Classification criteria for most of the disorders belonging to the spondylarthropathy group already exist. However, the spectrum of spondylarthropathy is wider than the sum of these disorders suggests. Seronegative oligoarthritis, dactylitis or polyarthritis of the lower extremities, heel pain due to enthesitis, and other undifferentiated cases of spondylarthropathy have been ignored in epidemiologic studies because of the inadequacy of existing criteria. In order to define classification criteria that also encompass patients with undifferentiated spondylarthropathy, we studied 403 patients with all forms of spondylarthropathy and 674 control patients with other rheumatic diseases. The diagnoses were based on the local clinical expert's opinion. The 403 patients included 168 with ankylosing spondylitis, 68 with psoriatic arthritis, 41 with reactive arthritis, 17 with inflammatory bowel disease and arthritis, and 109 with unclassified spondylarthropathy . Based on statistical analysis and clinical reasoning, we propose the following classification criteria for spondylarthropathy : inflammatory spinal pain or synovitis (asymmetric or predominantly in the lower limbs), together with at least 1 of the following: positive family history, psoriasis, inflammatory bowel disease, urethritis, or acute diarrhea, alternating buttock pain, enthesopathy, or sacroiliitis as determined from radiography of the pelvic region. These criteria resulted in a sensitivity of 87% and a specificity of 87%. The proposed classification criteria are easy to apply in clinical practice and performed well in all 7 participating centers. However, we regard them as preliminary until they have been further evaluated in other settings.From the European Spondylarthropathy Study Group (ESSG).
The effects of smoking on the localisation and clinical course of Crohn's disease is evaluated in 231 patients. Heavy smokers (>10 cigarettes/ day) had an increased risk of operation at least once -odds ratios for heavy smokers compared with never smokers after five and 10 years were
The aim of the study was to evaluate two essentially different methods of assessing differences in children's taste preferences with regard to five different paediatric penicillin formulations. The study was performed with a parallel group design comparing five groups. A taste evaluation was recorded in 103 children with upper respiratory tract infections after a single therapeutic test dose. First the patient's own spontaneous verbal judgement was recorded then a judgement was arrived at using a hedonic scale of facial expressions. Both judgements were passed immediately and also 3-4 minutes after the test dose. In the children who were 6 years of age or younger, a better discrimination of taste differences between formulations was achieved by using the patients' own spontaneous verbal judgements instead of the facial hedonic method. Both methods seem appropriate in older children, but the hedonic scale is preferable since its use implies a more standardised procedure.
1 The purpose of this study was to investigate the disposition of two aminopenicillins and their intra-and inter-individual variation in pharmacokinetic parameters in healthy, elderly volunteers. Two groups, each of 12 active, community-dwelling volunteers between 69 and 83 years of age participated. One group was given 500 mg of amoxycillin, the other group 500 mg of ampicillin as single i.v. infusions. Within the drug groups each volunteer was given the infusion at two different occasions separated by a time-period of 1 week. Amoxycillin and ampicillin were determined in plasma and urine by modern column liquid chromatographic methods.2 The mean plasma clearance was about 200 ml min-' 1.73 m2 for both drugs and renal clearance accounted for approximately 80% of this. As expected, drug clearance was correlated to renal function as determined by 5tCr-EDTA. The volume of distribution at steady-state (V.,) was about 0.3 1 kg-' for both drugs. Compared to our previous results in younger subjects, plasma and renal clearances were essentially similar in this study, but slightly longer half-lives and higher V. were seen for amoxycillin and ampicillin.3 The intra-individual variation, expressed as the error of a single determination (CV), was small, for plasma clearance 3.7% and 6.4% after amoxycillin and ampicillin. The corresponding inter-individual variation in clearance was higher, 14.4% after amoxycillin, and 11.9% after ampicillin. The results confirm a higher relative efficiency of a crossover vs a completely randomized parallel groups design in parenteral studies of these penicillins. 4 In our elderly subjects there was only an approximately 30% decrease in renal function. This was not enough to reduce the drug clearance and offers an explanation for the similarity between our present results in the elderly and our previous results in younger subjects. Elderly volunteers may be different from patients with disease as a confounding factor. Studies on elderly active and community-dwelling volunteers, as in this study, may therefore be more representative as to the effect of age per se on drug kinetics.
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