Biomedical subjects
Publications and source records attributed to V Wright.
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.
Floctafenine 200 mg four times a day was compared with placebo in 30 out-patients with osteoarthrosis in a double-blind controlled study. There was a significant patient preference for, and a greater relief of pain with, floctafenine. Pain on walking and joint stiffness after sitting were significantly less on floctafenine. There were no differences in side-effects between floctafenine and placebo.
Thirty-seven housewives treated in hospital for rheumatoid arthritis were investigated with particular reference to their husbands' reactions. Although most patients had 'accepted' the disease, many were distressed by both the physical aspects of it (tiredness, pain and limitation of activities) and by the psychological aspects (guilt, fear of being a burden, and not understanding the disease). In 70% it was felt that their husbands understood the disease, but half the patients had difficulties in coping with the anxiety of their husbands. Those whose arthritis had developed before marriage fared better in terms of fear of losing their independence, understanding the disease, guilt feelings, adjustment to the disease, their husbands' understanding and friction in the home. Patients with milder disease were more anxious, but experienced the greater understanding of their husbands. Help was required in enabling the patients to cope with their fears, to manage practically, and to deal with the anxiety of their husbands. Help in coping with the fears and in allaying the anxiety of their husbands was most required in those with mild disease and those in whom it had progressed to become socially disabling, but without confining the patients to their homes.
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(1) An apparatus has been constructed to measure the coefficient of friction of synovial membrane against a glass slider. (2) Provision was made to vary the load on the specimens. (3) The coefficient of friction varied from 0-006 to 0-07. (4) A presentation similar to that used in the Sommerfeld analysis of journal bearings indicated that in these experiments synovial membrane was lubricated in the hydrodynamic regimen.
A study of 200 rheumatic patients attending an outpatient clinic and 72 general practitioners (GPs) was undertaken in relation to the administration of antirheumatic drugs. (1) Both patients and GPs agreed that effectiveness, absence of toxicity, and once daily administration were the important features of administration. (2) Significant differences between GPs and patients were noted in that patients more frequently preferred capsules than tablets. (3) GPs thought red was the best colour for an antirheumatic tablet, whereas patients thought white, this opinion being partly determined by the possible confusion of red tablets with sweets by children. (4) In a survey of 174 outpatients with rheumatic diseases, those with rheumatoid arthritis did not like blister packaging. A detailed assessment of 30 patients with rheumatoid arthritis in hospital confirmed this. Patients with moderate or severe rheumatoid disease of the hands often could not extract tablets from blister packs. Those who could found the packs difficult to open, the tablets broke, and came out suddenly, falling to the floor.
227 patients with psoriasis and various forms of arthritis have been kept under review. Psoriasis and inflammatory arthropathy was present in 168 patients, of whom 94 have been followed up for more than 10 years. An arthritis indistinguishable from rheumatoid disease was present in 78%, distal joint arthritis in 16-6%, and deforming arthritis in 4-8%. There was a female predominance in the sex ratio of patients, although males predominated in the distal joint group (male:female 1-5:1). The peak age of onset was between 36 and 45 years, although in the deforming group the arthritis began before the age of 20 three times as commonly as it did in the indistinguishable group. Onset was acute in nearly half of the patients. At onset the distal joints were affected in one-third of the distal joint group. A synchronous onset of skin and joint changes was uncommon. Skin lesions usually preceded the arthritis but occurred after onset in 16%. Apart from in the deforming group, the arthritis was mild, judged by the number of admissions to hospital for treatment of the joint disease, and the time off work. Deterioration clinically and radiographically occurred in only a small portion of the distal joint and indistinguishable groups. Antimalarial drugs have been used in 7 patients, with deterioration of the skin condition in 4. Uveitis occurred particularly in the men of all three groups, but was most frequent in those with deforming arthritis. A family history of psoriasis was obtained in 26% of first-degree relatives and 13% of second-degree relatives. A history of polyarthritis was most common in patients in the deforming group. The sheep cell agglutination test was negative in the majority, but was positive in 16% of the indistinguishable group, fluctuating in a further 10%. A small number of joints only deteriorated radiographically (10% of the distal and indistinguishable groups). The men in the distal group showed greater radiographic changes and more deterioration in the terminal interphalangeal joints of the fingers than the women. Similarly they showed more deterioration of the metatarsophalangeal joints than the women. 18 patients died, one with gastric haemorrhage resulting from treatment of exfoliative psoriasis with immunosuppressive therapy, and 2 from bronchopneumonia thought to be related to immobility caused by the arthritis.
186 patients with periarthritis of the shoulder have been studied. The sex ratio was female:male, 1-52:1. The peak age of onset was 54-59 years in both sexes. Over 40% of the patients were referred to the clinic after 6 months had elapsed from the time of onset of the disease. The right shoulder was more frequently involved than the left, particularly in the men. One shoulder only was affected in 75% of patients. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. There were a number of associated diseases, ischaemic heart disease, thyroid disease among women, diabetes among women, hemiplegia, pulmonary tuberculosis, chronic bronchitis, and epilepsy. Acute trauma was rarely a precipitating factor. Manual workers were more frequently seen than sedentary workers in the sample, and there were more in the sample than in the general population of Leeds. The general psychological background was no different from a control group. The Maudsley Personality Inventory gave no different results among patients with periarthritis of the shoulder than among a control group and among the general population. It is suggested that there is no evidence in this study for a 'periarthritic personality'. It is suggested that the cause of periarthritis of the shoulder is likely to be related to chronic trauma occurring in an age range when changes in connective tissue are occurring. Certain associated diseases may predispose the patient to this disorder.
A group of 113 women and 73 men with periarthritis of the shoulder have been studied in detail. Electromyography showed 4 patients with neuralgic amyotrophy who had been referred for the shoulder study but were excluded on this basis. Nerve conduction studies showed little difference between the periarthritic group and a control group, apart from some reduction in amplitude and potential, and in women a suggestion of an increased latency. Duration of the action potential was equal. 6 patients had an undoubtedly long latency compatible with median nerve compression. Degenerative changes were found in the glenohumeral joints in 6-9%. Degenerative changes were found at the acromioclavicular joints in 31% of the men and 44% of the women. Calcification was found around 11 of the shoulder joints. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. Arthrography was performed in 7 patients and there was a reduction in volume of material that could be injected in only one patient. There was obliteration of the axillary fold in that patient, and a torn capsule in a patient who had previously been manipulated. Lateral cervical spine x-rays were compared with films from an epidemiological survey. The disc space/vertebral body height ratio was taken, overcoming the magnification effects shown by technical alterations in the method of taking films. Good intra- and interobserver correlation was found for this ratio, but not for the width of the canal. There was no difference in the disc/body ratio between the periarthritic and control group in the upper cervical region. In the C5/6 and C6/7 intervertebral discs there was evidence of more disc degeneration in the periarthritic group. The differences from the control group were not great because of the high incidence of disc space narrowing and osteophytosis after the age of 45 years in the general population.
In a study of 112 patients (49 men, 63 women) with psoriatic arthritis, ocular inflammation was noted in 35 (31.2%). Conjunctivitis was the most common lesion, being found in 19.6% (10 males, 12 females). Iritis occurred in 7.1% (5 men, 3 women), episcleritis in 1.8% (1 man, 1 woman), and keratoconjunctivitis sicca in 2.7% (3 women). 20 patients (10 men, 10 women) had radiological sacroiliitis and 11 of these (7 men, 4 women) had ankylosing spondylitis according to the New York criteria. Eye lesions were noted in 7 of the patients with sacroiliitis, 3 having iritis (15%) and 4 (20%) conjunctivitis. 2 patients with spondylitis had iritis (18%) and 1 (9%) conjunctivitis. It is concluded that inflammatory eye lesions are a frequent accompaniment to psoriatic arthritis. This is taken as further evidence for the concept of the seronegative spondyloarthritides.
Histocompatibility (HL-A) antigen typing was performed on 82 patients with psoriatic arthritis. The prevalance of HL-AB27 was increased (28%) compared with that in a control group (7-5%), and this was most marked in those with spinal changes. The prevalence in patients with sacroiliitis and syndesmophytes was 75%, with sacroiliitis alone 78%, but with syndesmophytes and normal sacroiliac joints only 36%. The overall prevalence in psoriatic spondylitis was 60%, with a prevalence of 71% in those fulfilling the New York criteria for anklosing spondylitis. The prevalence was not increased in those with only peripheral arthritis (11%). The prevalence of HLA-B13 was decreased in those with psoriatic spondylitis, though this was not statistically significant. The overall prevalence of HLA-BW17 was increased, this being particularly so in those with syndesmophytes, but values were not significant.
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Mechanisms of lubrication of human synovial joints have been analysed in terms of the operating conditions of the joint, the synovial fluid and articular cartilage. In the hip and knee during a walking cycle the load may rise up to four times body weight. In the knee on dropping one metre the load may go up to 25 time body weight. The elastic modulus of cartilage is similar to that of the synthetic rubber of a car tyre. The cartilage surface is rough and in elderly specimens the centre line average is 2-75 mum. The friction force generated in reciprocating tests shows that both cartilage and synovial fluid are important in lubrication. The viscosity-shear rate relationships of normal synovial fluid show that it is non-Newtonian. Osteoarthrosic fluid is less so and rheumatoid fluid is more nearly Newtonian. Experiments with hip joints in a pendulum machine show that fluid film lubrication obtains at some phases of joint action. Boundary lubrication prevails under certain conditions and has been examined with a reciprocating friction machine. Digestion of hyaluronate does not alter the boundary lubrication, but trypsin digestion does. Surface active substances (lauryl sulphate and cetyl 3-ammonium bromide) give a lubricating ability similar to that of synovial fluid. The effectiveness of the two substances varies with pH.
Thirty-six patients with active rheumatoid arthritis were treated in a double-blind cross-over study of phase-release aspirin tablets and aspirin B. P. tablest. Twenty-nine patients completed the study. The phase-release preparation given twice daily proved as effective as aspirin B.P. given four times daily. Better results were produced by the phase-release aspirin in respect of the degree and duration of morning stiffness, grip strength and joint size, although the differences did not reach the level of statistical significance. The E.S.R. was significantly reduced by the B. P. preparation but this result was thought to be due to an order effect in the weeks of therapy.
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