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Diagnosis of xerostomiaThe beck test.

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ledge and age, number of drugs, or duration of disease may
be more typical than those of previous studies. In addition,
the lack of knowledge about side effects and major therapeutic effects, which we found among all groups, may describe
a universal deficit in outpatients with chronic diseases. We
have developed handouts and initiated brief consultations
with a physician‘s assistant in an effort to correct these
deficiiencies. We hope that, when we have increased our
patients’ knowledge regarding side effects and therapeutic
purpose, we will, in a future study, be able to measure
increased compliance with drug treatment.
Murray Friedberg
Pennsylvania State University
Schooi of Medicine at Hershey
Hershey, P A
John J. Nicholas, MD
Wallace Christy, MD
Floyd H. Taylor, PhD
University of Pittsburgh School of Medicine
Pittsburgh, P A
I . Ropes MW, Bennett GA, Cobb S, Jacox R, Jessar RA: 1958
revision of diagnostic criteria for rheumatoid arthntis. Bult
Rheum Dis 9:175-176, 1958
2. Physicians’ Desk Reference. Thirty-ninth edition. Edited by BB
Huff. Oradell, NJ, Medical Economics Company, 1985
3. Higbee M, Dukes G, Bosso J: Patient recall of physician’s
prescription instructions. Hospital Formulary 17:553-556, 1982
4. German PS, Klein LE, McPhee SJ. Smith CR: Knowledge of and
compliance with drug regimens in the elderly. J Am Geriatr SOC
30: 568-57 1. 1982
Rheumatismo, Artritis y Otros Males. Donato AlauconSegovia. Mexico City,Siglo Veintiuno Editores, SA, 1984,
142 pages. Illustrated. Indexed.
Editor’s note: Dr. Alafcbn-Segovia has written an inexpensive, soft-cover manual for Spanish-speaking arthritis patients and
their families. Because of this orientation, the book has been
reviewed by a patient with rheumatoid arthritis.
In general, I found this book to be interesting
and educational but, perhaps, too detailed for the average
layperson. The material is presented at an intellectual
level above that of the average Spanish-speaking person
living in southern California. It would probably be an excelient easy-to-read text for Spanish-speaking people in the
health care field. Often, I had to read the same paragraph
several times before I got a clear understanding of the
meaning .
Diagnosis of xerostomia: the Beck test
To the Editor:
A recent article by Kohler and Winter describes the
use of the Saxon test for the diagnosis of xerostomia (1). This
test may be useful for research purposes; however, most
practicing clinical rheumatologists do not have a Mettler
A more practical test for xerostomia is the method
developed by Beck, described by Hollingsworth ( 2 ) and
Lenoch et a1 (3), which 1 have used for many years in my
private practice. With this method, the patient expectorates
for 15 minutes (rest salivation) and then expectorates while
chewing paraffin or gum (avoiding swallowing any saliva) for
an additional 15 minutes. Normal subjects produce more
than 9.5 ml of saliva during the entire 30-minute period. It
has been reported that 70% of patients with the fully developed sicca syndrome produce less than 9.5 ml of saliva
during this test ( 2 ) . I have the patients perform this test
several times, at their convenience, at home and have them
measure the saliva in a measuring teaspoon ( I teaspoon
approximates 5 ml). Though not as accurate as the Saxon
test, the Beck test has been practical and helpful for me in
the diagnosis of the xerostomia component of Sjogren’s
C. D. Burda, MD
Louisiana State University School of Medicine
Shreveport, LA
I . Kohler PF, Winter ME: A quantitative test for xerostomia: the
Saxon test, an oral equivalent of the Schirmer test. Arthritis
Rheum 28: 1128-1 132, 1985
2. Hollingsworth JW: Local and Systemic Complications of Rheumatoid Arthritis. Philadelphia, WB Saunders, 1968, p 86
3. Lenoch F, Bremova A, Kankova D, Streda A, Balik J: The
relation of Sjogren’s syndrome to rheumatoid arthritis. Acta
Rheum Scand 10:297-304, 1964
The manual covers a broad spectrum of rheumatic
diseases in an authoritative manner, beginning with a classification of the various rheumatic diseases, a discussion of
inflammation and injury to the joints, the role of autoantibodies (“Guerra Civil”), and a description of joint anatomy.
Unfortunately, the chapter titles do not specify the subject
matter. For example, “Renoir’s Illness” is a chapter discussing rheumatoid arthritis; “The Sun as Your Enemy” is
about systemic lupus erythematosus; “Diseases of Wisemen, Kings, and Bums” describes gout; and “From Dinosaurs to the Ancient Mexicans” is about osteoarthritis.
Although these are colorful descnptions, it is difficult for
patients to look up particular problems unless they refer to the
index, where, unfortunately, the terminology is quite
sophisticated. It is hoped that in subsequent revisions, Dr.
Alarc6n-Segovia will be more practical, because there i s a
great need €or this kind of manual for the person who has
Nan Kleinman
Sun Diego, CA
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