Conventional radiography lacks sensitivity in early rheumatoid disease. MRI with its advantages of soft tissue discrimination and multiplanar imaging facility might detect earlier disease. This study compares the MR images and conventional radiographs of 11 rheumatoid patients' wrists and carpi. In all cases, erosions were more extensive and numerous on the MR images compared to plain radiographs. MR is useful in detecting early aggressive disease and in monitoring the response to treatments.

No abstract

No abstract

In the majority of patients with neck pain, symptoms will resolve spontaneously or quite quickly in response to therapy. However, some patients' symptoms persist for a long period, irrespective of therapy. In this study, 20 patients with persistent (greater than 8 weeks) neck pain were enrolled in a double blind, placebo-controlled trial of low energy, pulsed electromagnetic therapy (PEMT)-a treatment previously shown to be effective in soft tissue injuries. For the first 3-week period, group A (10 patients) received active PEMT units while group B (10 patients) received facsimile placebo units. After 3 weeks, both pain (visual analogue scale (P<.023) and range of movement (P<.002) had improved in the group on active treatment compared to the controls. After the second 3 weeks, during which both groups used active units, there were significant improvements in observed scores for pain and range of movement in both groups. PEMT, in the form described, can be used at home easily in the treatment of patients with neck pain. It is frequently successful and without side effects.

SUMMARY An HLA-B27 positive 24 year old woman is described with a Staphylococcus aureus induced toxic shock syndrome precipitating a reactive arthritis. This is the first report of an S aureus associated toxic shock syndrome triggering a reactive arthritis in a genetically susceptible host.Case report A 24 year old woman presented with a 36 hour history of rigors, dry cough, arthralgias, myalgias, dizziness, and lethargy. She was menstruating at the time using tampons and gave a one day history of purulent vaginal discharge. On admission she complained of slight chest discomfort, though examination of her lungs and praecordium were normal. Vital signs showed a sinus tachycardia, a pyrexia of 39°C, and a blood pressure of 100/60 mmHg. Other important physical findings were bilateral conjunctivitis, bilateral metatarsalgia, and a tender right temperomandibular joint. She also had painful limitation of movement of her right ankle, right knee, and left elbow with swelling of these joints. Investigations showed a growth of S aureus on a high vaginal swab and midstream urine, a mild (10-5x109 g/l) polymorpholeucocytosis, a sedimentation rate of 13 mm/h, and repeatedly negative blood cultures. Fluid from the right knee and left elbow was sterile. x Rays of her chest, knees, ankles, wrists, and hands were normal. HLA typing showed a B27 haplotype. Later in the course of her arthritis she developed pain over her left sacroiliac joint. A bone scan showed no evidence of increased activity.Within 72 hours of starting treatment with intravenous cloxacillin she became apyrexial and her acute illness settled over the following days. A week after stopping antibiotics she again developed painful stiff joints. At this time she was found to have a tender right parotid gland, a tender right temperomandibular joint, a flexion contracture of her left elbow with associated synovitis, and painful swollen restricted ankles, knees, and metatarsophalangeal joints. Sedimentation rate was raised at 29 mm/h with a normal white cell count and temperature.