NSAIDs significantly reduce overall pain over 4 weeks. This short-term responsiveness is retained, and even after several years of therapy with tiaprofenic acid pain scores increased over 2 weeks when it was changed to placebo. Our results do not show long-term benefits from the use of NSAIDs in OA and the majority of patients had persisting pain and disability despite therapy.

A case of necrotising fasciitis in a patient receiving infliximab, an antitumour necrosis factor alpha (TNF-α) agent for rheumatoid arthritis, is presented. A widespread confluent, erythematous, pustular skin rash was the presenting sign. There was no fever throughout this admission. β-Haemolytic group A streptococcus was isolated from blood cultures and skin swabs. The adductor muscles and fascia around the site of a previous hip arthroplasty were necrotic on exploration. The case highlights the risk of severe sepsis in patients on anti-TNF-α treatment.

Photosensitivity investigations have been carried out using an irradiation monochromator on 31 patients taking one of seven different nonsteroidal anti-inflammatory agents for the treatment of rheumatoid and osteoarthritis. Six patients, who were taking either piroxicam, naproxen or tiaprofenic acid, experienced adverse immediate reactions of erythema and flaring, together with an urticarial response in four of these six patients. No phototoxic response was observed in patients taking either indomethacin, ketoprofen, benorylate or ibuprofen, although firm conclusions about the non-phototoxic nature of these four drugs cannot be drawn from this pilot study because of the small numbers of patients investigated.

Our results suggest that in the elderly a dose of 600 mg daily is associated with an unacceptable incidence of gastric side effects. It is not clear why elderly patients with osteoarthritis were more prone to gastric side effects than patients with rheumatoid arthritis. Tyson and Glynne reported that in patients over 60 with osteoarthritis benoxaprofen caused more gastric side effects than did ibuprofen, whereas in patients under 60 the reverse was true.4 Compared with other non-steroidal anti-inflammatory agents benoxaprofen has a unique side-effect profile. It remains to be established whether benoxaprofen has the disease-modifying properties that were claimed at the enthusiastic launch of the drug.' 9 We are grateful to Dr A W McKenzie for helpful comments and permission to publish the histological report. We also thank Mrs P K Bramble for help with analysis of data, and Mrs S Palgrave-Moore for secretarial work. Addendum Since the submission of our paper six cases have been reported with hypertrichosis and accelerated nail growth associated with benoxaprofen," one of whom also had milia.22

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