A. P. Andonopoulos

Methotrexate therapy in rheumatoid arthritis. A two year prospective follow-up.

SummaryOne hundred and thirty seven rheumatoid arthritis (RA) patients refractory to D-penicillamine and some of them (15%) refractory to other slow active drugs were treated with oral methotrexate (MTX) (10–15mg weekly). After 12–24 months of treatment, 94 and 74 patients respectively showed a significant improvement as judged by duration of morning stiffness (p<0.0001), grip strength (p<0.0001), degree of joint swelling (p<0.01) and tenderness (p<0.0001) compared to pre-treatment values. This clinical improvement was also associated with a decrease of erythrocyte sedimentation rate (p<0.0001), decrease of C-reactive protein (p<0.0001) and with improvement of anaemia (p<0.05). No changes were seen in rheumatoid factor titres. Seventy-four of the patients were followed for up to 24 months. Thirty-one of them (23%) had complete remission and 43 (31%) had an excellent response. Adverse drug reaction during MTX therapy included: elevated liver enzymes in 34 patients, mucosal ulcers in 21, nausea and vomiting in 8, diarrhoea in 4, leukopenia in 2, interstitial pneumonitis in one, intestinal bleeding in one and finally septic arthritis in another patient. The majority of these side effects were resolved without sequelae. However, 15 patients (11%) with adverse drug reactions had to discontinue the treatment. Forty-one of our patients who received a cumulative mean dose of MTX of 1550.5±235.5 mg underwent a percutaneous liver biopsy. Ten patients had normal tissue, 12 had minimal changes, 13 nonspecific changes and 6 patients had mild fibrosis. We conclude that MTX therapy in refractory RA patients appears to be effective, but requires close monitoring for toxicity. Hepatotoxicity with fibrosis and cirrhosis due to long term MTX therapy may be relatively uncommon in RA patients.

Pulmonary function of nonsmoking patients with rheumatoid arthritis in the presence and absence of secondary Sjögren's syndrome, a controlled study.

One hundred nonsmoking patients with rheumatoid arthritis, including 63 with rheumatoid arthritis alone (RA group) and 37 who also had secondary Sjögrens syndrome (sSS group), underwent a detailed evaluation of their pulmonary function. The results were compared with those of 110 age-matched nonsmoking controls. Normal function was significantly less common in both patient groups than in the controls. A significant percentage of patients had small airways disease (SAD) which was observed with similar frequency in the control group. If this were excluded, then isolated impairment of carbon monoxide diffusing lung capacity (DLCO) was the most commonly detected significant abnormality in both patient groups. Restrictive disease was following in frequency in the RA group, but was absent in the sSS group. Obstructive disease was very uncommon in all of the patients. In general, there were no significant differences in the frequency of the various respiratory function abnormalities between patients with RA only and those with concomitant sSS, whereas between patients and controls, the only statistically significant differences were the higher frequencies of isolated DLCO impairment and restrictive disease in the RA group.

Pulmonary function of nonsmoking patients with giant cell arteritis and/or polymyalgia rheumatica; a controlled study

SummaryThe pulmonary function of 26 nonsmoking patients with giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR) was evaluated and the results were compared with those of 28 age and sex matched nonsmoking controls. Normal function was observed in 30.8% of the patients and 50% of the controls (p=non significant). Isolated small airways disease (SAD) was detected in a high percentage of the patients (46.2%), but not significantly different from that of the controls (50%). Its clinical significance remains to be answered. Obstructive, restrictive and diffuse interstitial lung disease (DILD) was seen in one, three and two patients respectively, but was absent in the control population. All the patients had a normal chest radiograph and were asymptomatic, except for three. Two of them had normal respiratory function and one DILD. It is speculated that DILD and restrictive disease, seen only in patients with biopsy proven GCA, may be related to the underlying process.