For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. ____and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.

Subchondral bone changes have been proposed as an early event in the pathogenesis of osteoarthritis. In this study, microscopic computed axial tomography was used to evaluate the subchondral bone structure in femoral heads from a guinea pig model of osteoarthritis. Examination of trabecular bone within the femoral head showed a highly significant increase in bone fraction in the experimental animals. This was due to the development of trabeculae that were thicker and closer together. We conclude that trabecular remodeling may be an early event in this model of osteoarthritis. Submitted for publication November 2, 1987; accepted in revised form June 9, 1988. changes in subchondral bone is unclear (1). It is also unclear whether the primary lesion occurs in cartilage ( 2 4 , synovium (9, or the subchondral bone (6,7).Subchondral bone absorbs most of the mechanical force applied across diarthrodial joints (8-10). Experimental studies of subchondral bone changes induced by repetitive impact-loading indicate that subsequent trabecular remodeling results in less compliant trabecular bone and thereby transfers excessive mechanical stress to the overlying articular cartilage (1 1-14).We investigated subchondral bone changes in an animal model of early osteoarthritis. In the animal model we chose, the resection of gluteal musculature was used to alter the biomechanical forces acting across the hip joint. Microscopic computed tomography (pCT) was used to assess the architecture of the subchondral bone in an effort to evaluate subchondral bone changes in a model of early osteoarthritis. MATERIALS AND METHODSAnimal preparation. Ten male Hartley strain guinea pigs (Charles River Breeding Laboratory, Wilmington, MA) averaging 700 gm in weight and 8 weeks in age were divided into 5 pairs. One member of each pair underwent a right gluteal myectomy and infrapatellar tendotomy according to a standardized procedure (15). Briefly, a 0.5-cm wide X 2.5-cm long segment consisting of the right gluteus superficialis, biceps femoris, and gluteus medius was removed at the sacral origin. Extraarticular resection of the right infrapatellar ligament was also performed. The hip joint was not invaded at any time during this procedure. Postoperatively, the animals limped for approximately 2 weeks, after which time, no difference in gait or activity level was visually distinguishable between the animals that had undergone operations and the control animals. The second member of each animal pair was used as an unoperated control. The

A continuing medical education (CME) program in rheumatoid arthritis was implemented and evaluated in six community hospitals. It was targeted at primary care physicians and utilized physicians identified by their peers as being educationally influential for the dissemination of content knowledge. Although inpatient and outpatient audits of physician records demonstrated little change in three control communities, substantial improvement in the utilization of diagnostic procedures and patient management was documented in the three intervention communities utilizing the influential physicians. CME delivered through community-based educationally influential physicians is an effective way to change physician behavior in small communities with no prior ongoing educational programs. This approach should improve the primary care given to patients with rheumatoid arthritis and reduce the need for participation of academic faculty in traditional CME programs.The need for continuing medical education (CME) for physicians is well recognized and encom- passes all the fields of clinical practice. The traditional approaches to CME, short courses sponsored by academic medical centers, medical societies, and national organizations have been criticized because they are often unstimulating, irrelevant to the practice setting of the individual physician, inconvenient, expensive, and do not ultimately result in a change in physician behavior. Using this information, together with an increasing concern about faculty availability for postgraduate teaching, we developed a community-based educational program for primary care physicians that minimized academic medical center faculty input and maximized community resources.The subject matter for this program was rheumatoid arthritis (RA), and we utilized physicians, identified by their peers as being educationally influential, for the dissemination of information. The methodology for the selection of the participating physicians has been described previously (1). A survey instrument that accurately described the major attributes of these influential physicians was used in each of the project communities to successfully identify these key individuals. Instructional objectives which defined the knowledge and skills that primary care practitioners should possess were developed and a needs assessment was undertaken. Based upon these results, an educational program was developed (2). The major components of this program were a syllabus which provided a concise review of the recent literature dealing with RA, audiovisual materials which demonstrated subject matters that could best be shown using sound and motion, and a clinical preceptorship within the University of Michigan Arthritis Center. After completion of this program, these educationally influential physicians returned to their home communities

A patient population admitted to the hospital for either SLE or RA was surveyed for the subsequent development of neoplasms. The frequency of neoplasm in SLE patients appeared to be exaggerated, whereas the frequency of subsequent neoplasm in rheumatoid patients was unexpectedly low. A paucity of nephritis in the SLE group was noted. Further reports are encouraged so that the magnitude of the risk of malignancy developing with immunosuppressive therapy can be more precisely ascertained.Laboratory abnormalities suggesting that autoimmune mechanisms are responsible for some of the lesions seen with several of the connective tissue diseases have led to use of immunosuppressive drugs in the management of these disorders. Concern that such agents

Flurbiprofen pharmacokinetics were studied in 15 normal male subjects after four oral doses. Plasma levels of total (bound + free) drug were monitored for 48 h and urine was collected for 96 h after the doses. All subjects demonstrated linear relationships between administered dose and total flurbiprofen AUC, indicating that oral clearance is independent of dose for the dose range evaluated in this study. Urinary recovery data indicated that the efficacy of absorption was dose independent.