. It was planned that, unless withdrawn, patients from matched pairs received either flurbiprofen (150 mg to 300 mg daily) or indomethacin (75 mg to 150 mg daily) over a minimum period of 6 months, dosage being adjusted to suit exacerbations and remission of disease. In addition to clinical assessments of severity of pain, duration and severity of morning stiffness, joint size and joint score, routine laboratory measurements were carried out, including estimates of serum iron and total iron binding capacity, rheumatoid factor and immunoglobulin levels. This interim report gives the statistical analysis of results from the 17 patients completing from 2 to 4 months of treatment and shows that both drugs were equally effective in controlling disease activity. Withdrawals due to side-effects or exacerbations of disease were similar for both drugs.

HLA-B27 and frozen shoulder.

Histocompatibility antigens were determined in 38 patients with frozen shoulder and 216 normal blood-donors. HLA-B27 was significantly more common in patients with frozen shoulder (42%) than in the controls (10%). The distribution of the other 19 histocompatibility antigens was similar in the patient and control groups. This result may be associated with the suggested immunological pathogenesis of the condition.

Alclofenac in ankylosing spondylitis.

Eighteen patients with definite ankylosing spondylitis were treated with 3 to 4 g. alclofenac daily for up to 8 months in an open trial against previous therapy. Therapeutic efficacy was greater than or equivalent to previous therapy in 10 of 18 patients after 1 month and 8 patients remain on alclofenac. There was a significant increase in symptoms, particularly morning stiffness after 1 month, but they tended to improve with time. Measurement of spinal movements was not found useful. Side-effects were commoner than expected but not serious. Alclofenac may prove a useful alternative drug in the management of ankylosing spondylitis and further trials are indicated.