Poor relationship between joint swelling detected on physical examination and effusion diagnosed by ultrasonography in glenohumeral joints in patients with rheumatoid arthritis.

The purpose of this study was to assess the relationship between swelling detected on physical examination and effusion diagnosed by ultrasonography (US) in glenohumeral (GH) joints in patients with rheumatoid arthritis (RA). Fifty consecutive patients with RA entered the study and 20 healthy control persons formed a control group. Altogether 100 GH joints of the RA patients and 40 of the controls were evaluated. The clinical assessments were carried out by one doctor and the US investigations by another, and they were blinded to each other's results. The clinical examination and US gave similar results in 70 GH joints, whereas they differed in the remaining 30 GH joints. The kappa coefficient between these investigations was 0.202, showing poor agreement. These results showed poor agreement between the clinical assessment of swelling and effusion detected by US in GH joints. Therefore, US may considerably improve the accuracy of diagnosis of effusion in GH joints, which usually means synovitis in patients with RA.

Relationship between clinically detected joint swelling and effusion diagnosed by ultrasonography in elbow joints in patients with rheumatoid arthritis.

The aim of this study was to compare the relationship between clinically detected swelling and effusion diagnosed by ultrasonography (US) in elbow joints in patients with rheumatoid arthritis (RA). Fifty consecutive patients with RA entered the study and 20 healthy persons formed a control group. Altogether 100 elbow joints of the RA patients and 40 of the controls were studied. All the clinical assessments were performed by one doctor and the US investigations by the other and they were blinded to each others results. In 77 elbow joints of the RA patients the clinical assessment and the US gave similar results, whereas they differed in the remaining 23 joints. The kappa coefficient between these investigations was 0.371. In the control group no elbow joint showed either swelling in the clinical assessment or effusion in the US investigation. The results of this study indicate that clinical assessment of swelling and evaluation of effusion by US in elbow joints in patients with RA show only fair agreement. Thus, US may improve the accuracy of diagnosis of synovitis in many cases in these patients.

Effect of a three month course of ciprofloxacin on the late prognosis of reactive arthritis.

BACKGROUND: The value of antibiotics in the treatment of reactive arthritis (ReA) is still controversial. OBJECTIVES: To analyse the long term outcome of patients with ReA, treated with a three month course of ciprofloxacin or placebo. METHODS: Patients who had had ReA and had participated in a double blind, placebo controlled trial on the effectiveness of ciprofloxacin 4-7 years earlier were invited to a clinical examination. Of the 71 patients who were included in the original study, 53 agreed to visit the clinic for an examination. Twenty six of 53 patients had originally received ciprofloxacin and 27 had belonged to the placebo group. Of these, 20 in the ciprofloxacin and 25 in the placebo group were HLA-B27 positive. RESULTS: 11/27 (41%) patients in the original placebo group had now developed chronic rheumatic disease, as compared with only 2/26 (8%) patients originally treated with ciprofloxacin (p=0.006). Two patients who originally had received placebo, none in the ciprofloxacin group had developed ankylosing spondylitis, and three patients in the original placebo group, none in the ciprofloxacin group had recurrent anterior uveitis. The same tendency was seen when several different measures were analysed. Of the patients with chronic spondyloarthropathy, 10 in the placebo and none in the ciprofloxacin group were HLA-B27 positive. CONCLUSION: Analysis 4-7 years after the initial ReA suggests that a three month course of antibiotics in the acute phase may have a beneficial effect on the long term prognosis.

Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint.

OBJECTIVE: To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ in a double blind, controlled study. METHODS: Twenty-four consecutive non-spondylarthropathic patients with chronic pain in the region of the SIJ entered the study. Thirteen patients were treated with a periarticular injection of methylprednisoloneacetate and lidocaine (MP group) of the SIJ, whereas 11 patients received isotonic sodium chloride and lidocaine. Clinical assessment at the onset of the study and after one month included the patient's estimation of pain in the region of the SIJ by the visual analogue scale (VAS) and by a pain index, which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the one month's follow-up examination both the VAS (p = 0.047) and the pain index (0.017) had improved significantly in the MP group compared with the non-MP group. CONCLUSION: These results suggest that periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ in non-spondylarthropathic patients.

Effect of a three month course of ciprofloxacin on the outcome of reactive arthritis.

BACKGROUND: Treatment of reactive arthritis (ReA) with antibiotics has so far remained controversial. Eradication of the causative microbe appears logical, but short term antibiotic treatment has no beneficial effect on the outcome of ReA. OBJECTIVE: To evaluate the effect of a three month course of ciprofloxacin on ReA. METHODS: In a randomised, double blind, placebo controlled trial, between December 1992 and February 1996, 71 patients with acute ReA triggered by a gastrointestinal or a urogenital infection were randomly assigned to receive ciprofloxacin 500 mg or placebo twice daily for three months. Patients were assessed at study entry, at 6 weeks, 3 months, 6 months, and 12 months. Sixty two patients were valid for the efficacy analysis. The primary outcome measures were erythrocyte sedimentation rate, number of swollen joints, patients self assessment, and complete recovery. RESULTS: Adverse events were mostly mild and occurred in both treatment groups. There were no statistically significant differences in any of the primary or secondary efficacy variables between the study groups at baseline or during the 12 month follow up. All primary outcome measures indicated that the condition of the patients improved during the study. CONCLUSION: Both groups tended to recover. Ciprofloxacin, given as a three month course, had no advantage over placebo treatment.

Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy.

OBJECTIVE: To evaluate the efficacy of periarticular corticosteroid injection of the sacroiliac joint (SIJ) in patients with seronegative spondylarthropathy in a double blind, controlled study. METHODS: 20 patients with seronegative spondylarthropathy and clinical sacroiliitis entered the study. In 10 patients one affected SIJ was treated with periarticular injection of 1.5 ml (40 mg/ml) methylprednisoloneacetate and 1.5 ml (20 mg/ml) lignocaine (MP group), whereas 10 patients received 1.5 ml isotonic sodium chloride and 1.5 ml (20 mg/ml) lignocaine (non-MP group). Clinical assessment at the onset of the study and after two months follow-up included the patients' estimation of pain in the SIJ by the visual analogue scale (VAS) and by a pain index which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the two months follow-up examination the VAS (p = 0.02) and the pain index (p = 0.01) had improved significantly in the MP group compared with the non-MP group. CONCLUSION: The results of our study indicate that the periarticular injection of methylprednisolone may be effective in the treatment of clinical sacroiliitis in patients with seronegative spondylarthropathy.

Height loss rate as a marker of osteoporosis in postmenopausal women with rheumatoid arthritis.

The relation between the loss of height and bone mineral density (BMD) at the lumbar spine and proximal femur was determined in 61 women aged 56-70 years suffering from rheumatoid arthritis. Statistically highly significant negative correlations were found between the loss of height and the spinal and femoral BMD. A loss of 4 cm or more in height over 10 years seems to be associated with a significant decrease of BMD, and it can be recommended as a clinical marker of osteoporosis.