The Northwick Park Neck Pain Questionnaire, devised to measure neck pain and disability.

Neck pain is common in rheumatological practice. Assessment of outcome is difficult without objective measures. A neck pain questionnaire using nine five-part sections has been devised to overcome this problem. Forty-four rheumatology out-patients with neck pain were studied. Questionnaires were completed on days 0 and 3-5, and at 1 and 3 months. There was good short-term repeatability (r = 0.84, kappa = 0.62). Mean scores of each of the nine sections tended to rise with that of the pain section showing internal consistency. Questions on duration and intensity of pain were good indicators of a patient's global assessment. The questionnaire is easy for patients to complete, simple to score and provides an objective measure to evaluate outcome in patients with acute or chronic neck pain.

Study of antibodies to histones and histone synthetic peptides in pauciarticular juvenile chronic arthritis.

The objective of this study was to determine the prevalence of histone antibodies in early onset pauciarticular juvenile chronic arthritis (JCA), and to assess any association with disease activity in terms of arthritis or uveitis. Forty-four children with early onset pauciarticular JCA have been assessed prospectively using clinical and laboratory parameters. Sera were collected from these patients during clinical follow-up. Some of them had serial measurements during the period of study. Patient sera were analysed for histone antibodies by ELISA. A further study using 30 synthetic peptides of calf thymus core histones was performed by ELISA. Seventy-five per cent of children have IgM antibodies to histone, usually to more than one type. The highest values were anti H3 and H4 antibodies. There was no correlation between the level of anti-histone antibodies and anterior uveitis. There were increased levels of IgG antibodies to histone peptides, in particular the N- and C-terminal peptides of H3 in 70.5% of children. Antibodies to H3 peptides tend to be in patients with chronic anterior uveitis (P = 0.04).

Reduction in IgG galactose in juvenile and adult onset rheumatoid arthritis measured by a lectin binding method and its relation to rheumatoid factor.

Glycosylation changes in patients with juvenile chronic and adult onset rheumatoid arthritis have been studied using a novel binding method. Both these major types of arthritis showed decreased galactosylation of serum IgG, which confirms earlier studies using a different, more complex chemical method. No significant correlation between serum IgG, IgM, and IgA rheumatoid factors and age corrected G(o) (percentage of oligosaccharide chains lacking galactose) was found. The possibility that the less glycosylated IgG is preferentially confined to circulating IgM/IgG immune complexes cannot be excluded, however.

Infection of a prosthetic knee joint with Peptostreptococcus magnus.

Infection of a prosthetic knee joint with Peptostreptococcus magnus in an immunosuppressed patient with rheumatoid arthritis is described. The organism is a skin commensal, generally thought to be of low pathogenicity; the difficulty in making the diagnosis is emphasised.

A crossover study of naproxen, diclofenac and tolmetin in seronegative juvenile chronic arthritis.

Nonsteroidal anti-inflammatory drugs (NSAID) are useful in the management of juvenile chronic arthritis (JCA) and efficacy has usually been compared with aspirin. The disadvantages of aspirin include the frequency of dosage, monitoring of salicylate levels and concern about Reye's syndrome. We have performed a single blind crossover study comparing naproxen 10 mg/kg/day, tolmetin 25 mg/kg/day and diclofenac 2 mg/kg/day in 28 children with seronegative JCA over 12 weeks. Clinical and laboratory assessments were made after 4 weeks of treatment on each drug. Clinical improvement was seen with all three NSAID compared to baseline after a 24-hour washout period, but statistical significance was reached in only 2 or 3 of the clinical parameters for each drug. Side effects were mild and typical of NSAID, but occurred less frequently with naproxen (5) and tolmetin (5) than with diclofenac (7). Thus the anti-inflammatory effect of all three drugs was confirmed with no significant differences between them in terms of efficacy and tolerance. Tolmetin 200 mg tablets are now only available in France and N. America, therefore naproxen or diclofenac are recommended as the first line of treatment in children with chronic arthritis over the age of 5.

Autoantibody profile in juvenile chronic arthritis.

Patients with juvenile chronic arthritis (JCA) may be subdivided into a minority, who carry IgM rheumatoid factor and have erosive polyarthritis resembling adult rheumatoid arthritis, and the majority (90%), who are seronegative by conventional means. Between 30 and 60% of patients with JCA have positive antinuclear antibodies (ANAs) according to the choice of substrate for indirect immunofluorescence. The importance of ANAs is the frequent development of associated asymptomatic chronic iridocyclitis, which may impair vision causing worse handicap than the arthritis, which remains predominantly pauciarticular in two thirds of these young children. ANA positive patients rarely possess antibodies to deoxyribonucleic acid (DNA) or extractable nuclear antigens (ENA), and current studies suggest that several different nuclear antigens, including histones, may be involved.

Genetic susceptibility to early onset pauciarticular juvenile chronic arthritis: a study of HLA and complement markers in 158 British patients.

To investigate the genetics of susceptibility to early onset pauciarticular juvenile chronic arthritis (JCA), 158 unrelated ethnic British patients with a mean disease onset of 3.2 years, together with controls, were tested for HLA-A, B, C, and DR antigens. Additionally, 117 patients were also investigated for complement Bf and C4 markers. New observations included an increased frequency of the C4B 2 allotype (p corrected (pc) less than 0.02) and C4A 4,B 2 phenotype (p less than 0.0005). Findings suggested a unique increase of the haplotype HLA-DRw8, Bf*S, C4A*4, C4B*2, HLA-B39, possibly predisposing to more severe disease. Strong positive associations were confirmed with HLA antigens A2 (pc = 2.5 X 10(-8)), DRw8 (pc = 3.5 X 10(-14)), DR5 (pc less than 0.02), DRw52 (pc = 2.8 X 10(-6)) and DR5, w8 phenotype (pc = 3.9 X 10(-6)), and negative associations with DR7 (pc = 5.8 X 10(-7)), DR4 (pc less than 0.002), and DRw53 (pc = 0.004). Antinuclear antibody (ANA) seropositivity correlated with DR5 (p less than 0.02), and in children with chronic iridocyclitis (CIR) Bw62 incidence was raised (p less than 0.03) and B44 reduced (p less than 0.03). HLA-A2 was found in 88% of ANA+, CIR+ patients (p less than 0.01). A significant excess of DR5, w8 heterozygotes was present (relative risk = 41.1) and a lack of corresponding homozygotes. Results are inconsistent with a recessive, dominant, or intermediate mode of inheritance of susceptibility, and favour the existence of at least two DR linked 'disease' genes. Moreover, there may be an interaction in heterozygotes of combinatorial factors associated with DR5 and DRw8 in enhancing susceptibility. Possible immunogenetic mechanisms underlying the observed associations with three antigen classes are discussed. Evidence here suggests a role for the HLA-DQ locus in determining susceptibility to this disease.

Antinuclear antibody studies in juvenile chronic arthritis.

This study of children with chronic arthritis confirms that patients at greatest risk for chronic iridocyclitis have a young age of onset and positive antinuclear antibodies (ANA). Children who are ANA negative have a low risk of iridocyclitis. When it occurs it is at a significantly older age. No child developing juvenile chronic arthritis over 9, even with positive ANA, had chronic iritis. There was remarkable variation in ANA titres; these correlated with erythrocyte sedimentation rate, active arthritis, and iridocyclitis. Maximum ANA titres were often seen very early in the disease but at this time were usually not associated with a poor prognosis. Histocompatibility antigens A2 and DRw8 were significantly increased, suggesting primary associations in pauciarticular arthritis with ANA. HLA-DR5 was associated with mild forms of arthritis and with absence of, or only mild, iritis. HLA-B15/w62 was associated with severe forms of eye involvement.

Metabolic acidosis induced by carbonic anhydrase inhibitors and salicylates in patients with normal renal function.

Two young patients with unimpaired renal and hepatic function were found to have developed metabolic acidosis after treatment for glaucoma and joint pain with a combination of salicylates and carbonic anhydrase inhibitors in normal doses. Carbonic anhydrase inhibitors appear to interact with salicylates to produce serious metabolic acidosis in patients without the predisposing factors generally considered to constitute risks. It is recommended that treatment combining salicylates and carbonic anhydrase inhibitors is either kept to a minimum or avoided.