No abstract

As there is relatively little information about the effectiveness of occupational therapy (OT) in RA a questionnaire was devised to assess whether patient knowledge and performance of joint protection manoeuvres improved following OT intervention and, if improved, whether this was sustained over 6 months. A photographic multiple choice questionnaire was devised covering major categories of activities of daily living. The study population consisted of 55 patients with RA attending a rheumatology clinic who had not previously had OT treatment. Patients had a single instruction/treatment session with an occupational therapist of 1-h duration. Prior to treatment the questionnaire was administered by an independent assessor who re-administered the questionnaire 1 month and 6 months after the OT session. Following treatment there was a significant increase in scores at 1 month compared with pre-treatment (P < 0.001). There was no significant change in score at 6 months compared with 1 month. Qualitative analysis of age and sex showed no significant effects. OT leads to sustained improvement in patient knowledge and probably performance of joint protection manoeuvres in RA.

Postmenopausal osteoporosis is a common clinical entity; its complications represent a significant burden to society. In recent years the choice of therapies available for the treatment of postmenopausal osteoporosis has increased dramatically. There are a number of antiresorptive agents currently available including hormone replacement therapy (HRT), selective estrogen receptor modulators (SERMs), bisphosphonates, and dual action bone agents. It is difficult to truly compare these therapies given the lack of direct head-to head studies. The efficacy of antiresorptive therapies can be assessed in a number of ways including measurement of bone mineral density (BMD), assessment of bone turnover markers, and fracture reduction. Other important factors include ease of administration and consequent patient compliance. This article reviews the currently available antiresorptive agents and their effects on the above outcome measures.

A 56-year-old man presented with pain and stiffness in both shoulders and developed severe, rapidly progressive contractures of the fingers. Examination revealed subcutaneous thickening in both palms with fixed flexion deformities of all digits except the thumbs. Initial investigations including a malignancy screen were all normal/negative. Eighteen months later, he was diagnosed with metastatic non-small-cell lung carcinoma. Although rare, palmar fasciitis and polyarthritis syndrome is an important paraneoplastic syndrome for rheumatologists to be aware of, as the musculoskeletal symptoms may precede neoplastic manifestations by many months and may improve with appropriate treatment.

Agreement is poor among practising histopathologists in the recognition of abnormal mitoses. A standardized and robust definition is needed if diagnostic and prognostic significance is accorded to the finding of an abnormal mitosis in the context of neoplasia.