Allander and Hellgren (1964) made the interesting claim that topical fluocinolone could produce improvement in the hands in inflammatory polyarthritis. Their conclusion was based on a trial in twenty patients, using test solution on one hand and control solution on the other. We felt that their result warranted a stricter trial using the same treatment but different means of assessment.Material.-We selected 25 in-patients with symmetrical disease of the hands but no severe joint destruction, none of whom was receiving systemic corticosteroid therapy; 24 of them had classical or definite rheumatoid arthritis and one had systemic sclerosis with flexor tenosynovitis.Method.-Each patient was treated by smearing 0 * 025 per cent. fluocinolone acetonide in propylene glycol on one hand and the propylene glycol alone on the other, using polythene gloves as an occlusive dressing; 12-hrly applications were continued for 6 days in eighteen of the patients and a day or two less in the remainder.To make sure that neither observer nor subject knew which hand was being treated until after the trial, the manufacturers prepared a pair of numbered bottles for each patient by labelling one for the left hand and one for the right. According to a random plan they then put fluocinolone solution into one and solvent alone into the other.The response was assessed subjectively, and by strength of grip and ring size measurements. The strength of grip in each hand was measured in the usual way by squeezing a small rubber bag attached to a sphygmomanometer and taking the average of three observations. Ring sizes were measured over the finger proximal interphalangeal joints using a set of standard jeweller's rings with half sizes. (The diameter increment between sizes is 0 4 mm.) The measurements were carried out at the same time of day on the day before treatment, the day treatment started, and the day treatment finished, and the day after that.
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