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Talking of dissemination reminds me of the paper by Urban et al.
(J Bone Joint Surg Am 2000:82;45776)
British goblins (and rheumatologists) have, along with their colleagues in general practice, been pressured into generic prescribing whenever possible to save money. Davies reports however (Health Service Journal, 30th March 2000) that some generic prices are rising alarmingly, up to 700% in one instance. There are excusespatient pack prescribing being one, but going generic is clearly not all it's cracked up to be.
The obsession with evidence-based medicine drives Robin every now and again to browse the Cochrane database online (the rheumatology page is at http://www.update-software.com/ccweb/cochrane/revabstr/g05@in~1.htma formidable line to type correctly, but sadly leading to a page that is a year old. Even Robin's web page has a 2000 dateline. The interventions for shoulder pain summary is interesting; a paucity of evidence exists, largely because so few trials were suitable for analysis, but it refers to the British College of Rheumatologists. Robin has not previously heard of this august-sounding body and would welcome further information. If, as he suspects, it does not actually exist, reference to it somewhat undermines Cochrane's squeaky clean, state-of-the-art, accurate (and up-to-date) image.
An interesting editorial (McGonagle et al., J Rheumatol 2000;27:83740) argues the case for polymyalgia and seronegative arthritis associated with oedema (known by the ghastly acronym of RS3PE) being diseases of the joint capsule and enthesis. RA on the other hand is a synovial disease. Certainly the theory is attractive (and illustrated with some nice MRI picturesis there no end to the things this wondrous technique can tell us?).
Scleroderma is an awful, untreatable disease. Robin gets depressed at any meeting which reviews current therapy and which concludes that none of it works. Perhaps though there is some hope; a study of recombinant human relaxin
(Seibold et lots of al.there are 19 listed co-authorsAnn Intern Med 2000;132:8719)
Why does rheumatoid arthritis affect the neck as it does? Puttlitz et al. from the Iowa Spine Research Center have done some extraordinary modelling work (Spine 2000;25:160716).[ISI][Medline] Ligament compromise is important; weakening of the transverse ligament results in subluxation, and later involvement of the alar and capsular ligaments produces advanced slip, for which surgical intervention may be warranted. But mechanical stress may cause the erosions. Never heard of Wolff's Law of unloading considerations? You heard it here first.
Government departments are always bureaucratic, but when the politicians have a spin on things can get quite frenetic. So it must have been when it was decided that the public, and those who work in the NHS, should have the opportunity to shape the future (the premise being that the past and present are unacceptable). So out went a survey form, with space for three priorities and one comment. They could be returned free. Pity they arrived so late that the freepost service would not deliver them in time for the deadline. Robin thinks of motes and beams, and suggested that arthritis might just get some recognition if a National Service Framework was established so that targets could be set, and standards of service met. Whether this exercise will have any use at all is questionable. Certainly Robin has found no evidence base for it, and wonders how many consultant rheumatologists or allied health professionals could have been employed with the cash spent. Indeed he hears that meetings of the special panels were arranged and then cancelled and re-arranged at the last minute, thus ensuring that those who had real jobs (i.e. doctors) could not attend. He also hears that the group concentrating on inequalities of health care were told that the best way to prevent the rich/poor gap from widening was to stop all health education. This is on the basis that the middle classes pay attention, while those lower down the social scale do not. Common sense indeed; I bet it went down like a lead balloon.
Lastly, a mantra. Passive external rotation uniquely tests the gleno-humeral joint. Loss of this movement can only occur in capsulitis or osteoarthritis. The former is more likely by a factor of 50. The only treatment that has any proven effect is steroid injection, but the time-course of recovery may still be long.