Robin Goodfellow

How kind it was of the Editor to turn some correspondence over to me (and how kind of you to write). He has given me the opportunity to publish the letters here in summary, and comment, or recommend them for publication. Very nice. Robin loves a bit of power, and now needs a larger hat.


Smoking has turned around in the last fifty years. Robin has seen old photographs of doctors smoking in their out-patient clinics, but no self respecting rheumatologist could nowadays look a rheumatoid arthritis patient in the eye with a cigarette dangling from his/her lips. After all, whether smoking predisposes to autoimmune disease or not, pulmonary disease in RA shows a ‘striking’ correlation with smoking (Doyle et al., Clin Rheumatol 2000;19:217–21).[ISI][Medline]

Necrotizing keratitis, or corneal melting, is a pretty horrible complication of connective tissue disease, but fortunately it is very rare. A survey in Yorkshire (McKibbin et al., Br J Ophthalmol 1999;83:941–3) [Abstract/Free Full Text] suggests an annual population incidence of 3 per million per year; an average consultant rheumatologist could thus expect to see one every three years.

Donovan and Blake (Br Med J 2000;320:541–4) [Abstract/Free Full Text] produced an interesting study of reassurance in rheumatology clinics, and a recent response (Grogan et al., Br Med J 2000;321:300) [Free Full Text] suggests that education is necessary so that doctors can achieve better results. The fear element needs to be understood and dealt with and Robin thinks it is not just fear of a diagnosis that is important, but fear of doing anything that might make things worse. We all have patients with backache, who will not move. But there is perhaps a further element; often we must tell fearful people that the best thing for us to do is ... nothing. Selling nothing as a treatment in neck or back pain is jolly hard.

Robin was interested in a clinical review of oral health care for patients with special needs (Davies et al., BMJ 2000;321:495–498),[Free Full Text] but was epecting it to say something about why people with special needs had problems rather than simply describing the results of poor oral hygiene—like being unable to hold a toothbrush because of their arthritis. Robin has taught a few dental students; sometimes they need to be nudged to realize that the dentist's first problem is not getting into the patient's mouth, but getting the patient into the surgery.

Robin has a nice little internet site that provides a regularly updated digest of articles on various rheumatology topics, together with some case histories. It was a little embarrassing to read a really interesting abstract and then find that it was in the current issue of Rheumatology, which was lying, unread, on his desk under a pile of bills. Still, it shows how good the journal is ... One of the recent case histories, microvasculitis in SLE (http://path.upmc.edu/cases/case202.html) took one to the University of Pittsburgh Medical School Pathology Department, and some rattling good cases there are, with excellent pictures. Point your browser at http://path.upmc.edu/index.html.

Robin rarely does more than an ESR for his assessment of rheumatoid arthritis patients, not least because of the enormous cost (relatively) of other markers. Maybe this will have to change; Wollheim (Curr Opin Rheumatol 2000;12:200–4) [ISI][Medline] has reviewed some of the newer tests coming along and reports that some cartilage-derived tests may be useful; Robin will await further research, not least because he has some difficulty remembering what the acronyms stand for:

COMP or Y L K, CILP or CRP?

This poor goblin's all at sea ...

... to paraphrase ‘This old Man’.

... and, before you all write in to complain that Robin is becoming repetitive—yes, I have noticed that dear old Seibold got two successive mentions, not to forget all the et als. This is the trouble with instant journalism allied to amnesia, license to say what you like and poor proof-reading. And writing too much, so the nice publishers want to cut bits and Robin moves them to the net column except he is careless. Sore knuckles, he has. One just can't get the staff. Still, at least you got some other jolly interesting references the second time.

Lastly, a picture to illustrate the power of gluteus medius, or perhaps tensor fascia lata. He injected the gluteal enthesis, and a mere millisecond twitch of the muscle was enough to bend the needle. Robin is only glad it didn't snap, or he would have spent an unhappy half hour fishing for the fragment.






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