Robin has lowered his MRI threshold for shoulders quite dramatically, allowing only one failed injection for rotator cuff lesions before looking for real evidence of damage with a scan (though, to be honest, he is surprised by the number of entirely normal results in patients with classic symptoms and signs). So he was interested to read that post-traumatic impingement doesn't respond at all (
McInerney et al., Emerg Med J 2003; 20: 21821
And another for the Journal of Failed Treatments. Haake et al. report (
BMJ 2003; 327: 757
Will someone please provide an up to date algorithm, flow chart, patient journey or anything to explain to Robin the interaction of all these cytokines and enzymes? No sooner has he got his head around interleukins 1 to infinity than something new hits the stands. Cytosolic phospholipase A2 is the latest chemical to cause a stir in the corpus callosum; it seems to be essential in prostaglandin E2 mediated bone resorption (
Miyaura et al., J Experimental Med 2003; 197: 130310
Given the enormous price differential between intra-articular steroid and hyaluronic acid injections one might be watching carefully for the evidence base that supports use of the latter. Robin has certainly had some apparently dramatic effects following failure of steroids (and not just in knees), but a recent paper by Leopold and colleagues pours cold water on the idea (
J Bone and Joint Surg 2003; 85A: 11971203
Rodney Waterworth writes from the other side of the world. There, it appears, doctors and patients are all on first name terms but his secretary's slip of the finger gave him a very special patient: Last week my typist chose to add the letter "T" to a patient called "Chris" so the sentence went "Christ had normal elbow and shoulder mobility"! One wonders whether the second coming has come ...
Robin has often wondered what risk factors cause the development of extra-articular features in rheumatoid arthritis. Turesson and colleagues have come up with a large retrospective study examining patients diagnosed between 1955 and 1994 (
Ann Rheun Dis 2003; 62: 72227
More, too, on the psychology of pain. In the same issue Nahit et al. (
Ann Rheum Dis 2003; 62: 75560
Continuing on the theme of political correctness Robin was irresistibly drawn to a series of five articles on the possible deletion of a rheumatological eponymReiter's disease ( start with the editorial, Gottlieb and Altman, Seminars in Arthritis and Rheumatism 2003; 32: 207[CrossRef][ISI][Medline]). The affair was aired in 2000 by Wallace and Weisman, but this set of articles includes contributions from a clergyman and an historian. For those who are unaware, Reiter was a Nazi who was recommended for prosecution for war crimes after the Second World War (but wasn't). Some feel he should be penalised for his past. Feedback would be interesting (usual addressrobingoodfellow_rhu{at}hotmail.com) and Robin will offer no further comment, except to indicate his unease over rewriting history.
Being fond of eponymous names anyway, Robin has always had a fondness for LeschNyhan syndrome, if only to impress students by saying hypoxanthine-guanine phosphoribosyl transferase without tripping up (and he has often wondered whether he could fool some bureaucrat somewhere with a spoof that blinds with long words). Said syndrome being X-linked, it was most interesting to see a case report of a female patient with phosphoribosyl synthetase overactivity causing hyperuricaemia ( Garcia-Pavia et al., Arthritis Rheum 2003; 48: 203641[CrossRef][ISI][Medline]). As they say Results of enzymatic and genetic studies supported the view that accelerated purine nucleotide and uric acid production in this woman resulted from defective allosteric regulation of PRS activity, which is, in turn, a consequence of a mutation in one of the patient's PRPS1 genes: an A-to-T substitution at nucleotide 578, encoding leucine for histidine at amino acid residue 192 of the mature PRS1 isoform.
Wow. Enough of fixes of science. Back to the garden. Rosmarinic acid suppresses collagen induced arthritis in mice (Youn et al,
J Rheumatol 2003;30:12037[ISI][Medline]). Cheaper than TNF- blockade? Robin will abandon his commitment to oncological drug supplies, cut down his yew hedges and switch to rosemary instead.