SULPHASALAZINE ALONE OR IN COMBINATION WITH D-PENICILLAMINE IN RHEUMATOID ARTHRITIS

Thirty patients (22 women) with active rheumatoid arthritisparticipated in an open study of 6 months' treatment with eitherenteric-coated sulphasalazine (SASP) or SASP plus D-penicillamine(DPA). Patients were assessed at regular intervals using a numberof clinical and biochemical tests designed to detect specificantirheumatic activity. There were significant improvements in clinical and laboratoryvariables with both regimens consistent with second-line activity.Improvements were greater and more numerous with combinationtherapy. At the end of the trial period, there were nine ‘responders’in the SASP/DPA group but only six in the SASP group. Neitherefficacy nor toxicity could be related to patient acetylatorstatus. Nausea and dyspepsia were frequent problems with both treatmentregimens but dysgeusia and thrombocytopenia were confined tothe SASP/DPA group. Study withdrawals were twice as common withcombination therapy. These results suggest that a combination of SASP and DPA ismore potent than SASP alone but at the expense of poorer patienttolerance. KEY WORDS: Rheumatoid arthritis, Sulphasalazine, D-Penicillamine, Combination therapy     

PHTHALYLSULPHATHIAZOLE IN RHEUMATOID ARTHRITIS

Sixteen patients with active rheumatoid arthritis were treatedwith phthalylsulphathiazole (4 g/day) over a period of 24 weeks.Although there was some statistically significant improvementin plasma viscosity, IgM, pain score, morning stiffness andsummated change score, this was either intermittent or not maintained.Five patients withdrew from the trial before completion, four(25%) with non-serious adverse reactions and one patient fromlack of efficacy; only one patient elected to remain on thedrug beyond the 24-week period. Low free and total sulphathiazoleserum concentrations were found, confirming that most of thedrug remained within the gut. This investigation suggests, certainlyat the dose used, that phthalylsulphathiazole does not havethe properties of a second-line agent. Higher doses of the drugwill not be ethically feasible. KEY WORDS: Sulphonamides, Second-line agent, Rheumatoid arthritis     

METHYLSULPHASALAZINE IN RHEUMATOID ARTHRITIS

Methylsulphasalazine, which differs from sulphasalazine by theaddition of one methyl group, may provide the benefits of theparent drug with fewer side-effects in rheumatoid arthritis(RA). We describe the outcome of its use in RA. Of 21 patientsentered into the study, 10 successfully completed 6 months oftherapy; five developed adverse effects, four with drew forreasons unrelated to drug treatment and two stopped becauseof inefficacy. No serious adverse effects were reported. A statisticallysignificant improvement in most clinical assessments was observedfrom weeks 8–12 onwards. Significant improvement in plasmaviscosity was observed and there was a trend towards improvementin serum CRP, his tidine and IgM concentrations. There was agood correlation between mean serial changes in clinical andbiochemical assessments indicating that the drug may exhibitthe properties of a second-line agent. Median steady-state serumconcen trations of methylsulphasalazine and methylsulphapyridinewere 26.6 µg/ml and 2.85 µg/ml respectively. KEY WORDS: Therapy, Sulphasalazine, Second-line agent     

OPTIMIZING THE ASSESSMENT OF DISEASE ACTIVITY DURING TREATMENT WITH ANTI-RHEUMATOID DRUGS

Clinical trials in RA usually involve the use of several laboratoryassessments of disease activity. Their use is not universaland the relative value of many novel assessments has not beendetermined in relation to existing clinical and laboratory methods.This study attempts to investigate the value of establishedand novel assessments of disease activity during treatment withaccepted DMARDs. Over a 48-week study period, changes in cytidine deaminase (CD),ß₂-microglobulin, ₁-acid glycoprotein (₁-AGP) serumantibodies to Clostridium perfringens -toxin, pre-albumin andcaeruloplasmin were compared to a group of established clinicaland laboratory assessments including plasma viscosity, CRP haemoglobinand platelet count during treatment with the established second-linedrugs, D-penicillamine (n=20), sulphasalazine (n=17), gold (n=12)and hydroxychloroquine (n=18). Overall, the assessments showing the greatest degree of changewere plasma viscosity, articular index, summated change score,platelet count, CD, white cell count, ₁AGP, CRP and pain score.The assessments showing the greatest degree of change were nothomologous between the treatment groups and no single assessmentwas outstanding for a particular drug treatment. KEY WORDS: Rheumatoid arthritis, Cytidine deaminase, ß₂-microglobulin, ₁-acide glycoprotein, Caeruloplasmin     

Infection Risks in Hospital Staff from Blood: Hazardous Injury Rates and Acceptance of Hepatitis B Immunization

A questionnaire survey of 1800 clinical health care staff wasundertaken to determine hazardous injury rates and uptake ofhepatitis B vaccination. The overall sharps injury rate was116 injuries per 100 staff per year. Full-time doctors had thehighest rates. Surgical procedures were the commonest causeof accidental injury (58 per cent) and 30 per cent of all sharpsinjuries were attributable to careless handling. Injuries causedby bites and scratches from patients occurred mainly in nursesand auxilliaries in psychiatric and geriatric wards (115/100staff per year). Twenty-four per cent of respondents had received a full courseof hepatitis B vaccine and 51 per cent of the remainder wereplanning to have, or were in the process of receiving, a course.The most frequent reason given for not being vaccinated waslack of information about vaccination. This survey reveals injury rates higher than those observedin previous reports, particularly in doctors, and shows a needfor more information and advice about hepatitis B infectionand vaccination to be targeted to health care workers at risk. Requests for reprints should be addressed to: Dr C. Astbury, Occupational Health Department, Addenbrookes Hospital, Hills Road, Cambridge CB2 2QQ, UK     

Bronchopulmonary dysplasia in very low birthweight infants

ABSTRACT. Twenty-four (6%) of 375 infants with birthweights ≦1500g developed bronchopulmonary dysplasia (BPD); 16 (15%) of 107 in those ≦100g and 8 (3%) of 268 in those >1000g. The incidence was 10% in those who required assisted ventilation. Perinatal asphyxia, significant respiratory distress, pulmonary interstitial emphysema and patent ductus arteriosus were statistically more common in BPD infants compared with the remaining 351 very low birthweight infants. Hyaline membrane disease was the primary respiratory disease in 54% of BPD infants. The mean durations of oxygen and ventilatory therapy were 68 days and 37 days respectively. Twenty-nine percent did not require more than 60% oxygen for over 24 hours. Only 38% required a peak airway pressure of over 30 cmH₂O. Early postnatal growth was satisfactory on parenteral nutrition support. No perinatal factor was found to be predictive of death from BPD. The prolonged duration of hospital treatment has obvious implications to the psychosocial and economic costs of BPD.     

Outcome of extremely-low-birthweight infants

Summary. The overall 1-year survival rate of 261 infants born at 500 g–999 g over a 7-year period was 46%. The survival rate of the 220 inborn infants, corrected for birth defects, would have increased from 47% to 57% if delivery room deaths were excluded and to 62% if postneonatal deaths had also been ignored. Survival improved progressively with increasing 100 g weight groups. The disability rate in the 108 survivors who were at least 2 years old corrected for prematurity was 28% with little variation between the 100 g weight groups. There were no significant trends in annual perinatal mortality, 1-year survival and disability rate in survivors over the study period for the inborn population. The male infants had significantly lower normal-survival rate than the female infants. Small-for-gestational-age infants, comprising 11% of the inborn group, had significantly better survival but a higher disability rate. Multiple births had significantly lower survival and normal-survival rates than had singleton births. Infants whose mothers were transferred for delivery at the perinatal centre before onset of labour had a significantly better survival rate than those whose mothers had 'booked' and those who were transferred in labour.