BMJ  2004;328:1098 (8 May), doi:10.1136/bmj.328.7448.1098

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What's new this month in BMJ Journals

MRI predicts functional deterioration in rheumatoid arthritis

Magnetic resonance imaging (MRI) of the wrist can predict prognosis for newly diagnosed rheumatoid arthritis. Forty two patients were followed for six years with scans, x rays, a standard measure of physical function, and a validated patient centred questionnaire. Abnormality on scans—specifically, baseline bone oedema—predicted physical function at six years, which in turn correlated with patients' self reported health assessment. Standard clinical and radiographic baseline measures, did not predict the degree of ultimate impairment. Since most erosive disease starts within 2-3 years of onset of symptoms, the investigators speculate that early use of disease modifying antirheumatic drugs such as sulfasalazine and methotrexate and tumour necrosis factor inhibitors may reduce or prevent joint damage because of their anti-erosive effects. Consequently magnetic resonance imaging may be helpful in planning treatment regimens.

Ann Rheum Dis 2004;63: 555-61[Abstract/Free Full Text]

Mesothelioma rates decline in US but not UK

The incidence of mesothelioma in the United States rose steadily from 1973 to the early 1990s but is now declining. This is probably related to a fall in the use of the more dangerous amphibole asbestos in the 1960s. UK figures are likely to rise as the amphiboles—crocidolite and amosite—continued to be used for longer than in the United States.

Occup Environ Med 2004;61: 438-41[Abstract/Free Full Text]

Metoclopramide is better than pethidine for tension headache

A total of 336 adults attending an emergency department with vascular or tension headache lasting for more than one week were randomised to receive 10 mg of metoclopramide intravenously, 50 mg of pethidine intramuscularly, both, or neither. Metoclopramide alone produced the most effective analgesia, at least in the short term, and fewest side effects—but drowsiness, dizziness, nausea, dysphoria, or restlessness occurred in 39% of those who took it.

Emerg Med J 2004;21: 323-6.[Abstract/Free Full Text]

Dose of interferon may be critical in multiple sclerosis

A large randomised controlled trial of low dose interferon beta-1a (Rebif) given weekly for three years has failed to show any benefit for patients with multiple sclerosis. Previous studies have given varying results, possibly because of differences in preparation, dose, and frequency and route of administration. In this trial, 22 µg weekly was ineffective, suggesting that higher doses are needed, especially during relapses superimposed on secondary progression of multiple sclerosis.

J Neurol Neurosurg Psychiatry 2004;75: 706-10[Abstract/Free Full Text]

Musculoskeletal pain in children is mostly benign

A Spanish primary care paediatrician reports a personal series of 317 children treated for musculoskeletal pain over three years, representing 6% of all consultations. Soft tissue pain and arthralgia occurred in two thirds; trauma, mechanical overuse, and, in adolescents, osteochondroses were the commonest causes. Three children had reactive inflammatory arthritis.

Arch Dis Child 2004;89: 431-4[Abstract/Free Full Text]

Police chases kill 350 Americans every year The US National Highway Traffic Safety Administration found that 3146 people died as a result of 2654 police car pursuits between 1994 and 2002. A third of the casualties were not in the fleeing vehicle, mostly being in another vehicle not involved in the pursuit. Fleeing drivers were, unsurprisingly, mostly young men who tested positive for alcohol or drugs, and 60% did not have a valid driver's licence. They were more likely than other road crash victims to have previous convictions. Most crashes were at high speed, often on local roads in the dark. The researchers recommend public debate on policies for pursuing suspected offenders, pointing to Dade County, Florida, where chases were restricted to violent felons, reducing pursuits by 82%. They also suggest more use of barrier strips and road blocks. Injury Prevention 2004;10: 93-5[Abstract/Free Full Text] Credit: MIKE DEREK/AP

Chronic groin pain A soccer player experienced severe groin pain when kicking a football. During the next two years he had intermittent pain. Tenderness and a palpable mass were found at the adductor muscle insertion area. Radiography showed mature bone fragments in the obturator foramen (see arrow), and magnetic resonance imaging confirmed these were within the adductor brevis muscle. The authors have found reports of only two previous cases—both in the iliopsoas muscle. Br J Sports Med 2004;38: 223-4[Abstract/Free Full Text]

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