Objective. To assess the reliability of physical examination of the osteoarthritic (OA) knee by rheumatologists, and to evaluate the benefits of standardization.Methods. Forty-two physical signs and techniques were evaluated using a 6 ؋ 6 Latin square design. Patients with mild to severe knee OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of techniques. The standardization process resulted in substantial improvements in reliability for evaluation of a number of physical signs, although for some signs, minimal or no effect of standardization was noted. After standardization, warmth (PABAK ‫؍‬ 0.14), medial instability at 30°flexion (PABAK ‫؍‬ 0.02), and lateral instability at 30°flexion (PABAK ‫؍‬ 0.34) were the only 3 signs that were highly unreliable.Conclusion. With the exception of physical examinations for instability, a comprehensive knee examination can be performed with adequate reliability. Standardization further improves the reliability for some physical signs and techniques. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.In clinical practice and in research, the knee examination is a key component in the assessment of patients with osteoarthritis (OA). Recommendations for the physical examination of the OA knee include many different signs and techniques (1-9). In the American College of Rheumatology (ACR) clinical diagnostic

Cardiac tamponade in systemic sclerosis is rare. We report four cases of SSc with hemodynamically significant pericardial effusions associated with pulmonary arterial hypertension, three of whom died, two following pericardiocentesis. Of 26 SSc cases reported in the literature with large pericardial effusions, seven were associated with PAH. Including our series, the mortality rate is 55%.The potential contributory role of PAH in the development of pericardial effusion and the management implications are explored. In SSc patients with hemodynamically significant pericardial effusions and severe pulmonary hypertension, initial stabilization of pulmonary artery pressure and right heart function with vasoactive therapy and then cautious pericardial drainage should be considered.

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