Rheumatology 2001; 40: 360
© 2001 British Society for Rheumatology
Robin Goodfellow
Yee-hah, line dancers. No need to fear that you will have to give up for fear of developing osteoarthritis of the hip—unless it runs in the family. The Nottingham group (Lanyon et al., Br Med J 2000;321:1179–83)
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Osteoarthritis is attracting lots of interest at last. A large conference at the National Institutes of Health has been reported
(Ann Intern Med 2000;133:635–46—for part 1, which covers the condition and risk factors).
Lastly on OA Robin found an appraisal of the use of glucosamine and chondroitin in one of the new reviews of reviews of reviews journals
(Evidence-Based Nursing 2000;3:124)
Occasionally Robin goes hunting for malignancy in the patient with unexplained rheumatological manifestations or funny blood tests. A new review of paraneoplastic syndromes has recently appeared (Fam Clin Rheumatol 2000;14:515–33) which is quite useful. It would however, have been more helpful if it had included a list of cancers and the syndromes associated with them. Robin spent ages trying to track down whether uterine cancer was so associated, his friendly gynaecologists having denied all knowledge (it is, but he will leave the fun of discovery to y'all). And when did the Eaton–Lambert syndrome become the Lambert–Eaton syndrome? This eponymous fiddling gets on Robin's nerves (he was taught about Jakob–Creutzfeldt disease, which reversed to become CJD, but feels the biscuit must go to the Plummer–Vinson–Paterson–Brown–Kelly syndrome).
Robin's use of needles in gout is confined to aspiration of a joint to prove the diagnosis but an unusual paper appeared in Acupuncture in Medicine (Pang et al., 2000; 18:29–31) suggesting benefit from the traditional Chinese technique, both in reduction of attack frequency and in uric acid levels. The methodology is slightly suspect; diagnosis was made on clinical grounds alone and some of the records were lost in transit between Zanzibar, where the study was done, and China.
Robin wonders whether NICE should look at the cost-effectiveness analysis by Choi, Seeger and Kuntz (Arthritis Rheum 2000;43:2316–27).[Web of Science][Medline] The study examined treatment of methotrexate resistant arthritis; it concluded that in a methotrexate-naïve patient the cost of achieving an ACR-70 response over 6 months with 15 mg methotrexate weekly was US$1500, while methotrexate with etanercept came out at US$34800. Is this acceptable, they ask? This depends, Robin imagines, on whether you are a patient or a Health Authority Chief Executive. If you are both, a psychiatrist might be required.
Two papers on examination caught Robin's eye; the first entitled ‘How I examine the knee’
(Bollen, Curr Orthop 2000;14:189–92).
It is a useful guide especially for ligament testing, although his test for loss of extension (‘picking up the limbs by the toes will identify any difference ...’) would bring tears to most of Robin's RA patients. Somewhat surprisingly the still pictures and the descriptions do convey the message clearly (try writing down how to tie a tie). This could not be said of an illustrated tutorial of musculoskeletal sonography
(Part 3, lower extremity, by Lin et al., Am J Roentgenol 2000;175:1313–21).
A timely review of recent advances in rheumatology
(Madhok, Kerr and Capell, Br Med J 2000;321:882–5)
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