Biomedical subjects
Publications and source records attributed to I Haslock.
Rheumatoid arthritis and gout are both common rheumatic diseases, but their coincidence is rare. We report the case of a 67-year-old Caucasian woman with rheumatoid arthritis who later developed tophaceous gout. The tophi disappeared with remarkable rapidity on treatment with allopurinol.
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It is known that the surface of articular cartilage is rough and it has been suggested that this is likely to affect the lubrication of human joints. This paper describes the direct measurement of a cartilage surface with a stylus instrument. It is found that the height distribution is Gaussian with an inverse-square power spectrum. It is thus possible to calculate the elastic deflection of the surface under normal walking loads and it is shown that the mean separation of the cartilage surfaces in a human joint varies rather slowly with load. In one particular hip joint at heel strike the real area of contact was calculated to be about 1.3 cm2, the mean gap to be about 60 micrometers and the trapped volume to be about 80 percent of that when standing.
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A double-blind controlled trial was carried out in 18 in-patients with classical or definite rheumatoid arthritis to assess the effectiveness of night-time medication with 100 mg indomethacin plus 10 mg diazepam, 200 mg sulindac, and 200 mg sulindac plus 10 mg diazepam in improving sleep and reducing night pain and the duration of morning stiffness. Patients received each treatment regimen for 1 night. The results from the 17 patients completing the full trial protocol indicated that indomethacin plus diazepam was the most effective of the three regimens, although the differences did not reach conventional statistical significance. It is suggested that in further such studies with sulindac a larger dose and a longer duration of treatment should be used.
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Seventeen of eighteen patients hospitalized for active rheumatoid arthritis completed a three-day randomized, double-blind comparison of 100 mg indomethacin, 100 mg indomethacin with 10 mg diazepam and matching placebo as night medication. The results showed a consistent pattern in the four functions measured--pain, morning stiffness, sleep score and patient preference. In each, indomethacin proved superior to placebo and the combined therapy better than indomethacin alone. From this it has been concluded that the combination of indomethacin and diazepam should now be considered the treatment of choice for maximum control of night pain and morning stiffness in rheumatoid arthritis.
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Feprazone, 200 mg t.d.s., was compared with indomethacin, 25 mg t.d.s. rising to 50 mg t.d.s., in an eight-week double-blind cross-over study in twenty-three patients with active rheumatoid arthritis. Both therapies proved equally efficacious and acceptable. Measurement of the plasma levels of the two drugs showed no consistent correlation between efficacy and plasma concentrations.
A volunteer study was undertaken in which the effect of the co-administration of therapeutic doses of aluminium hydroxide and magnesium trisilicate on the excretion of aspirin derived from enteric-coated preparations was studied. A significant alteration in the pattern of salicylate excretion was seen, but the mechanism of the interaction cannot be deduced from the present study. It was concluded that the interaction was of potential therapeutic importance, and further studies based on this pilot investigation have been initiated.
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The efficacy of indomethacin 100 mg, diazepam 10 mg, and placebo in producing sleep, relieving night pain, and reducing the severity of morning stiffness, was compared in 18 patients in hospital with active classical or definite rheumatoid arthritis.There was no statistically significant difference in the preference of patients or sleep score among the three forms of treatment. Both indomethacin and diazepam were more effective than placebo in relieving night pain. Indomethacin decreased, but diazepam increased, morning stiffness in comparison to placebo. Neither active therapy produced significant side-effects.
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