Can foot orthoses prevent hallux valgus deformity in rheumatoid arthritis? A randomized clinical trial.

Hallux valgus deformity is the most commonly observed forefoot deformity in patients with rheumatoid arthritis. This 5-year, double-blind, randomized clinical trial compared treatment orthoses with placebo orthoses for the prevention of hallux valgus deformity in the rheumatoid arthritic foot.One hundred and two subjects with active rheumatoid arthritis and with foot pain and minimal radiographic changes of the feet participated in the study. They were recruited from five arthritis clinics in the Chicago metropolitan area that are affiliated with or are teaching clinics of area medical schools. Patients were followed for 3 years.Eighty-one subjects completed the study. In a logistic regression analysis, the treatment group was 73% less likely to develop hallux valgus deformity compared with the control group (adjusted odds ratio 0.27, 95% confidence interval 0.078, 0.916 p = .04). These findings suggest that foot orthoses can prevent or slow the progression of hallux valgus deformity.

Acute gouty arthritis. Modern approaches to an ancient disease.

The principles governing the pathogenesis and treatment of gout have been established with greater clarity than those for almost any other rheumatic disease. The benefits of treatment include the virtual cure of a disabling and deforming disease. Adherence to proper management guidelines provides predictable relief of symptoms for patients and great satisfaction for the treating physician.

Development of a shoulder pain and disability index.

A shoulder pain and disability index (SPADI) was developed to measure the pain and disability associated with shoulder pathology. The SPADI is a self-administered index consisting of 13 items divided into two subscales: pain and disability. Thirty-seven male patients with shoulder pain were used in a study to examine the measurement characteristics of the SPADI. Test-retest reliability of the SPADI total and subscale scores ranged from 0.6377 to 0.6552. Internal consistency ranged from 0.8604 to 0.9507. SPADI total and subscale scores were highly negatively correlated with shoulder range of motion (ROM) supporting the criterion validity of the index. Principal components factor analysis with and without varimax rotation supported the construct validity of the total SPADI and its subscales. High negative correlations between changes in SPADI scores and changes in shoulder ROM indicated the SPADI detected changes in clinical status over short time intervals. The SPADI should prove useful for both clinical and research purposes.

Gold pneumonitis. A case report with electronmicroscopy and electron probe analysis.

A case of classical RA developed severe interstitial pulmonary disease and respiratory failure while on chrysotherapy. A high concentration of gold was found in lung tissue. Electron microscopic and electron probe examinations confirmed the presence of gold in the interstitial and intra-alveolar macrophages. The clinical course and possible pathogenic mechanism were discussed.

Alpha1-antitrypsin deficiency with severe panniculitis. Report of two cases.

Two patients with profound decrease of alpha1-antitrypsin (PiZZ) presented with severe pannicultis (Weber-Christian disease); one had systemic panniculitis including pancreatitis. Another possible case is quoted from the literature. Although milder forms of panniculitis can have normal Pi phenotypes and alpha1-antitrypsin levels, the marked reduction of antiproteolytic activity found in PiZZ homozygotes may predispose to or aggravate the lesions of Weber-Christian disease.

Arthritis and osteomyelitis due to Candida albicans: a case report.

A case of Candida albicans arthritis involving a knee and cuneiform bone is presented. As with other forms of candidiasis, multiple antibiotic treatment and hyperalimentation predisposed to the infection. Fourteen previously published cases are reviewed. The knee is the most common site of infection and there is a high frequency of associated osteomyelitis. Treatment with both amphotericin and 5-fluorocytosine seems to be effective. The case presented was treated successfully with a small dose of amphotericin followed by five and one-half months of 5-fluorocytosine.

Effect of fenoprofen calcium on acute gouty arthritis.

Twenty-seven patients with thirty-six joints affected with acute gouty arthritis were treated with fenoprofen calcium for a duration not exceeding 8 days and with a variable dose not exceeding 3.2g daily. The results indicated that fenoprofen calcium was an effective drug in these patients. Side effects were modest.

A simultaneous method for detection and quantitation of T- and B-lymphocytes.

Assay for quantitation of B- and T--lymphocyted from small volumes of heparinized man blood has been developed by simultaneously reacting Ficoll-Hypaque purified mononuclear cells with antobody-coated chicken erythrocytes to for rosettes with B-lymphocytes, and sheep erythrocytes which formed non-immune rosettes with Tlymphocytes. Distribution of various lymphocyte populations in normals are T-cells, 60.9+/-7%, B-cells 16.4+/-4%, and lymphocytes with both receptors, 1.6+/-0.6%.