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Study objectives: Patients with rheumatoid arthritis (RA) have a high prevalence of pulmonary function test (PFT) abnormality, but the long-term significance of this is unknown. We performed a longitudinal study [...]

Testing for disease-associated genes, and measuring the erythrocyte sedimentation rate (ESR), may predict which patients with rheumatoid arthritis (RA) will require joint replacement surgery. Researchers compared the human leukocyte antigen types of 65 RA patients who underwent joint replacement early in their disease and 65 RA patients who did not. One-third of patients with two disease-associated antigens underwent surgery, compared to only 9% of patients with another genetic type. The ESR was higher in patients who underwent surgery than in those who did not. Patient with disease-associated genes may require more aggressive drug treatment to delay joint surgery.

Early treatment of rheumatoid arthritis with injections of gold may effectively improve the functional ability of patients. Intramuscular gold injections are generally reserved for more advanced cases of the disease. Researchers treated 440 patients with regular gold injections. In patients with recent-onset disease, gold treatments produced a 30% decrease in disability. Functional ability did not significantly improve in patients with arthritis of longer duration. Initiating treatment within two years of diagnosis may be most beneficial in patients with rheumatoid arthritis.

Raynaud's phenomenon is characterized by whitening and then cyanosis (bluish discoloration) of the hands during exposure to cold. The cyanosis may be followed by whitening. Transient vasoconstriction (narrowing of blood vessels) seems to underlie this disorder, which is often associated with diseases of connective tissue (skin, bone, and cartilage). This secondary Raynaud's phenomenon is often difficult to treat, as unpleasant side effects can accompany vasodilator drugs and responses to the drugs may be inconsistent. Prostacyclin is a naturally-occurring vasodilator that can improve symptoms of Raynaud's phenomenon, but is unstable and can cause adverse effects associated with vasodilation. Iloprost, a derivative of prostacyclin, has been shown to be helpful in treating Raynaud's phenomenon, although the specific mechanism is unclear and undesirable side effects such as nausea, headache, and flushing may occur with maximum doses. To determine whether lower doses of iloprost are equally effective and whether effectiveness is dependent on vasodilator effects, 55 patients who received a low or standard dose of iloprost were assessed. Of these patients, 51 completed the study. The frequency, severity, and duration of Raynaud's attacks decreased similarly in both treatment groups. Both the frequency and severity of attacks were significantly lower during the last half of the eight-week study period. Eighteen patients had ulcers on their fingers before or during the treatment period. Ulcers healed similarly in both groups, and the low-dose group developed slightly more new ulcers. Significantly fewer patients receiving the low dose of iloprost reported side effects. Dose reduction was required in one patient in this group and in 16 of the 27 patients in the high-dose group. Treatment with either dose resulted in significant increases in levels of platelets and white blood cells. The results indicate that low-dose iloprost therapy effectively treats Raynaud's phenomenon and that vasodilation may be only part of the cause for improvement. (Consumer Summary produced by Reliance Medical Information, Inc.)

There have been a variety of side effects from use of sulphasalazine (SSZ) or auranofin (AUR) over years of testing their effects on treatment of rheumatoid arthritis, but there has not been any case of systemic lupus erythematosus (SLE) connected with the use of these drugs, particularly in the five years of a current study. During that time patients who were taking either AUR or SSZ stopped because of rashes, mouth ulcers, leucopenia (which resolved immediately on stopping drug use). Also, some patients became positive for antinuclear antibodies (ANA) but presence of ANA is common in treatment of rheumatoid arthritis and none withdrew because of the rise in ANA.

Increased blood levels of interleukin 6 (IL-6) may be associated with the development and progression of rheumatoid arthritis. Rheumatoid arthritis is an inflammatory disorder that affects the joints. A study compared blood levels of IL-6 in 93 patients with rheumatoid arthritis to levels in 20 patients with osteoarthritis and 70 healthy individuals. Blood levels of IL-6 were significantly higher in the patients with rheumatoid arthritis than in patients with osteoarthritis or the healthy individuals. Blood levels of IL-6 were similar in men and women. Increased blood levels of IL-6 were not associated with age or longer disease duration. An association was found between increased blood levels of IL-6 and duration of morning stiffness. IL-6 is a substance found in high concentrations in the synovial membranes of joints affected by rheumatoid arthritis.

Measuring blood levels of soluble interleukin 2 receptor (sIL-2R) may not be effective method for monitoring the condition of patients suffering from rheumatoid arthritis. Rheumatoid arthritis is an inflammatory disorder that affects the joints. Among 79 patients between 46 and 64 years old suffering from rheumatoid arthritis whose blood levels of sIL-2R were measured, 41 were treated with sodium aurothiomalate, 18 were treated with auranofin and 20 were treated with sulphasalazine. No significant association was found between blood levels of sIL-2R and different clinical indications of disease severity. None of the drugs affected blood levels of sIL-2R significantly despite clinical improvement among patients in all three treatment groups. Blood levels of sIL-2R have been used to monitor the condition of patients suffering from other disorders involving the immune system.

The synthetic drug inosine pranobex is capable of modulating the immune system, and has been used to treat various viral diseases, including herpes simplex infections. Inosine pranobex has been shown to improve some symptoms of rheumatoid arthritis, such as morning stiffness, and is well-tolerated by patients, but may increase blood levels of urate. Rheumatoid arthritis (RA) is a joint disease characterized by inflammation of the joints, stiffness, swelling, overgrowth of cartilage tissue, and pain. The effectiveness of inosine pranobex in treating RA was assessed in 24 patients with RA who were given this drug for 24 weeks; 26 patients were given a placebo, a substance with no known therapeutic effect for the same time period. Various indicators of RA, such as morning stiffness, articular index, grip strength, pain score, erythrocyte sedimentation rate, C reactive protein, levels of immunoglobulins G and M, and blood urate levels were measured at the start of the study, and at 12 and 24 weeks thereafter. Before the study, all indicators of RA were similar for both the treated and untreated groups, with the exception of C reactive protein, which was greater in the placebo group than in patients treated with inosine pranobex. C reactive protein is an abnormal protein present in the blood during active disease activity. Inosine pranobex did not improve any of the symptoms of RA, but did increase blood levels of urate. The results show that inosine pranobex is ineffective in treating RA. (Consumer Summary produced by Reliance Medical Information, Inc.)

It has been previously suggested that increased levels of calcium (hypercalcemia) in the blood serum of patients with rheumatoid arthritis (RA) may result from their arthritis. However, a study of 35 patients with hypercalcemia showed that the causes of hypercalcemia were not different in the 21 patients with RA than in the 14 patients without RA. The most common cause of hypercalcemia was mild hyperparathyroidism, or increased amounts of parathyroid hormone, which was detected in 62 percent of the cases. Parathyroid hormone maintains a constant concentration of calcium in the body, regulating absorption from the digestive tract and from bone. Other causes of hypercalcemia were treatment with the diuretic medication thiazide (13 percent), cancer (8 percent), immobility (8 percent), vitamin D toxicity (5 percent), and chronic liver disease (3 percent). In conclusion, the causes of hypercalcemia in patients with RA are the same as those found in the general population, therefore hypercalcemia is not a complication of RA. These results contradict previous studies that suggested hypercalcemia may be a complication of rheumatoid arthritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Recent advances The health consequences and fiscal burden of musculoskeletal diseases has been acknowledged but never fully addressed. An agenda unveiled by the World Health Organization to redress the balance [...]

Jonathan P Fuld(*); Mark M Cotton; Simon W Watkin; Martin K Johnson; Hilary A Capell and Robin D Stevenson. Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, United Kingdom and Rheumatology, Glasgow [...]

Abstract Objectives--To determine the influence of interleukin 1[Alpha] (IL1[Alpha]), IL1Β, and IL1 receptor antagonist gene polymorphisms on disease outcome as assessed by the need for major joint surgery within 15 [...]