So to Robin Goodfellow ... a merry domestic fairy, according to Brewer's Dictionary of Phrase and Fable; synonymous with Puck, and famous for practical jokes; as described in A Midsummer Night's Dream:
Either I mistake your shape and making quite, Or else you are that shrewd and knavish sprite Called Robin Goodfellow ... Those that Hob-Goblin call you, and sweet Puck, You do their work, and they shall have good luck.Well, well. I did start my public life as an ill-tempered goblin in a primary school pantomime, and I have been responsible for a few naughty tricks, April Fools and so forth, so time has come full circle. The opinions and choices herein are mine alone; If we shadows have offended, Think but this, and all is mended, That you have but slumber'd here
While these visions did appear.
To work! Knee joint laxity may predispose to OA. Sounds likely, doesn't it! But then one could argue which came first; the laxity, or the cartilage and bone loss that lets the joint settle. If the study from Sharma is confirmed (Arthritis Rheum 1999;42:47582) [ISI][Medline] the former is true; the varus-valgus laxity in the uninvolved knee of OA patients was greater than in controls. Quite how we might treat this puzzles me, however.
Another article from the same Arthritis Rheum (1999;42:7516) [ISI][Medline] by Tatsis and colleagues identifies a high incidence of renal cell carcinoma in patients with Wegener's. Clearly something we should watch for, but should we hold our breath (I have seen only two Wegener's in the last fifteen years); and should we tell our renal physician colleagues to reciprocate and look for Wegener's?
Another monitoring question is raised by Dijkstra et al (Scand J Rheumatol 1999;28:337) [ISI][Medline] who suggest that ANA positive patients should be followed up, even if well, as 58% will develop some sort of connective tissue disease, three-quarters of these within two yr. I doubt my master Oberon will be pleased with that idea as such a protocol would have me seeing dozens of extra patients each month and the waiting times will soar.
Should we change our technique for carpal tunnel injection? Dammers et al. in Amsterdam think we should
(BMJ 1999; 319:8846).
Many rheumatology specialists see depressed patients, so it may be of interest that a recent study from Berlin confirms that the traditional cure, St John's Wort (Hypericum to Linnaeans) is as effective as imipramine
(Philipp et al., Br Med J 1999;319:153438).
The New England Journal of Medicine recently tried to inveigle Robin into taking out a subscription by sending him a free month's worth. It was very kind of them, and the issue of November 4th 1999 contained an article
(Anderson et al., N Engl J Med 1999; 341:142631)
Robin does a lot of his paper searching on the Internet these days. I shall throw a few Internet tips out each month, but would be delighted if readers with good sites pass them on to me.
My favourite search engine at present is Dogpile (http://www.dogpile.com). It does lovely fuzzy searches on a huge number of sites (although a quick trawl of gardening sitesRobin has green fingersdid turn up Miranda's Sex Garden. Being a Goodfellow he did not of course enter). Those of you that have failed to visit the ILAR site should remedy this, if only to have a chance of winning a tee shirt in the quiz. It is at http://www.ilar.org/ - interface/frsetsearch.asp. I will not insult your intelligence by giving you the URLs of the Big Sites (viz BSR and the ARA).
Robin collects macro mantras. These are little prose pieces that can be inserted into letters at the touch of a key. Here is one:
Gout cannot be diagnosed by the finding of a raised serum uric acid level, but only by finding uric acid crystals within an inflamed joint or bursa. Gout attacks can occur when the uric acid is normal, and hyperuricaemia can occur without gout. Thus measurement of the serum uric acid is unhelpful. Do not waste your time, and the laboratory's money, doing it. Please.
I am sure I am not alone in receiving referrals of patients with nodal OA, or palindromic rheumatism, who have been stuck on allopurinol. More mantras will follow, but if you have a nice one I would love to publish it too, if you are willing.