Patrick J. Rooney

Gold induced thrombocytopenia: 12 cases and a review of the literature

Gold induced thrombocytopenia is immune mediated, with the production of platelet associated IgG leading to peripheral platelet destruction. An association with HLA-DR3 has been demonstrated. Corticosteroid therapy is effective in treatment, although other modes of therapy may be as efficacious.

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.

Feprazone (DA 2370): Patrick long-term experience in the management of rheumatoid Marion McLeod, arthritis complicated by severe dyspepsia

SummaryTwenty-one patients with rheumatoid arthritis who had been unable to continue with standard non-steroidal anti-inflammatory drugs because of gastro-intestinal intolerance were treated with feprazone (DA 2370) for prolonged periods. Dosage varied from 300 mg. to 800 mg. daily. Mean duration of treatment in 15 patients continuing with the drug was 14.6 months {range 4 to 30 months). Of the 6 patients who were withdrawn, only 2 did so because of gastric intolerance and 2 because of lack of effect. In almost all other instances, improvement occurred in the indices of inflammatory joint activity and there was significant reduction in gastro-intestinal symptomatology over a period of the study. Other side-effects were generally mild and infrequent.

A controlled comparison of piroxicam and diclofenac in patients with osteoarthritis

SummaryEighty patients with osteoarthritis were randomly assigned to either piroxicam (20 mg daily) or diclofenac (75–150 mg daily) in a 12-week double-blind, parallel groups study. In the 70 patients who completed the study, both medications were effective; statistically significant improvement was observed on all assessments of efficacy. However, no statistically significant differences between the two drugs were seen on any of the efficacy parameters measured. There was a trend towards better tolerance in the piroxicam treated patients, although this was not statistically significant; 3 of the 40 piroxicam treated patients versus 6 of the 40 patients on diclofenac were discontinued from the trial due to intolerable adverse events.

Demonstration of H2 Receptors in Peripheral Blood Vessels

The varying actions of histamine in the body have been explained on the basis of 2 types of histamine receptor-HI and H2 receptors.! HI effects are antagonised by conventional antihistamines such as mepyramine while known H2 effects include histamines action in stimulating gastric secretion and atrial contraction and inhibiting uterine contraction. This study was designed to investigate the respective roles of HI and H2 receptors in the control of microcirculation by examining the effectiveness of the H2 receptor antagonist metiamide and the HI receptor antagonist mepyramine in blocking the actions of histamine on synovial perfusion. Synovial perfusion was monitored indirectly by calculating the half-life (Tt min.) of the clearance rate of 133Xe from canine diarthrodial joints.s Twenty-four dogs were anaesthetised using thiopentone induction and maintenance of anaesthesia with halothane « 1 %), nitrous oxide and oxygen were used. Blood pressure and blood gases were monitored and maintained consistent throughout all experiments. The 133Xe clearance rate was unaffected by metiamide alone in various-doses from 125 p.g.to 1,000 p.g., but consistently increased by 1 p.g. of histamine. Metiamide produced a dose related effect on the histamine response (Table I) with consistent abolition of response at dose ratios Met:H of 500:1, variable response in a dose ratio of 200:1 and a consistent histamine response at a dose ratio less than 200:1 Mepyramine alone in high dosage caused an increase in 133Xe clearance and produced no antagonism of the histamine response up to a dose ratio of 1,000:1 Some specificity ofmetiamide effect was demonstrated by the failure of the drug to affect the action of 1 p.g. isoprenaline in increasing 133Xe clearance rate or 1 p.g. nor-adrenaline in decreasing 133Xe clearance rate. Thus these experiments support the existence of histamine H2 receptors mediating the histamine vascular response in the synovial microcirculation.

Bleeding from peptic ulcers and use of non-steroidal anti-inflammatory drugs

SIR,-Because most studies of asymptomatic microhaematuria have dealt with referred populations, we read with interest the recent study by Dr Carolyn D Ritchie and others (8 March, p 861) on the importance ofoccult microhaematuria found at screening. Before fully investigating all patients with microhaematuria, as suggested in the article and accompanying leading article (p 645) we should consider several features of the article. Firstly, the population studied was not necessarily asymptomatic when it presented for health screening. Asymptomatic patients may have a lower prevalence of serious disease. Secondly, midstream analyses of urine were performed, and the application of the recommendations to routinely collected specimens is uncertain. Thirdly, many of the diseases found were not necessarily serious and the patients may not necessarily have benefited from their screening test. Finally, the presence of proteinuria and pyuria was not determined. Often the presence of these abnormalities leads to further testing in higher risk patients, leaving lower risk patients with isolated asymptomatic microhaematuria. To establish the use of the analysis of urine for blood as a screening test for serious urological disease a controlled study is needed to assess aspects of sensitivity and specificity. Asymptomatic microhaematuria has not yet been proved to have ahigh positive predictive value for serious urological disease in a truly asymptomatic unselected population of patients. D N MOHR K P OFFORD L J MELTON

SLE precipitated by antibiotics in a patient with Sjøgren's syndrome and rheumatoid arthritis.

Hydergine contains 1-5 mg of mesylates of dihydrogenated alkaloids of dihydroergokryptine. The substance is thought to have a profound alpha-blocking action. It has also been suggested that it may have beta-adrenergic blocking effects.4 The bradycardiac effect of Hydergine is mentioned in earlier European literature particularly in relation to the use of Hydergine in peripheral vascular disease, but we have been unable to find a mention in the more recent literature in this country referring to its use in cerebrovascular insufficiency. Further research into the action of Hydergine on the heart rate would be of interest. We feel the development of this complication in three out of eight patients treated with Hydergine associated with severe systemic symptoms is of sufficient importance to report these cases.