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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;19:21721).[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;83:9413)
Donovan and Blake
(Br Med J 2000;320:5414)
Robin was interested in a clinical review of oral health care for patients with special needs
(Davies et al., BMJ 2000;321:495498),
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;12:2004) [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 repetitiveyes, 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.