A Multidisciplinary and a Comprehensive Approach to Reducing Fragility Fractures in Preterm Infants.

With advances in neonatal care, bone fractures prior to discharge from the hospital in preterm infants receiving contemporary neonatal care, are rare. Nevertheless, such fractures do occur in very low birth weight and extremely low birth weight infants who go on to develop metabolic bone disease of prematurity (MBDP), with or without secondary hyperparathyroidism. MBDP is a multifactorial disorder arising from the disruption of bone mass accrual due to premature birth, postnatal immobilisation, and loss of placental oestrogen resulting in bone loss, inadequate provision of bone minerals from enteral and parenteral nutrition, and medications that leach out bone minerals from the skeleton.

The long-term effects of non-steroidal anti-inflammatory drugs in osteoarthritis of the knee: a randomized placebo-controlled trial.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat osteoarthritis (OA), though their long-term efficacy is uncertain. We report a comparison of the symptomatic responses to therapy with tiaprofenic acid, indomethacin and placebo over 5 yr.

Methods: A parallel-group, randomized, single-blind trial of patients with knee OA recruited 812 patients from 20 centres; 307 patients received tiaprofenic acid (300 mg b.

Continuing clinically severe vitamin D deficiency in Asians in the UK (Leicester).

Deprivational vitamin D deficiency began to be noted in immigrant Asians in the early 1960s. Although there have been suggestions that the level of this problem may be declining, we describe a number of clinical cases seen over a consecutive 3 1/2 year period. Musculoskeletal symptoms were the commonest though there were a variety of medical presentations requiring hospital referral.

The three week sulphasalazine syndrome.

We report a 53-year-old man with sero-negative rheumatoid arthritis who developed a fever, rash and hepatitis 3 weeks after starting sulphasalazine therapy. This was associated with a T cell lymphocytosis, eosinophilia and evidence of classical complement pathway activation. He responded to high dose corticosteroids.

Primary pulmonary hypertension associated with systemic lupus erythematosus.

A 24-year-old West Indian woman with a four-year history of systemic lupus erythematosus presented with progressive dypsnoea due to primary pulmonary hypertension. Despite showing a response to vasodilators, these failed to control the condition. Her pulmonary hypertension increased in severity, eventually resulting in her death.

High prevalence of systemic disease and mortality in Asian subjects with systemic lupus erythematosus.

All patients with systemic lupus erythematosus (SLE) (American Rheumatism Association criteria with positive antinuclear antibody titre) and who attended any of the three general hospitals in Leicester over a 10 year period were ascertained using several complementary sources. Eighty seven subjects (26 Asian, 61 white) were identified. The estimated prevalence of SLE in Leicester is 0.

Relapsing polychondritis: an unusual cause of PUO in an Asian lady.

A case of pyrexia of unknown origin (PUO) in a 54-year-old Asian lady is described. She subsequently developed ocular and aural inflammation suggestive of relapsing polychondritis (RP) with immediate clinical improvement following steroid therapy. PUO is an unusual presenting feature of RP.

Large granular lymphocytosis associated with rheumatoid arthritis.

A 74 year old woman with rheumatoid arthritis, hepatosplenomegaly, neutropenia, and peripheral blood lymphocytosis is described. The lymphocytes had a large granular morphology and expressed a CD3+ CD8+ Leu7+ surface antigen phenotype. They did not have natural killer cell function.

Synovial fluid and plasma kinetics of repeat dose sustained action tiaprofenic acid in patients with rheumatoid arthritis.

Tiaprofenic acid is a potent non-steroidal anti-inflammatory drug which, in conventional tablet form, has been shown to be rapidly absorbed and eliminated from the plasma, while synovial fluid concentrations remain constant for at least 8 hours. Recently, a sustained action formulation of tiaprofenic acid has been developed to provide the patient with the convenience of a once daily dosage. The purpose of this study was to measure plasma and synovial fluid concentrations over a 24-hour period following repeated administration of the sustained action formulation, and thus determine the pharmacokinetic profile.

Chemonucleolysis of lumbar intervertebral disc prolapse with chymopapain: outcome after 1 year.

One hundred and one consecutive patients with lumbar disc prolapse were treated by chymopapain chemonucleolysis and their response and favourable pre-treatment criteria determined. Most improvement occurred within the first month, and one year after treatment outcome was judged satisfactory (excellent or good) in 71%. Individual patient characteristics associated with a satisfactory response were sciatica of greater severity than back pain (p = 0.

Phenytoin in rheumatoid arthritis.

In a prospective open study, 18 patients with active rheumatoid arthritis were treated with phenytoin (300 mg/day) for 32 weeks. Clinical assessments improved significantly and there was no relapse 8 weeks after drug withdrawal. Serum C-reactive protein, plasma viscosity and hemoglobin also improved but changes were not significant.

Treatment of chronic knee effusions with 90yttrium-correlation of in vitro radiation and chemical effects with clinical results at three and six months.

Twenty seven knees, mainly of rheumatoid patients, received intra-articular 90Y for chronic effusions; 24% were effusion-free at 6 months. In vitro chemical, radiation (32P-induced), and combined effects of cold (non-radioactive) yttrium and 32P on synovial fluid mononuclear cells, failed to show any significant correlation with subjective and/or objective clinical effects at 3 or 6 months. If 90Y exerts its therapeutic effect via these cells, it probably does so other than by a direct effect on mononuclear cell viability.

A controlled trial of tiaprofenic acid against indomethacin in patients with rheumatoid arthritis.

A multicentre double-blind crossover study of tiaprofenic acid 600 mg daily against indomethacin 75 mg daily was carried out in 68 patients with rheumatoid arthritis to compare short-term efficacy and tolerance. There were no significant differences in efficacy between the two treatments, but significantly fewer C.N.

Genetic studies in ankylosing spondylitis.

It is likely that ankylosing spondylitis is genetically heterogeneous. The evidence favours the gene for HLA-B27 being the major genetic factor responsible for susceptibility. The finding of a greater prevalence of disease in B27 positive first-degree male relatives of probands than in random B27 positive controls, suggests the existence of other genes for susceptibility, possibly HLA-linked.

DR antigens and rheumatoid arthritis: a study of two populations.

Thr prevalence of HLA-DR antigens was determined in a group of white patients with rheumatoid arthritis, similar patients originating from the Indian subcontinent, and corresponding controls. Rheumatoid arthritis was found to be highly associated with DR4 in the white patients but with DR1 in the Indian patients. These results raise the possibility that the DR antigens themselves do not play a part in increasing susceptibility to rheumatoid arthritis, but the locus for increased susceptibility is probably closely linked to the DR locus.

An investigation of radiological, clinical and pathological correlations in osteoarthrosis of the hip.

Seventy per cent of cases of osteoarthrosis of the hip are regarded as being 'idiopathic' in type. Idiopathic osteoarthrosis of the hip is twice as common in females as in males. Osteoarthrosis of the hands shows a definite association with idiopathic osteoarthrosis of the hip, especially in women.