close

Вход

Забыли?

вход по аккаунту

?

Trapeziometacarpal osteoarthrosis in a painting by Diego velazquez.

код для вставкиСкачать
127
LETTERS
4. Burns JC, Geha RS, Schneeberger EE, Newburger JW, Rosen
FS, Glezen LS, Huang AS, Natale J, Leung DYM: Polymerase
activity in lymphocyte culture supernatants from patients with
Kawasaki disease. Nature 323:814-816, 1986
5 . Pelton BK, North M, Palmer RG, Hylton W, Smith-Burchnell C,
Sinclair AL, Malkovsky M, Dalgleish AG, Denman AM: A
search for retrovirus infection in systemic lupus erythematosus
and rheumatoid arthritis. Ann Rheum Dis 47:20&209, 1988
6. Mack D, Sninsky JJ: A sensitive method for the identification of
uncharacterized viruses related to known virus groups: hepadenavirus model system. Proc Natl Acad Sci USA 85:69774981, 1988
Clinical outcome in patients receiving nonsteroidal
antiinflammatory drugs
To the Editor:
The very detailed study by Cush et a1 (1) illustrates a
major dilemma for rheumatologists treating relatively early
rheumatoid disease, namely, how can the patients who will
improve spontaneously be identified? The authors report
that, among patients given a nonsteroidal antiinflammatory
drug, those who responded in terms of their acute-phase
reactants and other markers of disease activity also had an
improvement in their clinical indices. This is not surprising if
one believes that the acute-phase response is largely a
product of cytokines released as an integral part of the
pathologic process. A more important finding, however, was
that responding patients could not be distinguished from the
nonresponding ones on the basis of their clinical features at
onset. One crucial feature in these patients was not examined, however; namely, their genetic backgrounds.
We and others have studied this question in patients
with early arthritis (2) and have shown that, despite apparent
similarities in clinical features, the patients who have persistent disease can be distinguished on a genetic basis from
those who have self-limiting disease. Not only do patients
with persistent disease have a much higher frequency of the
so-called “disease-related’’ epitope of the third hypervariable region of DRpl (2), but there are differences between
the two groups in the prevalence of a defect of the enzyme
system responsible for sulfur oxidation (3). Therefore, although it is true that from the data presented in Cush et al’s
report, one could not predict clinical outcome, I think it
would be appropriate to make every effort to stratify for
known genetic factors. Certainly, this would provide a
further means of interpreting the data in the absence of a
placebo control group.
Paul Emery, MD
University of Birmingham
Birmingham, UK
Cush JJ, Jasin HE, Johnson R, Lipsky PE: Relationship between
clinical efficacy and laboratory correlates of inflammatory and
immunologic activity in rheumatoid arthritis patients treated with
nonsteroidal antiinflammatory drugs. Arthritis Rheum 33:623633, 1990
Salmon M, Emery P, Wordsworth BP, Tunn EJ, Bacon PA, Bell
JI: HLA Dw4 is associated with persistence rather than the
induction of rheumatoid arthritis. Submitted for publication
Emery P, Bradley H, Arthur V, Trueba Yanes T, Tunn EJ,
Waring RH: Poor sulphoxidation: a genetically determined factor
associated with persistent disease in rheumatoid arthritis (abstract). Br J Rheumatol 28:49, 1989
Trapeziometacarpal osteoarthrosis in a painting by
Diego Velazquez
To the Editor:
Recent exhibitions of Diego Velazquez’ (160G1661)
work held in New York and Madrid have allowed many
people to view the masterpieces of this great artist. More
than 300,000 people have visited the exhibition in Madrid.
I would like to comment on the trapeziometacarpal
osteoarthrosis seen in one of the exhibited pieces, “Old
Woman Cooking Eggs,” which is housed at the National
Gallery of Scotland in Edinburgh. The painting is of a
woman frying eggs in an earthenware vessel while a young
boy watches. Her right hand holds a wooden spoon while the
left one grasps an egg (Figure 1). Both hands show a marked
prominence on the trapeziometacarpal articulation. The
more advanced rizarthrosis appears to be on the left hand (1)
(Figure 2).
This painting is from Velazquez’ early period, when
he was living in Seville. It is dated around 1620 (2). Since the
painter was not well known at the time, he used his relatives
and servants as models. Velazquez was a disciple of the
painter Francisco Pacheco and was married to Pacheco’s
daughter (3). The old woman cooking eggs was Velazquez’
mother-in-law, who modeled for him in another picture from
his early years, “Christ at Marta’s Home,” which is exhibited at the National Gallery of London. At the Museum of
Seville, there is exhibited an altar piece where the same
woman appears with her husband, Francisco Pacheco (4).
In this fine exhibit, there are many examples of
pathologic conditions, such as hypotiroideus dwarfism,
achondroplasia, drunkenness, and knock-knees. As a rheu-
Figure 1. “Old Woman Cooking Eggs,’’ by Diego Velazquez, 1620.
(Reproduced with permission of the National Gallery of Scotland in
Edinburgh.)
LETTERS
128
Use of the pinch strength meter in tender point
examination
Figure 2. “Old Woman Cooking Eggs” (detail of left hand), by
Diego Velazquez, 1620. (Reproduced with permission of the National Gallery of Scotland in Edinburgh.)
matologist, I was particularly intrigued by the articular
condition depicted in “Old Woman Cooking Eggs.”
A. Castillo-Ojugas, PhD
Universidad Complutense
Madrid, Spain
1. Castillo-Ojugas A: Rheumatology and Spanish art, Seventeenth
Congress of the International League Against Rheumatism. Rio
de Janeiro, September 17-23, 1989
2. Rardi PM: La obra completa de Velazquez. Barcelona, NoguerRizzoli, 1969
3. Camon Aznar J: Velazquez. Madrid, Espasa Calpe, 1964
4. Gallego J: Catalog0 de la exposicion de Velazquez. Madrid,
Museo del Prado, 1990
To the Editor:
In a recent report by the Multicenter Criteria Committee for the Classification of Fibromyalgia (Wolfe F,
Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P,
Fam AG, Farbor SJ, Fiechtner JJ, Franklin CM, Gatter RA,
Hamaty D, Lessard J, Lichtbroun AS, Masi AT, McCain
GA, Reynolds WJ, Romano TJ, Russell IJ, Sheon RP: The
American College of Rheumatology 1990 criteria for the
classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 33: 160-172, 1990), the
committee recommended that tender point examination be
done at a pressure of approximately 4 kg (approximately 10
Ib). The pressure level was “determined by having observers
palpate the cork end of the dolorimeter and observing the
effect required to reach the 4-kg mark.”
Not having a dolorimeter available, we found an
easier way to determine the effort-by using a pinch strength
meter, which is available in virtually every occupational
therapy unit. The instrument is placed on the table with one
end steadied. The pulp of the thumb is pressed against the
upper part of the spring, with the observer noting the
pressure achieved (Figure 1). This small instrument can be
easily carried in the pocket, and is useful in teaching
residents the amount of pressure to apply. Some physicians
might want to buy one of these instruments for their own
use, but I found it easier to borrow one from a friendly
occupational therapist to use during the course of the clinic.
It comes with a loop at one end, which is too small to put
over the head. It can be looped around a wrist or through a
buttonhole or belt, if desired.
John Baum, MD
University of Rochester Medical Center
Rochester. N Y
Figure 1. Use of pinch strength meter to determine finger force needed for 4 kg of pressure.
Документ
Категория
Без категории
Просмотров
0
Размер файла
702 Кб
Теги
diego, velazquez, osteoarthrosis, painting, trapeziometacarpal
1/--страниц
Пожаловаться на содержимое документа