What's new this month in BMJ JournalsBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7448.1098 (Published 06 May 2004) Cite this as: BMJ 2004;328:1098
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 factorα 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 Dis2004;63: 555-61
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 Med2004;61: 438-41
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 J2004;21: 323-6.
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 Psychiatry2004;75: 706-10
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 Child2004;89: 431-4
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