[Sulfasalazine in rheumatoid arthritis]

Sulfasalazine (SLZ) is now a second-line treatment in rheumatoid arthritis (RA), as well as in psoriatic arthritis and ankylosing spondylitis. 54 patients with active RA were treated with enteric coated SLZ (2 g daily) in a 24-week open study. Clinical and laboratory parameters of disease activity were monitored initially and thereafter at 2-week intervals for the first 2 months, and then at 4-week intervals until the end of the 24-week study. There was significant clinical improvement at the end, as shown by scores for joint pain (Ritchie), grip strength and morning stiffness (p less than 0.0001, less than 0.0001 and less than 0.01, respectively, by paired t test). Clinical improvement was accompanied by significant decrease in erythrocyte sedimentation rate and increase in hemoglobin (p less than 0.002 and less than 0.016, respectively). There was improvement in some cases as early as 3 weeks after starting therapy. The drop-out rate was significant: 19/54 (35%), most (13) due to side-effects, mainly gastrointestinal; none of the side-effects were serious. Our results, similar to those of other studies, indicate that despite the high rate of side effects, SLZ is an effective, second-line drug for RA.

[The liver in juvenile rheumatoid arthritis]

Hepatic involvement in juvenile rheumatoid arthritis of the systemic type (JRA) is a diagnostic challenge because of the varied clinical picture it presents. We describe a 21-year-old woman in whom JRA had started at the age of 4 years as an illness resembling familial Mediterranean fever. This long-standing illness was complicated by liver damage and needle biopsy showed massive hepatic deposition of amyloid. It is possible that this patient may have developed JRA as a complication of familial Mediterranean fever.

Direct detection of Neisseria gonorrhoeae with monoclonal antibodies characterized by serotyping reagents

A panel of monoclonal antibodies (MAbs) directed to outer membrane protein I were generated with the ultimate aim of detecting Neisseria gonorrhoeae in patient samples by a direct immunofluorescence (IF) test. In an initial evaluation of the sensitivity of these reagents, a cocktail of six IF MAbs recognized 491 (91%) of 540 gonococci isolates from several centers in Sydney, Australia. IF MAbs designated 185 and 228 recognized serovars of WI serogroup and IF MAbs 208, 210, and 312 recognized serovars of WII/III serogroup. IF MAb 198 recognized serovars within both serogroups. Three additional IF MAbs, designated 322, 323, and 330, were then generated by using strains which failed to react with the original MAb cocktail and which belonged to particular serovars. The new cocktail of nine IF MAbs recognized 96% of the gonococcal isolates, which incidentally contained representatives of serovars shown to have a worldwide distribution in previous studies. Although subtle differences were apparent in the reaction patterns found with coagglutination (serotyping) and IF, there nonetheless seems to be merit in the approach of continually evaluating the sensitivity of diagnostic reagents such as MAbs. This is especially true with an organism such as N. gonorrhoeae, which has the capacity to regularly alter the antigenic structure of its outer membrane proteins.

Ability of different techniques of measuring bone mass to determine vertebral bone loss in aging female rats

Changes in vertebral trabecular bone were quantified in female Wistar rats. This study utilized single photon absorptiometry for the measurement of bone mineral content (BMC), quantitative computed tomography (QCT) for the measurement of bone mineral density (BMD), and image analysis histomorphometry for the measurement of trabecular bone volume (TBV). The above measurements were accompanied by biochemical assays of protein and calcium concentrations in the tissues. Also, the activity of bone alkaline and acid phosphatases was measured. Lumbar vertebrae (L4, L5) in old rats 27 months old, compared with those of young rats 7 months old, showed significant decreases in BMC, BMD, TBV, protein and calcium, and enzyme activity. A high degree of correlation was recorded between the above changes. The various changes were accompanied by a marked reduction in the overall wet weight of the vertebrae. Hence, new noninvasive methods to quantitate bone mass can be applied in vivo to small laboratory animals such as the rat. These methods are much more accurate than standard radiographs in quantitating bone loss and are, therefore, recommended for experimental longitudinal studies related to aging of the skeleton.