Arthur L. Scherbel

Ocular lesions in rheumatoid arthritis and related disorders with particular reference to retinopathy. A study of 741 patients treated with and without chloroquine drugs.

THE occurrence of ocular lesions of variable severity in patients with rheumatoid arthritis, discoid and systemic lupus erythematosus and other diseases who have received long-term chloroquine ther...

FURTHER OBSERVATIONS ON THE EFFECT OF DIMETHYL SULFOXIDE IN PATIENTS WITH GENERALIZED SCLERODERMA (PROGRESSIVE SYSTEMIC SCLEROSIS)

Systemic scleroderma (progressive systemic sclerosis) is a connective tissue disorder of unknown etiology. According to Talbott,’ the disease is ultimately fatal, although duration of life following onset of symptoms is extremely variable and unpredictable in most patients. Varying degrees of cutaneous and subcutaneous involvement of the hands, forearms or face are generally observed. Raynaud’s phenomenon occurs almost consistently and subsequently, ischemic ulcers may appear a t the fingertips, elbows or ankles. As the disease progresses, all systems of the body may be affected. Eventually, disabling changes in skin, muscles and joints may be associated with circumscribed or interstitial calcinosis. Pathologic changes involving the connective tissue have not been clearly defined and opinions vary regarding the abnormal changes that occur. Some investigators report that there are no abnormalities in the collagen or amorphous ground s u b ~ t a n c e . ~ ’ ~ Others believe that amorphous material is inwhile still others say that the collagen fibers are increased.6 Various other studies have suggested that there are biochemical abnormalities within the connective tissue, i.e., depolymerized ground substance and increased cutaneous hexosamine. Numerous therapeutic measures, including corticosteroids, sodium endrate, reserpine, serotonin inhibitors, potassium aminobenzoate, chloroquine and cytotoxins have been used, but none is consistently or highly effective, The dismal outlook regarding treatment of this disease is reflected in an editorial comment in the Sixteenth Rheumatism Review, which states, “We doubt the efficacy of any therapy for systemic scler~sis .”~ 7

THE EFFECT OF PERCUTANEOUS DIMETHYL SULFOXIDE ON CUTANEOUS MANIFESTATIONS OF SYSTEMIC SCLEROSIS

DMSO exerts a palliative, therapeutic effect on healing of cutaneous ulcers in systemic sclerosis. The therapeutic response was variable and, therefore, the concentration of DMSO, as well as frequency and duration of treatments, should be individualized to obtain maximum healing effect with a minimum of adverse reactions. There was no evidence of ocular toxicity or other serious toxicity manifestations in this group of patients treated with topical DMSO for one year or longer. Delayed improvement was observed in the untreated extremity in the majority of patients studied. In no instance did improvement in the untreated extremities exceed improvement in the treated, bilateral counterpart. It is believed this resulted from a systemic, carry-over effect of DMSO rather than spontaneous improvement in the disease course. DMSO is a worthwhile, supplemental, therapeutic agent providing the limitations of therapy are understood.

The effects of iproniazid and other amine oxidase inhibitors in rheumatoid arthritis.

Many of the central nervous system manifestations characteristic of rheumatoid arthritis are favorably altered by the administration of small doses of iproniazid (Madid*) . These characteristic manifestations include retarded psychomotor activity, intolerance to stressful situations, vasomotor reactions, transient bouts of flushing, decreased tolerance to cold, transient paresthesias, muscular weakness, and alteration in deep-tendon reflexes. With larger doses there is lessening of the inflammatory joint manifestations.

Rheumatic musculoskeletal symptoms associated with carcinoma of the prostate gland.

The importance of searching for a malignancy in patients in whom rheumatic symptoms develop for the first time after the age of 60 years is emphasized. Case histories are presented to illustrate the disabling rheumatic symptoms that led the patients to seek medical aid. Treatment with estrogens alleviated the rheumatic symptoms in these patients, all of whom had carcinoma of the prostate gland.

Nonsteroidal antiinflammatory drugs: new alternatives for rheumatic disease.

New antirheumatic drugs which are moderately effective clinically and less toxic than similarly acting, previously available drugs are believed to act by blocking certain mediators of inflammation. At present, there is no evidence that they influence the release of lysosomes, inhibit the action of complement, or modify immune mechanisms.

Amine oxidase inhibitors

The numerous clinical effects that have been attributed to potent inhibitors of monoamine oxidase have stimulated interest in many fields of medicine. It is interesting that iproniazid, originally introduced as a tuberculostatic agent, was discarded because of undesirable stimulation of the central nervous system. Subsequently, this undesirable effect was found to alleviate numerous unrelated manifestations, and interest was renewed in the drug. The pharmacologic actions of iproniazid are numerous, but little is known regarding those responsible for all the clinical effects that occur. Two discoveries have elucidated somewhat the possible mechanisms of action: that iproniazid is a potent inhibitor of monoamine oxidase in vitr022 and that the administration of large doses of the drug increased levels of serotonin and norepinephrine in the brain of experimental animals.a At present, little is known about monoamine oxidase activity in health or disease, and only recently have clinical tests been devised to measure the activity of this enzyme.1 .,18 It should be emphasized that less well-known or unknown biochemical reactions other than inhibition of monoamine oxidase may be responsible for certain clinical effects of these drugs. Experimental studies have shown some variation in· pharmacologic actions of these compounds that inhibit monoamine oxidase activity, but clinical comparison of the hydrazine compounds presently available indicates that they act similarly and may produce the same toxic reactions; they differ primarily in potency and duration of effect.

Ocular Changes in Rheumatoid Arthritis: Comparison of Patients Treated with and without Antimalarial Drugs.

Excerpt Recent reports on ocular toxicity of chloroquine emphasize the frequent occurrence of keratopathy and retinopathy. The incidence and severity of lesions vary greatly in these reports. Our e...