Rheumatology 2001; 40: 718
© 2001 British Society for Rheumatology
Robin Goodfellow
Bonjour. A greeting used advisedly, in view of the new continental gateway disease invented by a temporary secretary—Doverlap syndrome. It appeared the same week as an inflammation of the pace antirhinus and a part of the body only to be identified when reading aloud (or is it allowed? I am getting muddled) as somewhere near the knee. Bless.
|
I wonder what those thick, or not so thick (at least in our neck of the woods) orthopaedic surgeons will make of the elegant analysis of Gulf War syndrome by Simon Wessely (Clin Medicine 2001;1:28–37). For years orthopods have argued that much of the post-injury compensation ‘illness’ they have seen is imaginary. Wessely and colleagues suggest that symptoms were reported when triggered ‘as an unexpected reaction to measures taken to protect the armed forces against modern warfare, reinforced by the social and psychological pressures and changes that war brings to all it touches. These narratives were taken up by the powerful media, and shaped into a particular syndrome under the influence of popular views of health, disease and illness. Further impetus came from the actions, or inactions, of government, and only recently by the activities of doctors and scientists’. Sounds just like fibromyalgia to me—a load of mysticism dignified by (often pretentious) pseudoscience. Back to the evidence base, I cry. Having ranted, of course it now appears that another crazy notion, namely that overhead power lines may cause cancer, has acquired some respectable evidence. We will have to wait and see.
Two articles discuss the management of post-stroke shoulder pain
(Price and Pandyan, Clin Rehabil 2001; 15:5–19,
Robin's hospital has been smitten recently by an outbreak of epidemic winter vomiting (a highly infectious aerosol-borne virus) which shut four wards at once and resulted in much staff and patient inconvenience. Some inter-ward spread was attributed to the movement between wards of junior medical staff and bank nurses, and there is little doubt that MRSA is spread by the failure to wash hands between patients. Some contrast between the precautions in and around hospitals against these things (i.e. not a lot) and those employed for foot and mouth disease, isn't there? There are no disinfectant footbaths outside Robin's wards, neither do we slaughter all patients with colds. I tell this tale because a South African patient described how on her uncle's farm, years ago, a handkerchief would be wiped round the nose of a cow with foot and mouth and dipped in a water trough so all the animals got it. Herd immunity, truly. Robin cannot quite see what is wrong with vaccination or how human and animal infections should be treated so differently, but he is presently unable to walk in his local park lest the deer catch it.
Other less prosaic bugs are discussed by Taylor-Robinson and Keat in an editorial which examines the potential role of Borrelia, Mycoplasma and Chlamydia in inflammatory arthritis
(Ann Rheum Dis 2001;60: 177–84).
Could lupus be due to sand? A curious case report suggests that silica has potentially serious effects on the immune system; a girl whose face went through the windscreen in a car accident developed discoid lupus erythematosus in the cheek where glass had been embedded (Ueki and Omori, Eur J Dermatol 2001; 11:127–30.)[Medline] Robin owns to believing that the deleterious effects of summer holidays has more to due with sun exposure than having sand kicked in one's face.
If one can give alendronate at a dose of 10 mg daily, why not give 70 mg once a week? Robin's patients like the idea, and it seems to be just as effective (Baran, D., Geriatrics 2001;56:28–32).[Web of Science][Medline]
By the time you dear readers read this, it is likely that the British General Election will have come and gone, and no doubt we will be in for more of the same (rationing, double counting of new money, doctor-bashing, etc). Robin is interested to learn that the availability of TNF-
blockers across the UK is remarkably patchy. Some Health Authorities have stumped up extra cash, some have dribbled a little but many have flatly refused to fund them at all. Human Rights issue? Questions in the House? Impressed by the government's sudden and bewildering determination to offer universal prostate cancer screening with a blood test for PSA (one might say a piss-poor discriminator), Robin hopes that it will come to its senses and enforce a fair and uniform policy across the nation. Elections do funny things to governments (like they start making promises) but I fear that the cumbersome bureaucracy of NICE may be a cunning excuse to do nothing. Back to the high dose methotrexate, chaps.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||