Biomedical subjects
Publications and source records attributed to R Grahame.
Artificial insemination by donor (AID) has been complicated by the transmission of several genital infections. We describe the case of a man with Reiter's syndrome whose illness followed AID treatment of his wife.
Serum and synovial fluids from 16 patients with seronegative arthritis and eight with rheumatoid arthritis were studied for immunoglobulin levels and for antibody levels to five viruses. When allowances were made for the distribution of immunoglobulins between serum and synovial fluid there was evidence that in several patients antibody to one or more viruses was synthesised locally in the joint. IgG and especially IgM were present in greatly increased amounts in arthritic joints compared with normal joints. On the basis of serum/synovial fluid ratios inflammation and local immunoglobulin synthesis are discussed as possible causes. These results are compared with antiviral antibody and immunoglobulin ratios observed in the serum and cerebrospinal fluid of patients with multiple sclerosis.
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A double-blind, placebo-controlled, crossover trial was carried out to assess the efficacy and tolerance of nabumetone in patients with osteoarthrosis of the hip or knee. Patients were allocated at random to receive either 1 g nabumetone twice daily or matching placebo for 2 weeks and then crossed over to the alternative treatment for a further 2 weeks. Clinical assessments of pain and function were made before and at the end of each treatment period. Seventeen of 18 patients completed the trial and the results showed that most clinical parameters assessed were improved during active treatment, with significantly more patients preferring nabumetone (p less than 0.001) to placebo. Only 1 patient reported what was considered to be a drug-related adverse event (irritation of the scalp) during nabumetone treatment.
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Rheumatoid arthritis and primary hyperparathyroidism have been diagnosed in three patients. This is likely to represent the coincidence of two common diseases but the clinical features are discussed with particular reference to the presence and withdrawal of raised levels of circulating parathyroid hormone (PTH). It is argued that raised levels of PTH potentiate the effects of the rheumatoid disease on bone and joints. Other musculoskeletal features of hyperparathyroidism and the actions of PTH on bone are reviewed.
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A double-blind cross-over study of cyclofenil and placebo treatments was conducted in 11 scleroderma patients. Each treatment period was for four months. A range of subjective and objective measurements failed to reveal any consistent or obvious response to cyclofenil. One patient died of his disease during active treatment. Four were withdrawn because of liver dysfunction which was attributed to cyclofenil. It remains to be seen whether treatment over longer periods will exert a clinically significant effect.
In this report we present 21 instances in which live rubella virus was isolated from synovial fluid obtained from 6 cases of inflammatory oligoarthritis or polyarthritis over a period of 2 years in the absence of firm clinical evidence of rubella. In 3 cases (cases 1, 2, 6,) a persistent oligoarthritis predominantly affecting the knee joints occurred in 2 adult women and one man, lasting to date 27, 29, and 18 months respectively, and in one of these cases virions were found in cells of the synovial membrane. In case 3 a boy of 9 presented with an illness indistinguishable from the systemic variety of juvenile chronic arthritis (Still's disease). In case 4 a young man with persistent monoarthritis was found to have ankylosing spondylitis, and in case 5 a progressive erosive polyarthritis developed 5 years after an attack of rubella complicated by rubella arthritis. The virus was identified by a variety of virological techniques and infection confirmed by immunofluorescence and (in one case) electron microscopy.
In a double-blind crossover trial, 200 mg feprazone 3-times a day was compared with 200 mg twice a day in the treatment of osteoarthritis. There was no difference in clinical efficacy or in adverse effects between the two dosage schedules. Because of its long elimination half-life (approximately 24 hours) it is suggested that feprazone should be given in twice daily dosage and is a simple and effective treatment for osteoarthritis.
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Four cases of the triad of rheumatoid lung disease, spontaneous pneumothorax, and peripheral blood eosinophilia are reported. Cavitation of a rheumatoid lung nodule caused the pneumothorax in at least 1 case. The significance of eosinophilia and its value as a marker of extra-articular manifestations of rheumatoid disease are discussed.
Clinical evidence for an abnormally of extracardiac connective tissue was sought in 21 patients with idiopathic mitral valve prolapse and was compared to that in 21 matched controls. The incidence of rheumatic and orthopaedic complaints and the prevalence of hypermobile joints, Marfanoid habitus, and skeletal deformity were compared in the 2 groups. Skin thickness and elasticity were measured, and the mean values in the 2 groups were compared. hypermobile joints were significantly commoner in patients with mitral valve prolapse. Easy bruising was reported significantly more commonly by patients with mitral prolapse; the incidence of other rheumatic complaints was similar in the 2 groups. There was no significant difference in skin thickness, skin elasticity, and the prevalence of either skeletal deformity or Marfanoid habitus between patients with mitral valve prolapse and controls. The results support previous evidence of an association between mitral valve prolapse and benign hypermobility of the joints, but emphasise that many patients with mitral valve prolapse have no clinically apparent connective tissue abnormality outside the heart. It remains uncertain whether the valve lesion in these patients represents a tissue-specific abnormality of mitral valve collagen or the only clinical expression of a minor systemic connective tissue abnormality.
A cytopathic agent indistinguishable from rubella virus was isolated from the synovial fluid of five patients (two male and three female). In two patients isolations were made on two separate occasions, and in two others on five separate occasions. The patients ranged in age from 9-58 years, and they presented with a variety of clinical syndromes. In particular, none had clinical features suggestive of recent rubella infection; but most cases had very high serum rubella haemagglutination inhibition titres. The identity of the cytopathic agent was shown by a variety of virological techniques to be rubella virus.
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