Obituary: Philip J. R. Nichols.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to V Wright.
Explore the source record for details and available documents.
A five-centre double-blind crossover trial of two two-week periods using diclofenac and indomethacin showed that both drug groups (51 patients) with rheumatoid arthritis responded similarly in relation to pain scores and morning stiffness. It was noted that the response was better in inpatients than in outpatients, despite differences in disease severity. In the osteoarthritis trial (58 patients) it was shown that neither drug significantly reduced resting pain, although both drugs were significantly better in reducing pain on movement; however, patient preference was for diclofenac. Three patients treated with indomethacin withdrew owing to side-effects, compared with one on diclofenac. A slight but significant decrease in haemoglobin levels was observed in both treatment groups with osteoarthritis, but this did not appear to be symptom-related.
A group of diseases--ankylosing spondylitis, psoriatic arthritis, Reiter's disease, ulcerative colitis, Crohn's disease, juvenile chronic arthritis (Still's disease), Whipple's disease, and Behçet's syndrome, which previously were thought to be variants of rheumatoid arthritis, now appear to be distinct from that disease but linked together in a group termed "seronegative spondyloarthropathies." Detailed studies have been made of the clinical, radiologic, and serologic features of these individual diseases. Extensive family studies have been done epidemiologically and through examining pedigrees. These have demonstrated clinical interrelations and familial aggregation. Ankylosing spondylitis is a feature of all the groups. Studies in which B27 was found more frequently in each of these groups confirm the interrelation and suggest a genetic predisposition with a gene related to B27. There is other evidence for environmental factors such as infection in certain of the diseases. The findings have important implications in the management of the disorders.
Of 227 patients with psoriasis and rheumatic complaints, inflammatory arthritis was present in 168 patients, of whom 95 have been followed up for more than 5 years and 28 had been followed up for more than 10 years. In patients with psoriasis and inflammatory arthritis the majority were women, but in the Distal joint group, males predominated. The skin disease usually began on the arms and was restricted in extent, initially. It usually began before the arthritis. A few cases were apparently precipitated by trauma, but more by psychological factors. The course pursued by the skin lesions was generally favourable. The skin lesions were resistant to treatment in 20% of the patients. Puberty, pregnancy and the menopause had little effect on the skin lesions. Nail lesions were present in 80%, a greater frequency than that seen in uncomplicated psoriasis. These nail lesions began at a later age than the skin lesions, and commonly preceded the development of arthritis. There was a family history of psoriasis in 26% of first-degree relatives. A history of polyarthritis was obtained quite frequently, and of psoriatic arthritis in 3% of patients with Distal arthritis, and 2% of the Indistinguishable group. The arthritis was usually mild in degree. Ankylosing spondylitis occurred in 5% and sacro-iliitis in 19%. The sheep cell agglutination test for rheumatoid factor was negative in the majority of patients. It was positive in 16% and a fluctuating positive result was obtained in 10%.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
It has been recommended that benorylate may be administered with hot beverages to overcome the problem of its relative unpalatability. Urine salicylate recovery used as a measure of bioavailability in 20 normal subjects has shown that hot coffee has no significant effect on drug availability from the orally administered suspension.
Indomethacin, 100 mg orally, was compared with prednisolone, 5 mg, as addititional therapy at night, in a two-week, double-blind, between-patient study in twenty-four in-patients with rheumatoid arthritis. Both therapies proved equally effective, and significantly lessened morning stiffness and increased grip strenght. Two patients with dyspepsia were discontinued from the indomethacin group. Using indomethacin at night avoided the central nervous system side-effects frequently seen with this compound.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A clinical and radiological survey of bone and joint changes in 42 lower limb amputees is reported. There was a significant increase in osteoarthrosis in the knee of the unamputated legs compared with the amputated side. The amputated side characteristically showed osteoporosis. Comparing the prevalence of osteoarthrosis in this study with figures in the population, it is more likely that the osteoporosis of the amputated limb had a protective effect on that side than that mechanical factors produced more osteoarthrosis on the contralateral side. Backache occurred in about half the patients, and was severe in 19%. It did not appear to be related to disc degeneration, but scoliosis was observed in 64% of patients.
Nitroblue tetrazolium test scores were obtained in 43 patients with psoriatic arthritis, 32 patients with rheumatoid arthritis, and 16 patients with osteoarthrosis. The mean score in all groups was similar and was higher than previously reported in patients awaiting heart surgery or with noninfective dermatoses. The test is not thought to be helpful in differentiating psoriatic arthritis from rheumatoid arthritis, and its usefulness in the diagnosis of septic arthritis superimposed on other forms of arthropathy is limited.
Good correlation has been shown between pain scores derived from 4 different rating scales. The correlation was maintained when presentation of the scales was separated by a series of questions and by physical examination. There is good evidence that the 4 scales are measuring the same underlying pain variable as they calibrate well. There is also evidence that an 11-point (0-10) numerical rating scale performs better than both a 4-point simple descriptive scale or a continuous (visual analogue) scale.
The accuracy of information derived from a visual analogue scale has been assessed by comparing the measured grip strength of 100 subjects against their estimate of grip strength scored on a visual analogue scale. There was relatively poor correlation between the measured and assessed values, suggesting that similar inaccuracies may occur when the scales are used to assess subjective phenomena.
Seven different types of lecturing technique were assessed in 14 groups of nurses at 2 hospitals. Two lectures in rheumatology were given to each group and a multiple choice questionnaire answered by the nurses immediately after the lecture and 3 months later. A significant amount of knowledge was imparted by the lecturer. About a third of the knowledge, however, was lost within a minute of the end of the lecture, and a half to two-thirds within 3 months. There was no correlation between scores and the row on which the students sat. There was no significant difference between the scores of overseas students and those of British nurses. At immediate recall the techniques differed little. The techniques which scored best were giving the questionnaire before the lectures, giving handouts and using the blackboard. At delayed recall 100% differences in marks were seen between the worst and best techniques in the second lecture. The same techniques which scored best at immediate recall did so on delayed recall. The lowest score occurred where note taking was forbidden. Some questions scored significantly better with note taking. When note taking was forbidden, it made no difference if the student was an habitual notetaker or not. Nor did it make any difference if she was frustrated by the ban. There was no correlation between entry qualifications and the scores obtained. Nurses at a non-teaching hospital did just as well as those at a teaching hospital. It should be emphasised that teaching endeavours to influence 3 aspects-knowledge, skills and attitudes. This series of experiments largely tests the first, but does suggest that a technique which scores highly on information recall may be less helpful in forming constructive attitudes to the patient.
Gamma glutamyl transpeptidase (GGTP) was measured in 62 patients with rheumatoid arthritis (RA) and 27 with osteoarthrosis (OA). The values for GGTP were significantly higher in the subjects with RA compared with the OA group. The prevalence of elevation of GGTP was higher in the RA subjects (77%) than in the OA patients (33%). Levels of GGTP correlated significantly with a number of objective indices of activity of RA in a separate group of 28 patients. Following treatment with penicillamine, GGTP levels showed a significant drop towards normal levels.
Explore the source record for details and available documents.