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Autonomic Nerve Function in Rheumatoid Arthritis of Varying Severity

Autonomic nerve function was evaluated by deep breathing and tilt table tests in 17 patients with rheumatoid arthritis (RA) and in 24 healthy control subjects. The results showed that all RA patients had increased heart rates at rest, irrespective of the severity of the disease. Patients with severe RA had increased systolic and diastolic blood pressures before and after tilting. Pronounced abnormalities in the immediate heart rate reaction to tilting indicating autonomic neuropathy (AN) were also demonstrated in patients with severe RA. The abnormal immediate reaction to tilting was mainly the result of vagal neuropathy. From the present study it is evident that severe RA may be accompanied by AN and the consequences need to be elucidated.

Musculoskeletal chronic pain in general practice : studies of health care utilisation in comparison with pain prevalence

OBJECTIVE To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. DESIGN A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. SETTING General population in a well-defined Swedish PHC district. SUBJECTS A random sample of 15% of the population aged 25-74, n = 1101. Annual visitors to district physicians at the health centre. MAIN OUTCOME MEASURES Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. RESULTS Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. CONCLUSION Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.

Predictors of positive health in disability pensioners : a population-based questionnaire study using Positive Odds Ratio

BackgroundDeterminants of ill-health have been studied far more than determinants of good and improving health. Health promotion measures are important even among individuals with chronic diseases. The aim of this study was to find predictors of positive subjective health among disability pensioners (DPs) with musculoskeletal disorders.MethodsTwo questionnaire surveys were performed among 352 DPs with musculoskeletal disorders. Two groups were defined: DPs with positive health and negative health, respectively. In consequence with the health perspective in this study the conception Positive Odds Ratio was defined and used in the logistic regression analyses instead of the commonly used odds ratio.ResultsPositive health was associated with age ≥ 55 years, not being an immigrant, not having fibromyalgia as the main diagnosis for granting an early retirement, no regular use of analgesics, a high ADL capacity, a positive subjective health preceding the study period, and good quality of life.ConclusionPositive odds ratio is a concept well adapted to theories of health promotion. It can be used in relation to positive outcomes instead of risks. Suggested health promotion and secondary prevention efforts among individuals with musculoskeletal disorders are 1) to avoid a disability pension for individuals <55 years of age; if necessary, to make sure rehabilitation actions continue, 2) to increase efforts to support immigrants to adjust to circumstances connected to ill-health and retirement, 3) to pay special attention to individuals with fibromyalgia and other general pain disorders, and 4) to strengthen ADL activities to support an independent active life among disability pensioners.

NERVE PALSY AFTER KNEE ARTHROPLASTY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Forty-two consecutive knee arthroplasties on rheumatoid knees (19 Attenborough, 20 Total Condylar, 3 Marmor) were examined pre- and postoperatively for signs of below-the-knee nerve lesions. Sixteen of these knees were also studied neurophysiologically (EMG). Four patients (knees) had peroneal nerve palsy, three early and one late. Three further knees had only EMG signs of nerve lesion. Predisposing factor was correction of flexion contracture of more than 10 degrees and especially when combined with varus change in alignment. Preoperative EMG could not predict nerve lesion.

Locomotor system disorders in diabetes mellitus. Increased prevalence of palmar flexortenosynovitis.

Diabetes mellitus (DM) may be accompanied by a variety of locomotor system disorders including several hand syndromes. It has been suggested that palmar flexortenosynovitis (FTS) might be included among these hand syndromes, but no conclusive data have been available. Furthermore, recent studies have indicated that FTS may be a clue to previously undiagnosed impaired glucose tolerance. In the present study the prevalence of FTS among diabetics without inflammatory rheumatic disease was 11% compared with less than 1% (p less than 0.001) in a reference group. Thus, FTS could be included among the locomotor system disorders which are associated with DM.

Flexor Tenosynovitis (FTS): A risk indicator of abnormal glucose tolerance

Diabetes mellitus (DM), particularly of long duration and insulin dependent, can be accompanied by a variety of locomotor system disorders. However, musculo-skeletal syndromes can also appear in patients with mild glucose homeostasis disturbances. Sometimes these locomotor complaints may precede the diagnosis of the deranged glucose metabolism and hence give a clue to the underlying glucose homeostasis abnormality. In the present work, glucose metabolism was studied in 39 patients presenting with palmar flexor tenosynovitis (FTS) but without any other rheumatic manifestations. For comparison, glucose homeostasis was also studied in 44 patients with FTS accompanying rheumatoid arthritis (RA). In the first group, 23% had an abnormal oral glucose tolerance test (OGTT), a significantly increased frequency vis-à-vis the 4.5% found in the RA group and vis-à-vis the 5.4% reported for the general population. It is concluded that in the absence of any other rheumatic disease, FTS is a risk indicator of disturbed glucose metabolism and that a simple screening procedure for the purpose of disclosing glucose homeostasis abnormalities is warranted in patients presenting with FTS.

Characteristics of disability pensioners returning to work: an interview study among individuals with musculoskeletal disorders.

Purpose. To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on ‘resting disability pension’. Method. Qualitative analyses of interviews with 17 individuals going back to work. Results. Three adaptation patterns were identified: The Go-getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality. Conclusion. Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/her life.

Varying Distribution of Acetylation Phenotypes in RA Patients with and Without Sjögren's Syndrome

The acetylator phenotype status was studied in 61 patients with rheumatoid arthritis (RA), of whom 27 had associated Sjögrens syndrome (SS). The acetylation tests were carried out by means of isoniazid and in 24 patients also with the use of dapsone; there was complete agreement between the outcome of the two tests. The results showed that the frequency of slow acetylators in the whole material was 59%. In RA patients with SS, however, the frequency of slow acetylators was as great as 78%, while it was only 44% among patients without SS (p less than 0.02). Thus, there appears to exist a (pharmaco) genetic difference between RA patients with and without SS. In addition, toxicodermias were found to be more frequent in RA patients with than without SS (P less than 0.01). However, this could not be systematically correlated to slow acetylation.

Anaerobic Bacterial Coxitis and Pseudocystic Tumour in Rheumatoid Arthritis: A Case Report

When patients with rheumatoid arthritis develop rapidly growing tumours around the hip or elbow joint, the possibility should be considered that this condition could be pseudocystic with a low virulent infection. The present report describes such a case of anaerobic bacterial coxitis with rapidly growing tumour.

Ankylosis of wrist and small joints of the hand occurs in rheumatoid arthritis: Diagnostic implication in paleopathology

There are no universally accepted criteria for the paleopathological diagnosis of rheumatoid arthritis (RA). Recent clinical studies show that small joint ankylosis occur in RA at a low frequency (2%). Presence of small joint ankylosis in paleopathological material does therefore not allow one to exclude a diagnosis of RA provided no other bone changes suggestive of spondyloarthropathy are present.