Rheumatology 2001; 40: 116
© 2001 British Society for Rheumatology
Robin Goodfellow
Heigh ho, dwarves and trolls. The mischievous Robin must report to you an amazing study that has won the IgNobel Prize for Chemistry this year. Marazziti et al. from Pisa (Psychol Med 1999;29:741–5) [Medline] evaluated the serotonin transporter in those who had recently fallen in love and discovered that the density of 3H-paroxetine binding sites was significantly lower than in controls, and similar to that of sufferers from obsessive-compulsive disorder. One wonders what the effect of aspirin might be, or whether they have studied patients with Hughes’ syndrome. Further IgNobel prizes can be found on the Web at http://www.improbable.com/ig/ig-top.html.
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Robin wonders, apropos nobelity (sic) whether we should have a journal called ‘Archives of the Blindingly Obvious’ to take articles rejected by the Journal of Negative Results. His award for unsurprising conclusion of 2000 has to go to Kauranen and colleagues
(Ann Rheum Dis 2000;59:812–6)
Will we learn further lessons applicable to RA from studying Leishmaniasis? If a recent review is anything to go by the answer is yes
(Roberts, Handman and Foote, Br Med J 2000;321:801–4).
is implicated and the pattern of disease exhibited depends on the T-helper cell response, as in leprosy. Not only is this genetically determined, but also it may be possible to identify susceptible individuals and target therapy appropriately.
Robin's thoughts were provoked by a study of early ‘poor prognosis’ RA from Leeds (Proudman et al., Arthritis Rheum 2000;43:1809–19) [Web of Science][Medline] which compared a combination regime of methotrexate, cyclosporin and steroids against sulfasalazine. It concluded that at 48 weeks the ACR 20 score was not significantly different. It was not the largest of studies, though, and although they suggest a ‘step-up’ approach to early treatment is more appropriate I'm not so sure. There was a significant difference in erosion counts—only in the right hand, but that being in all probability the dominant hand in the majority that difference might be more significant than they think. I will await the 15-yr follow-up data on surgical intervention (or a larger study). Nice of them to include the formula for calculating the DAS 28 score—I’ve been hunting for that for ages.
Orthopaedic surgeons are showing an embarrassing interest in whether physicians are doing their job. Freed-man and colleagues (J Bone Joint Surg 2000;82A:1063–9) conducted a huge survey of over-55s who had sustained a wrist fracture, and found that only 24% received diagnostic evaluation or treatment for osteoporosis, suggesting in conclusion that they, the orthopaedic fraternity, should step into the breach. It is an American study; but already over here they are teaming up with elderly care physicians to deal with this problem. How long will it be before primary care physicians have got their finger on this pulse?
Many crusty old physicians berate physiotherapists for continuing with outdated methods for which there is little evidence base, but the times they are a-changing. A very large study by Enderby et al. (Br J Clin Governance 2000;5:86–92) has compared practice in a number of hospitals and concluded that there are no common criteria for discharge, and that the same therapy in different departments produced different results. Hardly surprising, perhaps, but we do need to know where we are starting from before we can set standards and guidelines and it is good to see that all professions are taking governance seriously.
Some physiotherapists of my acquaintance still seem to think that knee treatment is not worthwhile in anterior knee pain, but not so, according to Clark et al.
(Ann Rheum Dis 2000;59:700–4).
In the same issue is a review of the rheumatological manifestations of Parvovirus
(Kerr, Ann Rheum Dis 2000;59:672–83).
Another bug may just be implicated in systemic sclerosis, as a report suggests that antibodies against human cytomegalovirus cause apoptosis of endothelial cells (Lunardi et al., Nature Med 2000;6:1183–6).[Web of Science][Medline] One does wonder, given the diversity of organisms that exhibit cross-reactivity or molecular mimicry, whether the key peptide chain may be something quite small and possessed by a number of related bacteria or viruses, which might explain why it is so difficult to pin them down. Such a hypothesis is not new, as it was outlined by Brewerton many years ago, but Robin likes a bit of history.
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