Citations

ABSTRACT As a means of evaluating the effect of each presentation at a national medical conference and of the meeting as a whole, the scheduled lecturers were asked to supply the testers with several questions that summarized the most important points of their talks. Audience participants at the meeting were given tests drawn from these questions — one test before the beginning of the meeting, and another at the end. The results were compared for the answers to each lecturer's 3‐question group, and for the complete tests. All scores were better at the end than at the beginning of each lecture. A follow‐up survey of the attitudes of participants showed a positive reaction to the use of such testing at future meetings.

ABSTRACT The basic conservative therapy programs for elderly patients with arthritis include adequate physical rest and mental relaxation, analgesics, aspirin, and physical rehabilitation consisting of occupational and physical therapy with a good home therapy program providing appropriate balance between rest and activity. Proper protection from trauma and overuse of the involved joints, and appropriate nutrition can afford optimal improvement in health status and general resistance. Proper orientation of the patient regarding the nature of his disease and treatment program usually is required to obtain his full cooperation. A kind, encouraging, and understanding approach is most helpful in the elderly patient. Physical rehabilitation can help to relieve pain, decrease edema and deformities, improve muscle weakness and incoordination, and increase stamina. Difficulties with gait, transfers, and self‐care can be solved or improved. Physical medicine and rehabilitation measures are important components of the challenging treatment of patients of all age groups who are afflicted with severe arthritis. It is most important to tailor these components of the treatment program to the problem presented by geriatric arthritic patients.

ABSTRACT The principles of total joint arthroplasty recently have been expanded to the upper extremity, following the dramatic success with total hip and total knee replacement procedures. New problems have been encountered with the rebalancing of the soft tissues and the technical nature of joint mechanics in the upper extremities. Work on shoulder joint replacement is in the very early stages and of unknown success. Several prostheses are being used and tested. For elbow and wrist replacement, early and predictable success has been accomplished, enabling relief of pain and satisfactory motion. Total joint replacement in the fingers and thumb has provided excellent relief of pain but has been hindered by difficulties in rebalancing the soft tissues in patients with rheumatoid arthritis. It appears that total reconstruction of arthritic upper‐extremity joints will be commonplace in the not‐too‐distant future. Clinical trials are being expanded, with increasing success.

ABSTRACT In experience with total joint replacement in the lower extremity, to date, total hip arthroplasty has been the most successful. Total arthroplasty operations as applied to the knee and ankle are giving promising results. These methods offer new avenues for relief of pain and deformity and stabilization of arthritic joints in the lower extremity.

ABSTRACT Older people often complain of back pain, but it usually is not a major complaint except in the presence of serious disease such as malignancy, compression fractures from osteoporosis, or disc‐space infections. When back pain is a serious symptom in the elderly patient, the physician should look beyond the obvious evidences of degenerative joint disease for these other more serious conditions. Satisfactory examination of the back does not require an undue amount of time. It is important that it be done systematically. Simple, rapid, and adequate procedures are described.

ABSTRACT The indications and contraindications for use of intrasynovial steroid therapy are discussed. When properly used, the intrasynovial injection of steroids is a valuable method of treatment.

ABSTRACT To illustrate the diagnostic problems of rheumatic disease in patients over 60 years of age, 4 cases are presented: 1) osteoarthritis, 2) late‐onset rheumatoid arthritis, 3) polymyalgia rheumatica, and 4) pseudogout with crystalline synovitis. In each case the correct diagnosis should have been suspected from the history and physical examination alone, with the laboratory and x‐ray findings providing supportive evidence.

ABSTRACT The diagnosis and the treatment of rheumatic diseases in older people pose special problems. Degenerative joint disease, almost universally present in the elderly, may not be the basis for the newly developing rheumatic symptoms. Systemic inflammatory disease may be confused with malignancy or it may be an initial manifestation of malignancy. Some drugs used to control central‐nervous‐system or cardiovascular disease may produce painful rheumatic syndromes. Results of laboratory tests used in the diagnosis of rheumatic diseases may be altered by other nonrheumatic disorders in older people. Papers in this symposium will explore these concepts in greater detail.

Fragile X syndrome (FXS) affects individuals with more than 200 CGG repeats (full mutation) in the fragile X mental retardation 1 (FMR1) gene. Those born with FXS experience cognitive and social impairments, developmental delays, and some features of autism spectrum disorders. Carriers of a premutation (55–200 CGG repeats) are generally not severely affected early in life; however, are at high risk of developing the late onset neurodegenerative disorder, Fragile X‐associated Tremor/Ataxia Syndrome (FXTAS), or Fragile X‐associated Primary Ovarian Insufficiency (FXPOI), and may have other medical conditions such as developmental delay, autism spectrum disorders, hypertension, anxiety, and immune‐mediated disorders. Here we present a case of a 58‐year‐old man with a borderline IQ, average memory skills, and executive function deficits. He met criteria for multiple psychiatric diagnoses and presented with tremor and ataxia, meeting criteria for FXTAS. Molecular testing unveiled a completely unmethylated FMR1 full mutation in peripheral blood mononucleated cells with elevated FMR1 mRNA and premutation alleles of different sizes in two other tissues (primary fibroblasts and sperm), indicating the presence of allele instability based on both inter‐ and intra‐tissue mosaicism. The observation of FXTAS in this case of a full mutation mosaic man suggests that the pathogenic mechanism underlying this disorder is not observed exclusively in premutation carriers as it was originally thought. The concomitant presence of features of FXS and late onset neurological deterioration with probable FXTAS likely result from a combined molecular pathology of elevated FMR1 mRNA levels, a molecular hallmark of FXTAS and low FMRP expression that leads to FXS. © 2015 Wiley Periodicals, Inc.