Jan P. Vandenbroucke

Radio-synovectomy in chronic synovitis of the knee joint in patients with rheumatoid arthritis

The influence of intra-articular (i.a.) colloidal 198Au (5 mCi) or 90Y-silicate (5 mCi) on synovitis of the knee joint in patients older than 45 years with rheumatoid arthritis (RA), who had been treated since 1970 in our hospital, was investigated. Of the 89 knee joints of 77 patients studied, 65 had no or minimal radiological abnormalities of the knee joint treated (group I), whereas 24 patients had moderate to severe changes (group II). Before and at regular intervals after radio-synovectomy the clinical response was scored using pain, hydrops and warmth as parameters. The results indicated that 1 year after treatment the percentage of knee joints with a favourable response was greater in group I than in group II (58% versus 25%, P=0.001). This difference was still present 3 years after treatment. Clinical response showed no correlation with initial inflammatory activity as measured by 99mTc-pertechnetate uptake measurements. However, in group I, those patients with an ESR below 60 mm/h, measured just before radio-synovectomy, more often had a favourable response than those with an ESR in excess of 60 mm/h (P=0.01). No or only slight complications of radio-synovectomy were noted, whereas leakage of radioactivity from the knee joints was minimal.It is concluded that radio-synovectomy is an effective and safe procedure in those patients with rheumatoid synovitis of the knee joint without the presence of significant radiological damage and the absence of active systemic disease.

Side effects of azathioprine treatment in Rheumatoid Arthritis: analysis of 10 years of experience

Our experience with azathioprine in the treatment of rheumatoid arthritis covers ten years, during which 91 rheumatoid patients (66 female and 25 male) received this drug, with a median treatment period of 36 months. Total follow-up experience, during and after treatment, was 399 person years. Twelve patients died. The principal causes of death were malignant neoplasm (six patients) and cardiovascular diseases (three patients). The mortality in our patients was compared to that of the general Dutch population by the Standardised Mortality Ratio (SMR). In the male patient group a significant excess of both total mortality and mortality from malignancy was observed. The female patients showed no differences from the general population. In this follow-up study, no lymphoreticular tumours occurred during or after azathioprine therapy.

The Relationship between Aurothioglucose- and D-Penicillamine-Induced Proteinuria

We studied patients with rheumatoid arthritis who have been treated with aurothioglucose (Au) and subsequently with D-penicillamine (DP), and who developed drug-induced proteinuria, over a 10-year period. Twelve patients developed Au-induced and 19 DP-induced proteinuria. Of the 12 patients with Au-induced proteinuria, only 2 (17%) developed DP-induced proteinuria, indicating a slightly increased risk as compared with the overall incidence (9.3%) of this reaction in 168 DP-treated patients. In addition, only a minority (2 out of 19, 10.6%) of patients with DP-induced proteinuria had previous Au-induced proteinuria. These data may indicate that different mechanisms are operative in Au and DP-induced proteinuria, as is also suggested by the finding that HLA-DR3 was present more frequently in the latter (50%) than in the former (21%). A history of previous Au-induced proteinuria is insufficient reason to deny these patients the benefits of subsequent treatment with DP.