No abstract

SUMMARY Tinnitus or subjective hearing loss, or both, were reported by 61 of 134 (45%) patients with rheumatoid arthritis (RA) taking regular salicylates and by 73 of 182 (40%) untreated healthy subjects. In the patients with RA mean salicylate levels were not higher in those with tinnitus than in those without tinnitus, but levels were significantly higher in those with subjective hearing loss than in those with no symptoms. Twenty five per cent of the patients with RA had tinnitus or subjective hearing loss with salicylate levels <1 42 mmolIl. Audiometric responses in 31 patients correlated poorly with symptoms. Tinnitus and subjective hearing loss may be too non-specific to be reliable as tools for adjusting the salicylate level into the therapeutic range.

Seventeen of 19 patients with mixed connective tissue disease (MCTD) had arthritis as a significant initial feature of their disease; 8 were given an initial diagnosis of rheumatoid arthritis (RA) and 4 received chrysotherapy. RA‐like hand deformities were present in 35% and contractures and/or persistent loss of joint motion in 47%. Joint radiographs showed abnormalities in 41% and included erosions and/or cysts in 30%. The arthritis of MCTD may be both erosive and deforming and this disease should be considered in patients presenting as RA with unusual features.

Osteoarthritis of the atlantoaxial facet joints was identified radiologically in 27 patients, and these comprised 4% of all outpatients with osteoarthritis or degenerative disease of the spine seen during a 36‐month period. These patients had a clinical syndrome which differed from those seen in patients who have subaxial degenerative disease of the spine or myofascial cervical pain. Occipital pain, occipital trigger points, crepitus in the occipital region, and a rotational head tilt deformity (in 13 patients, usually associated with collapse of 1 of the lateral masses [facets]), were the major features of this distinctive syndrome.

Six hundred fifty outpatients with rheumatoid arthritis (RA) were evaluated and followed up during a 7‐year period. As part of their routine evaluation or because of neck‐shoulder girdle symptoms, 48% of the patients underwent routine cervical spine radiography. Sixty‐one RA patients (9% of the total population) had C1‐C2 involvement. Compared with the 589 patients with no evidence of C1‐C2 involvement, these 61 patients were significantly more likely to be younger, female, and seropositive, and they had significantly more nodules and erosions, as well as a longer disease duration. Based on radiographic evidence of C1‐C2 disease severity, 3 groups emerged. Group 1 (28 patients) had lateral mass collapse, group 2 (27 patients) had lateral facet joint sclerosis, erosion, or loss of joint space with no collapse, and group 3 (6 patients) had lateral subluxation with no bone or cartilage changes. Nine patients in group 1 had severe pain, and 25 had a nonreducible rotational tilt of the head. None of the patients in the other 2 groups had either of these signs or symptoms. Moreover, patients in group 1 were more likely to have other C1‐C2 or subaxial subluxations and were more likely to have myelopathy. C1‐C2 lateral facet joint involvement is common in RA, correlates with disease severity generally and specifically with that in the cervical spine, and, when severe, causes nonreducible rotational tilt of the patient's head.