Absence of Rheumatoid Arthritis in Schizophrenia*

Summary: Middle-aged women with a substantiated diagnosis of schizophrenia from Victorian Psychiatric Hospitals were examined for clinical, radiological and serological evidence of rheumatoid arthritis. Clinical or radiological evidence of rheumatoid arthritis was detected in none of the 301 patients studied, where-as the expected prevalences would be 7.7%; this difference is highly significant (p < 0.001). On the other hand, the prevalence of serologically demonstrable rheumatoid factor in the women with schizophrenia was similar to that in subnormal women in hospital under the same conditions and in women from a normal Australian population. The demonstrable polarity of schizophrenia and clinical rheumatoid arthritis in women might be explained either on a genetic basis or through the “protective” effects of one disease, schizophrenia, on the occurrence of the other, rheumatoid arthritis.     

Gold Therapy in The Elderly Rheumatoid Arthritis Patient

Forty elderly (≥60 years old) and 101 young (<60 years old) rheumatoid arthritis patients receiving injectable gold therapy were followed prospectively between April 1971 and April 1982. The mean total gold compound received was 1,392 mg in the young group and 1,861 in the elderly group. Besides age, the only significant difference between the two groups was the increased gold compound received by the elderly. To determine efficacy and toxicity within and between certain age groups, the 141 patients were divided into 4 arbitrary age groups: group A (<30 years), group B (30—44 years), group C (45–59 years), and group D (≥60 years). The elderly responded to the gold therapy as well as the young patients did, at any time frame examined after 3 months of therapy. There was no difference in clinical benefit among groups A, B, C, and D. Nine patients in the elderly group and 15 in the young group had therapy discontinued because of no response. This difference was not significant among the groups A, B, C, and D. There was no difference in outcome of individual toxicity between the elderly and the young groups, and no difference in frequency of toxicity between the age groups A, B, C, and D. Serious hematologic toxicity occurred only in patients over 47 years of age, and nephrotic syndrome occurred only in patients over 52. In this study, gold therapy was found to be as clinically beneficial in the elderly as in the young patients, and the toxicity and drug failure rates were not significantly different.     

A Controlled Trial of Gold Salt Therapy in Rheumatoid Arthritis

Sixty-eight patients with definite or classic rheumatoid arthritis were enrolled in a double-blind, controlled study of gold salt therapy. The initial phase compared weekly injections of gold thiomalate to placebo. One-third of the gold group were withdrawn from the trial because of toxicity and one-fourth of the controls because of no benefit. The gold-treated patients showed slight, but definite, improvement in all parameters measured, although only the change in sedimentation rate was statistically significant. In Phase 2, designed to ascertain the effects of maintenance therapy, the gold group showed no increase in the number of involved joints, improved their grip strength and had a fall in erythrocyte sedimentation rate. Over the same period the placebo group deteriorated in all these parameters. The number of patients treated, however, was too small to allow definite conclusions.     

Epidemiology of Rheumatoid Arthritis: Rheumatoid Arthritis and Mortality

Increased mortality in rheumatoid arthritis (RA) is widely recognized but not fully explained. Despite substantial improvements in management and growing knowledge of the determinants of increased mortality, evidence for reduction in mortality in RA has lagged behind. Indeed, most studies report no apparent reduction in mortality in RA. However, emerging evidence from some recent RA inception cohorts suggests no increased mortality, including cardiovascular mortality, but this awaits further confirmation. Although it is possible that recent advances in RA treatment may manifest in improvement of survival in the near future, other factors, including undertreated or unrecognized low-grade inflammation, comorbidities, and immunogenetic factors, may contribute to the excess mortality in RA and impede its improvement. In this review, we summarize the current knowledge of the rates and determinants of mortality in RA, identify and discuss potential explanations for excess mortality, and outline promising research avenues for targeting mortality in RA.     

Lipid Paradox in Rheumatoid Arthritis: Changes With Rheumatoid Arthritis Therapies

Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality, related not only to traditional CV risk factors, but also to a chronic inflammatory state. However, lipid profiles in RA are different from those observed in the general population at risk of CV disease, where there is evidence of a positive relationship between disease and high cholesterol levels. In untreated patients with active RA this relationship is different, with a paradoxical effect resulting in lower levels of cholesterol associated with an increased risk of CV disease. In this review, we summarize the latest evidence on lipid abnormalities in the setting of RA and the interaction between inflammation and lipoproteins, as well as the effect of DMARDs and biologic therapies on lipid profiles and the possible implications for CV outcomes in this population.     

Gold Levels in Serum during the Treatment of Rheumatoid Arthritis with Gold Sodium Thiomalatet‡

Summary: Serum gold levels estimated in the course of therapy with gold sodium thiomalate were found to be closely related to dose and patient body weight. Maximum information was obtained from gold levels estimated on blood samples taken the day before and at 24 hours after gold administration. Serum gold levels did not reflect tissue concentrations, but provided a consistent parameter of gold metabolism during long term therapy. Individual differences in gold metabolism were apparent in serum levels estimated three weeks or more after administration.     

Albuminuria in Rheumatoid Arthritis: Associations With Rheumatoid Arthritis Characteristics and Subclinical Atherosclerosis

Objective

Albuminuria is a marker for subclinical cardiovascular disease (CVD ) in the general population. It is uncertain whether this association is present in patients with rheumatoid arthritis (RA ), a population with increased atherosclerosis and CVD events.

Methods

Urine albumin from a spot morning collection was measured, and the urine albumin‐to‐creatinine ratio (uACR ) was calculated for RA patients and a population‐based sample of demographically matched non‐RA controls. Associations of elevated uACR (≥25 mg/gm for women and ≥17 mg/gm for men) with CVD risk factors and measures of atherosclerosis (coronary artery calcification, ultrasound‐determined maximal intima‐media thickness of the common carotid artery and internal carotid artery [ICA ], and the presence of focal plaque in the ICA ) were compared cross‐sectionally according to RA status.

Results

We compared 196 RA patients with 271 non‐RA controls. Elevated uACR was found in 18% of the RA patients compared with 17% of the controls (P = 0.89). After adjustment, RA was associated with 57% lower odds of elevated uACR (P = 0.016). Higher serum creatinine levels and hypertension were both strongly and significantly associated with elevated uACR in the control group but not in the RA group (both P for interaction < 0.05). Among RA characteristics, the adjusted prevalence of elevated uACR among those treated with tumor necrosis factor inhibitors was less than half that among those not so treated (9% versus 20%, respectively; P = 0.047).

Conclusion

There was no association in the RA group of elevated uACR with measures of atherosclerosis or with several key cardiometabolic risk factors, which suggests a lower usefulness of elevated uACR as an indicator of subclinical CVD in RA.