British journal of rheumatology
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Case Reports
Non-Hodgkin's lymphoma and subsequent acute lymphoblastic leukaemia in a patient with polymyalgia rheumatica.
A patient presenting with polymyalgia rheumatica-like symptoms was found to have non-Hodgkin's lymphoma which later transformed into acute lymphoblastic leukaemia. The association of polymyalgia rheumatica-like symptoms and lymphoreticular/haematological malignancies is discussed.
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Clinical assessment of ankylosing spondylitis: a study of observer variation in spinal measurements.
Twenty-two measurements repeated non-sequentially on each of 10 patients by five observers were undertaken to determine their reliability for routine clinical use. Measurements without significant inter-observer variation or with a coefficient of reliability greater than 0.70 were cervical rotation, cervical lateral flexion, tragus to wall distance, fingertip to floor distance on sagittal and lateral flexion, C7 to iliac crest line distraction and modified Schober index. It is concluded that many of the currently used measurements are either statistically unreliable or clinically unhelpful in mild or moderate ankylosing spondylitis. The most clinically useful were cervical rotation using a protractor, cervical lateral flexion using a goniometer, thoracolumbar flexion as the C7 to iliac crest line distraction, thoracolumbar lateral flexion as the fingertip to floor distance and the modified Schober index.
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Sixty-three unselected consecutive patients with primary Sjögren's syndrome (pSs) were prospectively evaluated for evidence of neurological manifestations. Seventeen had a mild sensory or mixed neuropathy. Two of these plus one more patient had trigeminal neuropathy. ⋯ Severe mononeuritis multiplex and symptomatic symmetrical distal neuropathy were seen in two patients with vasculitis. One patient, with a history of hypertension and no subjective sicca complaints, had a mild cerebrovascular accident and objective evidence of changes compatible with pSs. The study suggests that peripheral neurological involvement is relatively common and benign in the majority of pSs individuals, whereas central nervous system (CNS) disease must be rare.
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The temperature response of the hands to mild cold stress (20 degrees C for one minute) has been measured in 20 normal subjects, 20 patients with reflex sympathetic dystrophy (RSD) and 10 patients with chronic upper limb pain (CULP) of uncertain origin. The results of RSD and CULP groups were significantly (p less than 0.05) different from normal but were indistinguishable. ⋯ The thermal stress test is useful in the objective assessment of RSD. It is non-invasive, patient acceptable and reproducible.