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The restless legs syndrome (RLS), defined by Gibb and Lees criteria, was investigated in patients with RA. RLS symptoms were more frequent in RA patients (25%) than in non-RA controls with OA or seronegative arthropathy (4%). RLS was significantly more common in females. Judged by a variety of clinical and laboratory indices, RA disease severity and current disease activity were greater in patients with RLS than in RA patients unaffected by RLS. In five out of 14 RLS patients undergoing neurophysiological study, delays in the P40 component of posterior tibial somatosensory evoked potentials (SSEPs) were observed suggesting the existence of myelopathy, whilst in another four RLS patients evidence of peripheral neuropathy was found. Though the higher frequency of neurophysiological abnormalities in RA patients with RLS was not statistically significant, possibly because of the small numbers of patients studied, these data suggest that RLS symptoms in RA may reflect the presence of neurological disorder.

NSAIDs significantly reduce overall pain over 4 weeks. This short-term responsiveness is retained, and even after several years of therapy with tiaprofenic acid pain scores increased over 2 weeks when it was changed to placebo. Our results do not show long-term benefits from the use of NSAIDs in OA and the majority of patients had persisting pain and disability despite therapy.

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A major aim of the government's white paper Working f6r Patients is to make the services provided by general practitioners more responsive to patients' needs.' Patients consider that the convenience of surgery hours is important," but no reliable information exists to show what appointment times patients prefer. We therefore collected and analysed data on this subject. Subjects, methods, and resultsWe performed the study in a general practice in Leyland, Lancashire, that had seven partners and a list of 11 655 patients. Surgeries were held continuously from 8 am to 6 pm on Mondays to Fridays. All patients on the age-sex register of the practice who were over 18 and had their birthday in April were sent a questionnaire that asked what time they would prefer to attend the surgery, both generally and for specific clinics; how often they had visited a doctor at the surgery in the past year; and whether inconvenient times of access had caused problems. Patients with children were asked what time they would prefer to have appointments for them, and whether this differed from their choice for their own appointment. Patients were also asked when they worked and whether they would like surgeries at weekends.We sent 949 questionnaires and 586 (62%) were returned completed. Four hundred and fifty three patients had a convenient time in mind when they made a routine appointment. Clinics before 9 am were preferred by 133 patients, from 9 to 11 am (the conventional time of morning clinics) by 192, from 3 to 6 pm by 147, and after 6 pm by only 29 (table). Appointments between 9 and 11 am were preferred by the largest proportion (44%) of parents with children aged under 5. Women with children aged under 5 were significantly more likely to want an appointment between 9 am and 11 am for their children than for themselves (p<0-0001, X2 test). One hundred and nine (57%) parents with children of school age preferred appointments for them between 3 and 6 pm. Patterns ofwork influenced preferences: the 29 patients who preferred appointments after 6 pm all worked during the day, and the 20 who worked only in the afternoons preferred to attend during the morning. The table shows the appointment times preferred by people attending well woman clinics and for health checks.

SUMMARY A collaborative study of 75 selected patients with rheumatoid arthritis (RA) employing 6 different methods for the detection of antibodies to type II collagen showed highly significant correlations between all the assays. The radioimmunoassays showed a greater sensitivity than either the passive haemagglutination or immunofluorescent techniques, and when the native collagen molecule was heat-denatured a higher number of patients showed increased antibody levels. In 33 patients the measurement of serum antibody levels to human, bovine, and rat native type II collagen showed a lack of species specificity, indicating that heterologous collagens can be employed in these assays. A retrospective analysis of the clinical, laboratory, and radiological features in the 41 patients with raised antibody levels and the 34 patients with normal antibody levels showed very few differences, but there was a significantly lower incidence of subcutaneous nodules (24 % versus 56 %) in patients with raised antibody levels. This study emphasises the need to standardise assays for the measurement of serum antibody levels to native type II collagen. More extensive studies will be required before the clinical significance of these antibodies can be fully established.Elevated serum antibody levels to collagen have been detected in patients with rheumatoid arthritis (RA) with different types and species of collagen and a variety of immunological methods.`These differences have led to a marked variation in the reported incidence of these antibodies in patients with RA and have led to difficulties in determining their significance.The restricted distribution of type II collagen to articular cartilage, the vitreous humour of the eye, and the intervertebral discs makes this collagen of particular relevance in the chronic inflammatory arthritides when compared with the more universal distributions of types I and III collagens.8 Evidence that antibodies to type II collagen may play a pathogenic role in RA is suggested by studies on native type II collagen-induced arthritis in rats and mice.9"11Our laboratories have independently developed different immunological methods to detect elevated

SUMMARY Fifty patients who had received a hinge arthroplasty of the knee were investigated for possible metal sensitivity. Patients were patch tested against all the metal constituents of the prosthesis. Positive patch tests were found in 32% of patients. Seventeen patients had either loosening or a persistent sterile discharge from the knee. No correlation was found between these complications and metal sensitivity. It was concluded that metal sensitivity is probably not a primary factor in the pathogenesis of complications, particularly loosening.Patients who have metal on metal prostheses have been shown to have a raised incidence of metal sensitivity as demonstrated by patch tests (Benson et al., 1975;Elves et al., 1975). This has been suggested as a possible cause of loosening in these prostheses (Evans et al., 1974;Benson et al., 1975;Jones et al., 1975). Prosthetic joints shed a considerable number of metallic particles (Charoskey et al., 1973) and patients have elevated blood levels and a raised urinary excretion of cobalt (Coleman et al., 1973). If metal sensitivity were a primary event in the production of loosening or other complications such as sterile discharge, positive skin tests might be expected in these cases. Previous studies (Evans et al., 1974;Benson et al., 1975;Elves et al., 1975;Jones et al., 1975;Brown et al., 1977) have been mainly in hip replacements. We decided to investigate our patients who had received a hinge arthroplasty of the knee to determine the incidence of metal sensitivity and to assess whether any correlation existed with complications which had occurred. Patients and methodsFifty patients with a hinge arthroplasty of the knee either of the Walldius or Guepar type were studied. These prostheses were inserted between 1971 and 1975 and all patients who were able to attend in 1976 were investigated.Thirty-nine patients had rheumatoid arthritis and 11 had osteoarthrosis.Accepted for publication November 7, 1977 Correspondence to Dr M. Webley, Department of Rheumatology, Westminster Hospital, Horseferry Road, London SWIP 2AP Thirty-three control patients, with either rheumatoid arthritis or osteoarthrosis, but without prostheses were also tested.The ages of the patients ranged from 44 to 76 years (mean 66) and the ages of the control group ranged from 47-76 years (mean 64).Thirty-eight of the patients were women and 12 were men. In the control group, 26 were women and 7 were men.A history of allergy was sought with particular reference to metals. An occupational history was also taken. Patients were patch tested using 'AL' test strips to which the allergens were applied. The test strips were placed on the the patients' backs and held in place with micropore tape.All the metal constituents of the prostheses were tested. These were cobalt chloride 2 %, nickel sulphate 5%, and potassium dichromate 0 5 % (obtained from the Trolle Lassen Laboratories, Hellerup, Denmark). Manganese 2 %, silicon 2 %, iron 2%, and molybdenum 1 %, made up in white paraffin. In addition, patients were...

SUMMARY Thirty-one patients with rheumatoid arthritis maintained on prednisolone 5 mg daily for an average period of 9 4 years were assessed radiologically to determine the degree of osteoporosis in their spine and peripheral skeleton. They were compared with a control group of 32 rheumatoid patients who had never received corticosteroids. The steroid-treated patients had more severe osteoporosis than the controls, though the difference was not statistically significant. In the female patients the spine appeared to be more sensitive than the peripheral skeleton to the osteoporotic effect of corticosteroids.