Biomedical subjects
Publications and source records attributed to J A Mathews.
Two cases are reported of a reactive arthritis due to infection with Yersinia enterocolitica. These are the fifth and sixth cases reported in the United Kingdom. This interesting cause of arthritis may be more common than previously thought and should be considered even in the United Kingdom, although the practical implications are limited.
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Raised serum alkaline phosphatase (AP) levels were found in 13 of 76 patients (17%) with ankylosing spondylitis (AS), and 11 of these 13 underwent further investigation to determine the origin of the increased enzyme activity. Three had levels within the normal reference range on re-estimation, and, of the remaining 8, AP isoenzyme studies indicated an increased liver fraction in 6. Serum gamma-glutamyl transpeptidase (GGT) was raised in only 3 patients. Increased AP activity did not appear to be directly related to disease activity or to drug therapy. These findings confirm the occurrence of increased serum AP activity in AS but challenge a previously reported suggestion that bone is the source of the increased enzyme.
In rheumatoid disease only 4 cases have been reported in which lung nodules preceded arthritis. Two further cases are presented in which intrapulmonary nodules were noted at the onset of the disease, thus provoking a diagnostic dilemma. In the first patient rheumatoid factor tests were initially negative, and diagnostic thoracotomy was performed. In the second patient serological tests were positive, and biopsy was avoided. It therefore seems that detection of circulating rheumatoid factor in patients with lung shadows can be a useful aid to diagnosis and management.
The concentration of lactic acid in synovial fluid was estimated in 43 specimens from patients with an acute monoarthritis by a simple enzyme method. In 9 patients with 10 episodes of septic arthritis concentrations of synovial fluid lactic acid were significantly higher (mean 10.8 mmol/l) than in 33 patients with nonseptic effusions (mean 3.1 mmol/l). With this method concentrations of synovial fluid lactic acid provide a rapid diagnostic guide in the separation of septic from nonseptic arthritis.
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A double-blind, cross-over comparison of Naprosyn (naproxen) 750 mg daily and Butacote (enteric-coated phenylbutazone) 300 mg daily was carried out in a multi-centre trial. Twenty-five patients, mostly male and under 40 years of age, were entered. After a 2-week period in which any existing anti-inflammatory drugs were tailed off, patients were entered into the trial and treated for 1 month with each drug. Patients were assessed at 4-weekly intervals. Both drugs significantly reduced morning stiffness. Morning pain and discomfort and wall-tragus distance were also significantly reduced by both drugs during the trial. Results of the Schober test showed improvement during both treatment periods. There were no overall statistically significant differences between the effects of the 2 drugs on objective parameters. However, overall subjective assessment of symptoms showed a greater improvement on Butacote. Treatment preferences by physician and subjective assessment by the patient both favoured Butacote but the difference between the 2 drugs was not statistically significant. Side effects were mostly of a minor nature. One patient had to discontinue the trial, due to indigestion while taking Butacote.
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A double-blind control study of lumbar traction for sciatica has been carried out. Although there is a tendency for traction to produce improvement in pain and straight-leg raise the extent does not achieve statistical significance. Changing 'control' patients to 'treatment' seemed to produce worthwhile relief of pain for all who were not already improving. It is suggested that a large trial using more discriminating criteria might delineate a group of patients susceptible to help by traction.