Calcifying supracoracoid bursitis as a cause of chronic shoulder pain.

A case of chronic shoulder pain is reported with marked limitation of both active and passive elevations and a normal range of motion of the glenohumeral joint. X-ray examination demonstrated cloudy calcification in the coracoclavicular region, presumably indicating calcifying supracoracoid bursitis

Development and validation of a computer program using Bayes's theorem to support diagnosis of rheumatic disorders.

A computer program has been developed to support the differential diagnosis of major rheumatic disease categories. Knowledge for the program was derived from the sensitivity and specificity of findings in a group of 1052 consecutive patients of a rheumatological outpatient clinic. Computer predictions based on two variations of Bayes's theorem were compared with 'gold standard' diagnoses in 570 test cases from the same clinic. The results demonstrate the feasibility of this approach, but also that refinements of both the method of calculation and the knowledge are required

Food intolerance in rheumatoid arthritis. I. A double blind, controlled trial of the clinical effects of elimination of milk allergens and azo dyes.

The hypothetically negative influence of food on the clinical activity of seropositive rheumatoid arthritis was studied using two types of artificial elementary food. One diet was allergen free, the other allergen restricted, containing only lactoproteins and yellow dyes. Ninety four patients entered the study, which lasted 12 weeks. During the second four week period they were randomly assigned to one of the two artificial foods. Comparison between baseline and subsequent periods showed only subjective improvements. No differences were seen between the clinical effects of the two tested diets. Nine patients (three in the allergen restricted group, six in the allergen free group) showed favourable responses, followed by marked disease exacerbation during rechallenge. Dietary manipulation also brought about changes in objective disease activity parameters in these patients. The existence of a subgroup of patients in whom food intolerance influences the activity of rheumatoid factor seropositive rheumatoid arthritis deserves serious consideration

Terminal phalageal osteosclerosis.

Osteosclerosis of the terminal finger phalanges was assessed by means of a grading score in two age-matched groups of 96 females, each suffering from rheumatoid arthritis (RA) and osteoarthrosis (OA), respectively, and in a sample of 894 males and females, above the age of 44 years, from Dutch small town populations. Cortical thickness of the therminal phalanges decreases markedly with age. Whereas in the age group 45-54 years, terminal phalangeal osteosclerosis is more pronounced in females, at higher ages the difference between the sexes disappears. The diameter of the terminal cortex increases gradually from the second to the fifth finger. No differences were found between the RA and the OA groups, nor were these groups different from the population survey except for a lower incidence of terminal phalangeal osteosclerosis in female osteoarthrotics between 45 and 55 years of age, compared to females of the same age group from the population sample

Bone metabolism in rheumatoid arthritis compared with postmenopausal osteoporosis.

Calcium and bone metabolism in 29 rheumatoid arthritis (RA) patients were compared with those in 27 postmenopausal osteoporotic patients. Signs of vitamin D deficiency were found in 20 RA patients, including 12 who took recommended amounts of vitamin D in their diets and were exposed to sufficient sunlight, and in none of the osteoporotic patients. There were no signs of malabsorption. In six out of 15 patients we found increased liver enzyme activity, which may have a role in vitamin D metabolism. We propose the influence of non-steroidal anti-inflammatory drugs (NSAIDs) on vitamin D metabolism in the liver as a possible explanation

Extra-articular manifestations of rheumatoid arthritis: risk factors for serious gastrointestinal events.

OBJECTIVES--Serious upper gastrointestinal events are an important threat to patients with arthritis who are treated with non-steroidal anti-inflammatory drugs (NSAIDs). In this study risk factors for serious upper gastrointestinal events are identified in patients with possible or definite rheumatoid arthritis (RA). METHODS--A retrospective analysis of factors that might contribute to the risk of serious upper gastrointestinal events was performed in a cohort of 2315 consecutive patients with possible or definite RA. The relative influences of disease severity, drug treatment, particularly with corticosteroids, and history of peptic ulceration were analysed with a conditional logistic regression model for the 106 patients with serious upper gastrointestinal intestinal events and for an equal number of control patients who were matched for age, gender, number of criteria for RA, and disease duration. RESULTS--The incidence rate for serious upper gastrointestinal events was 4.0/1000 patients in each year. The study reconfirmed that age over 60 years, history of peptic ulceration, and use of corticosteroids are risk factors. The presence of extra-articular manifestations of RA was associated with a two to 11-fold increase in the risk for serious upper gastrointestinal events. This risk was independent of the use of corticosteroids. CONCLUSION--Disease severity, in particular the presence of extra-articular features, may be an important factor in the pathogenesis of upper gastrointestinal ulceration in patients with RA who are treated with NSAIDs