Alastair C. Kennedy

Bone Loss in Patients with Rheumatoid Arthritis

Both male and female patients with rheumatoid arthritis show a significant bone loss in the femur, compared with the loss of bone seen in normal subjects with increasing age. A very similar pattern is seen in corticosteroid treated patients with rheumatoid arthritis. There is no evidence to suggest that the corticosteroid therapy has caused a greater loss of bone from the femur than would have occurred as a result of the rheumatoid arthritis alone. There was a statistically significant relation between the duration of the rheumatoid arthritis and femoral bone lo-s in women over the age of 45 years, whether or not they had been given steroid therapy in both male and female patients over 45 years of age, but again it appears unlikely that corticosteroid therapy had contributed significantly to the femoral bone loss. The Metacarpal and Femoral Indices of the patients were significantly related in both male and female groups.

Zinc: Its Relationship to Osteoporosis in Rheumatoid Arthritis

Preliminary studies indicate that plasma zinc concentrations, as estimated by atomic absorption spectrophotometry, are reduced in rheumatoid arthritis. A relationship has also been established between metacarpal index of osteoporosis and plasma zinc concentrations in rheumatoid subjects.

Abnormalities in mineral metabolism suggestive of parathyroid over-activity in rheumatoid arthritis.

A three-part study on mineral metabolism in patients with classical rheumatoid arthritis is described. In the first two parts, biochemical abnormalities were revealed suggestive of parathyroid over-activity, and in the third part, observation on calcium absorption provides a hyperparathyroid pattern. The importance of these findings in relation to demineralisation of bone in rheumatoid arthritis is discussed.

The evaluation of antirheumatic drugs.

SummaryThe available methods of evaluation of an antirheumatic compound in a clinical trial situation are discussed. The techniques of single-blind and double-blind studies are described and their respective merits analysed. Proposed new techniques for the measurement of joint inflammation are reviewed.

Preliminary clinical evaluation of azapropazone in rheumatoid arthritis

SummaryAzapropazone, a new non-steroidal anti-inflammatory drug, was investigated in a single-blind, crossover clinical out-patient trial in 12 patients with definite rheumatoid arthritis. The drug was given at two dose levels, 900 mg./day and 1800 mg./day in 2-week treatment periods. The drug was shown to have an antirheumatic effect in both doses in terms of pain relief and in high dose in terms of pain relief and morning stiffness. Gastro-intestinal side-effects were more common, however, with the high dose.

Serum Uric Acid Levels in England and Scotland

A survey of serum uric acid levels in 766 subjects in England and 337 in Glasgow was carried out. There was no difference in the frequency distribution of uric acid or the mean levels in the two countries. A serum uric acid of 7 mg/100 ml or over was found in 7.2% of the men and 0.4% of the women. The previously described sex difference and association of serum uric acid with weight were confirmed. No association was found with social class. The suggestion of an increase in uric acid levels in the United Kingdom over the past 14 years is discussed.

The Arthritis of Behcet's Syndrome: Two Case Reports with Histological Examination of the Synovial Membrane

SummaryTwo case reports of patients with Behcets syndrome are presented. The disease was dominated by arthritis, which necessitated synovectomy in one of the patients. Histological examination of the synovium revealed synovial hyperplasia and abundant lymphocyte and plasma cell infiltration in the subsynovial tissue.

Clinical Evaluation of Niflumic Acid (Squibb) in Rheumatoid Arthritis

SummaryThe effect of 750 mg. of niflumic acid per day administered orally was studied in 15 patients with active rheumatoid arthritis in a double-blind cross-over trial. The patients were followed over a 2-week period with 3 assessments of joint pain and tenderness, duration and severity of morning stiffness, digital joint circumference, grip strength and radioactive pertechnetate (99m Tc) knee and wrist joint uptakes.The results show that niflumic acid was more effective in relieving pain than placebo. Anti-inflammatory effects could not be demonstrated.

Evaluation of the effect and duration of triamcinolone acetonide in the treatment of rheumatoid arthritis

SummaryThe effect of 80 mg. triamcinolone acetonide given by intramuscular injection was studied in 12 patients with active rheumatoid arthritis. The patients were followed for 4 weeks, with weekly assessments of joint pain and tenderness, digital joint circumference, hand grip, and radioactive pertechnetate (99mTc) knee joint uptakes. Another 12 patients with active rheumatoid arthritis received an injection of saline and acted as controls.The results showed that triamcinolone acetonide acted on average for 3 weeks. Subjective clinical parameters showed greater improvement than objective measurements, such as 99mTc knee joint uptakes.

Relationship between haemoglobin and the other clinical and laboratory parameters in rheumatoid arthritis

A retrospective study is reported of 160 patients with definite or classical rheumatoid arthritis, in which changes in haemoglobin concentration were analysed against changes in various routine clinical and laboratory indices of disease activity over a period of time. Although statistically significant correlations were found between haemoglobin concentrations and the articular index of joint tenderness, serum albumin concentration, and erythrocyte sedimentation rate at one point in time, significant relationships in changes in haemoglobin concentration were only found with changes in the latter two laboratory indices. The significant correlations were weak and less important than the cumulative effect of unknown variables in determining haemoglobin level. The study shows that the routine clinical and laboratory parameters of disease activity in rheumatoid arthritis are of no value in predicting the haemoglobin concentration.