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Ann Rheum Dis: first published as 10.1136/ard.48.8.617 on 1 August 1989. Downloaded from

Annals of the Rheumatic Diseases 1989; 48: 617-618

Journal summary

Leader loss of function may be proportionately much more serious in therefore. Chondroprotection and NSAIDs p 619 The leader this month looks at the problems of Neopterin and in chrondroprotection and the action of various non- rheumatoid p 636 steroidal anti-inflammatory drugs (NSAIDs). Dif- Synovial neopterin seems to be a marker for the ferent drugs act at different points in cartilage activity of the systemic inflammatory activity in metabolism and the potential of this has been little rather than for the local disease explored: Can the effects of one be compared with activity in the joints. It is produced by the macro- another in outcome studies to help us unravel the phages and reflects the pathogenetic role of the complex mechanisms operating in joint repair? In activated immunocellular reaction in rheumatoid the meantime we should be careful about claims for arthritis. It is not specific for this disease, however. one drug as opposed to others. The evidence is not yet hard enough for such claims to be made with any Rheumatoid arthritis and coDagen reliability. cross links p 641 Urinary hydroxypyridinium cross links of collagen Scientific papers were examined in patients with seropositive rheu- matoid arthritis (RA). There was a strong correlation Indomethacin and cartilage between pyridinoline concentrations in and

proteoglycan depletion p 623 the serum C reactive protein values, and the authors copyright. In experimental studies on antigen induced arthritis argue that this is consistent with the involvement of in rabbits indomethacin certainly improved the joint various cytokines in the pathogenesis of RA. These signs of inflammation. This seemed to be at the cost urinary concentrations are it seems strongly asso- of increasing the loss of proteoglycans from the ciated with the disease activity and may be useful as articular cartilage, among other effects. This study is a sensitive and non-invasive biochemical marker for pertinent in the light of the leader on chondro- studying disease progression. protection. We certainly need to know far more about the effects of drugs on the articular cartilage Stromelysin, synovial B cells, http://ard.bmj.com/ before we can be sure about which side we are on in and rheumatoid arthritis p 645 the equation of benefit versus loss. Metalloproteinases such as stromelysin are produced by connective tissue cells and may play a significant Ankylosing spondylitis and squaring part in the destruction of joints seen in rheumatoid of the vertebrae p 628 arthritis. They seem to be produced by synovial B This Swiss study took advantage of the sad suicide of type cells and their production is stimulated by

a young man with ankylosing spondylitis to look at factors derived from activated macrophages present on September 23, 2021 by guest. Protected the pathology of squaring of the vertebrae in this in the synovium. condition. The author was able to show that the effect is the result of the combination of a destructive Serum osteocalcin in rheumatoid arthritis p 654 osteitis and repair. Osteocalcin acts as a marker of bone formation, and normal serum concentrations were found in rheuma- Ankylosing spondylitis and toid arthritis despite the bone demineralisation that pulmonary function p 632 is known to occur commonly in this disease. This Thirty patients were studied and shown to have slight suggests that bone formation rates are normal in reduction in various measurements of pulmonary RA, as indeed other work has indicated. function. Even where there was a markedly reduced thoracic expansion the vital capacity was reasonably Polymyalgia rheumatica and giant well maintained, presumably because the diaphragm cefl arteritis I p 658 was compensating for the loss of thoracic expansion. This and the following paper from Cambridge look The authqrs account for the loss of respiratory at the treatment of polymyalgia rheumatica and muscle strength that they observed by postulating with steroids. This first paper atrophy of the intercostal muscles. Diaphragmatic compares two regimens-high or low dose steroid 617 Ann Rheum Dis: first published as 10.1136/ard.48.8.617 on 1 August 1989. Downloaded from

618 Journal summary schedules for the first two months of treatment. Case reports Those patients taking lower doses had a higher relapse rate, particularly if the dose was reduced too Sj6gren's syndrome, , rapidly. The dose required to maintain suppression and polychondritis p 683 of disease activity seemed rather higher than other The development of and studies have found. Deviation from prescribed dose rapidly progressive renal failure from a proliferative levels, with the low dose regimen in particular, glomerulonephritis in a middle aged woman with brought on worrying signs of retinal involvement. Sjogren's syndrome is highlighted. This responded to steroids but required long term maintenance treatment it appears. Polymyalgia rheumatica and giant cell arteritis II p 662 Reactive arthritis and the streptococcus p 686 The second paper looks at steroid side effects. These The authors differentiate between occurred in two thirds or more of the patients if complicating streptococcal and a true weight gain is included and not surprisingly were reactive arthritis after such an event. The reactive more obvious when higher doses were used. Dura- arthritis described here responded well to treatment, tion of treatment was also related to the severity of and with a good outcome. side effects. Pyrophosphate tenosynovitis p 689 Three patients developed crystal deposits in tendon sheaths outside the carpal tunnel. The crystals were Polymyalgia rheumatica, giant cell arteritis, identified as calcium pyrophosphate, and in two of and how to assess it p 667 the three excision of the tendon sheath was required. More on this theme. The erythrocyte sedimentation rate (ESR) and C reactive protein were compared to

Now and then copyright. assess progress and monitor the success oftreatment. The ESR seemed to be the better indicator, par- Swelling spondylitis and spears p 692 ticularly if the disease relapsed. The clinical picture This is a new feature in which we will publish still seems to be the most useful guide to progress, occasional articles about the more lighthearted sides however. to . Gavin Clunie went off to Papua New Guinea as a medical student to study arthritis and the HLA-B27 antigen in the native population.

SLE and avascular necrosis of bone p 672 He escaped with his head still attached after a series http://ard.bmj.com/ Avascular necrosis of bone in this disease occurred of adventures, and I daresay will dine out on the in patients taking a high steroid dose compared with stories for several years to come. those taking lower doses. Features of systemic erythematosus (SLE) such as hyperlipidaemia, renal Review involvement, and hypertension among others were not associated with bone necrosis, but the presence Amyloid and the rheumatic diseases p 696

of the lupus anticoagulant was. This particular factor on September 23, 2021 by guest. Protected is again seen to indicate a poor prognosis in SLE. Back to the problems of arthritis again, this time concerning amyloidosis as a complication of the rheumatic diseases. The authors take a wide ranging Double stranded DNA and SLE p 677 view of the situation and make the point that studies The polyethylene glycol (PEG) assay measures low of the prevalence of amyloid have tended to avidity antibodies to double stranded DNA, whereas underestimate it because of the ways in which the the Farr method tends to identify the presence of diagnosis is made. It complicates some rheumatic high avidity antibodies. This study from Holland disorders, notably rheumatoid arthritis and ankylos- shows that the Farr assay has a good ability to ing spondylitis, more than others. In SLE it is predict major exacerbations of the disease, but the unusual, but newer methods of investigating it may PEG assay on its own does not. The FarrIPEG ratio cause us to revise our ideas of prevalence rates. At seems to be particularly useful in indicating changes all events, patients with continuing active disease in disease activity, not least as a herald to renal and are particularly more prone to get it than are those cerebral complications. with milder, more intermittent disease.