Ninety patients with active rheumatoid arthritis took part in a cross-over trial comparing diclofenac sodium, diflunisal and naproxen. The efficacy of the three drugs was similar though there were trends in favour of diclofenac sodium in some measurements. The incidence of side-effects was similar with the three drugs and each was chosen by a significant group of patients as continuation therapy at the end of the study.

Responses to a symptom questionnaire, together with an erythrocyte sedimentation rate (ESR) estimation, were used to screen for polymyalgia rheumatica (PMR) in 247 elderly people receiving social services care. Three cases of PMR were discovered of whom two were previously undiagnosed. The prevalence of PMR in this study is higher than that estimated from hospital ascertained cases.

Fifty-three stroke patients with severe functional loss at two weeks, following the stroke were followed up for one year. No improvement occurred in 47% during this time and this was associated with abnormalities of muscle tone, incontinence of urine or faeces, perceptual disorders and previous disabilities affecting locomotion. Remedial therapy continued for long periods especially in the group who did not improve. It is suggested that rehabilitation resources could have been used more appropriately. Further research is required to determine whether intensive therapy is of value in the severely disabled stroke patient especially those with perceptual and cognitive dysfunction.

A 20-year-old man experienced the onset of progressive scleroderma-like skin changes with eosinophilia and hypergammaglobulinaemia after strenuous military activity. A biopsy showed faciitis. Concomitant splenomegaly, polysynovitis, restrictive lung function, myositis, decrease hepatic clotting factors and proteinuria were documented. He responded well to corticosteroids, relapse upon their discontinuation and had a complete remission of both skin and systemic features while on penicillamine and azathioprine. He is new in good health and has received no medication for the past two years.

Six cases of Lancefield Group G streptococcocal arthritis are described. Two cases had pre-existing chronic arthritis (one rheumatoid) with infection of a joint prosthesis. Three cases had neoplastic disease before or at the same time as septic arthritis. Skin reactions, including cellulitis and scarlatiniform rash were prominent in five cases. One patient may have acquired a Group G streptococcus from her dog. Five cases responded well to penicillin and the sixth who was allergic to that drug was cured by erythromycin. This unusual cause of septic arthritis is being recognized more frequently in the United Kingdom.

The clinical features of the first attack acute rheumatic fever in 32 adults are described in a prospective study. Classical migratory polyarthritis occurred in 11 patients whilst the arthritis in the remaining 21 was additive in type, rapidly becoming symmetrical. The lower limb joints were involved more frequently than those of the upper limb. Mild transient carditis was present in only one patient. All patients showed evidence of antecedent streptococcal infection but none had chorea, subcutaneous nodules or erythema marginatum. The disease ran a benign course so that the sensitivity of the modified Jones criteria for adult rheumatic fever needs re-evaluation. Rheumatic fever is still a significant health problem in Iraq and should always be considered in the differential diagnosis of acute polyarthritis in adults.

The results of an audit, by a hospital pharmacist, of antirheumatic drug use at four rheumatology units are presented. Profiles can be developed for each drug which indicate their efficacy and the adverse reaction rate in clinical practice. These can be used to make rational therapeutic choices. A pharmacist can effectively collate such data to provide an unbiased information source.

Fatal toxic epidermal necrolysis is described in a patient, treated concurrently with sodium aurothiomalate and benoxaprofen, who had previously had these two drugs separately, with only minor mucocutaneous problems while on gold, and no adverse effects from benoxaprofen. It is suggested that benoxaprofen could act synergistically with gold, resulting in enhancement of mucocutaneous side-effects, which are common to both these drugs.

A six-week double-blind randomized cross-over trial comparing the safety and efficacy of 250 mg naproxen administered twice daily and 500 mg naproxen administered as a single dose at night in osteoarthritic patients stabilized on naproxen 250 mg twice daily is reported. There was no significant difference between the two regimens. This study provides evidence that naproxen can be given to patients with osteoarthritis on a single-daily-dose regimen without any loss of anti-inflammatory/analgesic activity.