Oh, and a closer-to-home error has just pitched up a really nasty liver problem with an abhorrent enzyme that metabolises things slowly. Robin finds it embarrassing to realise that he has signed out a letter saying this, and must mend his aberrant ways.
Now. Robin is prepared to throw the fat on the fire and no doubt suffer an abusive torrent of emails (reminder: robingoodfellow_rhu{at}hotmail.com). He saw, recommended in the British Medical Journal, a book by Andrew Malleson entitled Whiplash Injury and other Useful Illnesses (McGill-Queens University Press, 2002). While somewhat polemical and populist in style (and not without a few errors) it demolishes whiplash injury, RSI and all the other non-diseases such as ME and fibromyalgia. Malleson draws an analogy with the now vanished railway spine of the 19th century and the collapse of the RSI epidemic in Australia. Talking of compensation he quotes Myre Sim: The Plaintiff may already be suffering from a psychiatric disability, usually of a depressive nature, and the accident provides a heaven-sent opportunity for an honourable and even lucrative escape from a situation which was becoming unbearable. He also points out that, despite the forces on necks being vastly larger, no claims for whiplash injury ever originate from those that drive stock cars or dodgems. QED? To the psychiatrists with em all? Whatever the UK government says, Robin is convinced enough that he will not quote any research on fibromyalgia ever again.
Sticking with the subject of the mind, the discussion continues on the psychosis observed in lupus and that seen with steroid treatment in lupus. Why does it happen?
Shuk and Chi (if their names are given in Chinese order, else it will be Chau and Mok forgive the ignorance of elves in Neurology 2003; 61: 1047
As all are aware by now, this goblin is not keen on unnecessary tests, so a review reminding us that tests are not infallible is timely. Fritzler et al. have produced it (Arthritis Res Ther 2003; 5: 192201[CrossRef][ISI][Medline]). Robin's lab has been doing its own quality control, and there are some significant, and occasionally alarming, differences. He supposes that if you stick to your own lab's results you will at least be internally consistent, but when they fire in from at least three, if not four sources, depending on the area from which the patient has been referred, things get very muddy (especially when the units of measurement are different). This article might help standardise when positive is negative, if you see what I mean.
Lindqvist and colleagues report a survey of radiological damage in a cohort (always reminds me of Assyrians, that, wolves and gold and purple) of early rheumatoid arthritis patients (Ann Rheum Dis 2003; 62: 611616
What causes the antiphospholipid antibody syndrome? Is it a bug? Is it the genes? According to von Landenberg et al., it is parvovirus (Arthritis Rheum 2003; 48: 193947[CrossRef][ISI][Medline]); there appears to be a high prevalence of persistent parvovirus infection in both juveniles and adults with APL antibodies.
Arterial disease is definitely associated with inflammation, and not just in the coronary vessels. Del Rincón and co-workers (too many et als is boring, no?) show an increase in carotid intimal thickness and plaque in RA patients (non-smoking ones at that Arthritis Rheum. 2003; 48: 183340[CrossRef][ISI][Medline]). This fits with several other studies (two from this very journal) and makes it all the more important both in getting patients to reduce other risk factors, and in applying early effective treatment. It also adds weight to the political argument that RA treatment needs proper funding, as if we didnt already know, but let's blind the politicians with science.
Dear George Ehrlich has, of course, forced Robin to go back on his word about no more fibromyalgia. In a response to a British Medical Journal editorial he writes (and I omit the references but you can get them off the BMJ website) Peter Croft's wise words are slightly marred by his reference to the ACR criteria for fibromyalgia as diagnostic criteria, rather than as classification criteria for reporting purposes. There are no diagnostic criteria, as even the "tender points" are circular reasoning and self-reported (and in many instances, learned). The sooner we abandon fibromyalgia as a diagnosis and treat the very real physical and psychological symptoms that characterize chronic pain, the better off we and the patients will be. So Robin is not alone, after all. Cheers, George!