Reversal of bone loss in mice by nongenotropic signaling of sex steroids

We show that sex steroids protect the adult murine skeleton through a mechanism that is distinct from that used to preserve the mass and function of reproductive organs. The classical genotropic actions of sex steroid receptors are dispensable for their bone protective effects, but essential for their effects on reproductive tissues. A synthetic ligand (4-estren-3alpha,17beta-diol) that reproduces the nongenotropic effects of sex steroids, without affecting classical transcription, increases bone mass and strength in ovariectomized females above the level of the estrogen-replete state and is at least as effective as dihydrotestosterone in orchidectomized males, without affecting reproductive organs. Such ligands merit investigation as potential therapeutic alternatives to hormone replacement for osteoporosis in both women and men [corrected].

Differential expression of members of the tumor necrosis factor alpha-related apoptosis-inducing ligand pathway in prostate cancer cells

Androgen ablation therapy induces apoptosis only in androgen-sensitive prostate cancer cells; therefore, other cytotoxic drugs are being used to induce apoptosis in androgen-refractory cells. Mifepristone, an antiprogestin used individually or together with the antiestrogen Tamoxifen, has been recommended for induction of cell death and treatment of several hormonal cancers. However, little is known about the mechanism of action of these drugs in prostate cancer. Therefore, we investigated the effect of Mifepristone on the tumor necrosis factor alpha-related apoptosis-inducing ligand (TRAIL) pathway, a newly identified and very effective member of tumor necrosis factor-alpha family. Mifepristone and Tamoxifen induced significant expression of death receptors in prostate cancer cells in vitro and in xenografts. However, Mifepristone in combination with Tamoxifen did not increase prostate cancer cell death compared with their individual values. The involvement of the TRAIL pathway was further confirmed by the activation of caspase-8 in Mifepristone-treated cells. This was followed by truncation of Bid, confirming that Mifepristone activates the TRAIL pathway. This knowledge is being used to design a combination treatment of TRAIL and Mifepristone to induce significant apoptosis in prostate cancer cells.

Attenuation of the self-renewal of transit-amplifying osteoblast progenitors in the murine bone marrow by 17 beta-estradiol

In agreement with evidence that estrogens slow the rate of bone remodeling by suppressing the production of both osteoclasts and osteoblasts, loss of estrogens leads to an increase in the number of osteoclast as well as early osteoblast progenitors (CFU-osteoblasts; CFU-OBs) in the murine bone marrow. Here we show that CFU-OBs are early transit-amplifying progenitors, i.e., dividing cells capable of limited self-renewal, and that 17 beta-estradiol acts in vivo and in vitro to attenuate their self-renewal by approximately 50%. Consistent with a direct receptor-mediated action of estrogens on early mesenchymal cell progenitors, anti-estrogen receptor-alpha (anti-ER alpha) Ab's stain a small number of marrow cells that exhibit characteristics of primitive undifferentiated cells, including a high nucleus/cytoplasm ratio and lack of lineage-specific biochemical markers; the effect of 17 beta-estradiol on CFU-OB self-renewal is absent in mice lacking ER alpha. Because both osteoblasts and the stromal/osteoblastic cells that are required for osteoclast development are derived from CFU-OBs, suppression of the self-renewal of this common progenitor may represent a key mechanism of the anti-remodeling effects of estrogens.

Co-oximetry interference by hemoglobin-based blood substitutes

The blood substitutes now being developed from molecularly modified hemoglobin interfere with a wide variety of clinical analyzers, but their effects on cooximeters are unknown. Therefore, we investigated the effects of five hemoglobin-based blood substitutes on the measurements of eight different oximeters and cooximeters: the AVL Omni 6, the AVOXimeters 1000 and 4000, the Ciba Corning (now Bayer) CC270 CO-Oximeter, the Instrumentation Laboratory Synthesis 35, the IL482 and IL682 CO-Oximeters, and the Radiometer OSM3 Hemoximeter. The five blood substitutes in this study were obtained from Apex Bioscience (Research Triangle Park, NC), Baxter Healthcare Corp. (Deerfield, IL), Biopure Corp. (Cambridge, MA), Hemoglobin Therapeutics, and Hemosol, Inc. (Etobicoke, Ontario, Canada). A cooximeter control was used to compare the eight different instruments' measurements on unaltered human hemoglobin. The instruments yielded measurements of total hemoglobin concentration in undiluted blood substitutes that were generally not more variable than those on the control material. By contrast, when compared with readings on controls, the test instruments yielded measurements of the fractional concentrations of oxy-, deoxy-, carboxy-, and methemoglobin that showed greater instrument-to-instrument disparities and larger standard deviations about the all-instrument means. In some cases, the interference was even more obvious: five of six cooximeters gave negative carboxyhemoglobin readings on one particular product. Our findings indicate that the instruments will give less accurate but clinically useful measurements in the presence of these hemoglobin-based blood substitutes.

IMPLICATIONS

We investigated the effects of five hemoglobin-based blood substitutes on the measurements of eight different cooximeters. Some blood substitutes caused obvious interference, such as negative carboxyhemoglobin readings; however, the findings indicate that cooximeters will generally give less accurate but clinically useful measurements in the presence of the hemoglobin-based blood substitutes that were tested.

Sorption kinetics of lead ions by zeolite tuff

The kinetics of sorption of Pb ions by zeolite tuff treated with NaCl solution was studied using agitated batch laboratory apparatus. The uptake of ions was determined as a function of time at different values of initial Pb ion concentration, zeolite particle size, slurry concentration, solution temperature and pH. The pseudo-second order reaction model was successfully applied to the experimental data with correlation coefficients higher than 0.98. Sorption rates decreased with increase in average particle diameter while it increased with increase in each of the initial Pb ion concentration, slurry concentration, solution temperature and solution pH. Results indicate the importance of chemisorption.

Report of a medical mission to Somaliland, 2001

Somaliland is a self-declared state, not recognized by the nations of the world. Sixty percent of the population are herders or small scale farmers. Gross national product and other data are not available, but it is evident, according to surveys conducted by the United Nations, that most of the population has a low income. The health-care system consists of a public sector, which covers primary care, hospital care, immunizations, and tuberculosis care. The major clinical problems are tuberculosis, malaria and childhood diarrhea. Lack of trained personnel is a major difficulty in the health care system. This paper describes visits to health care facilities in Somaliland, and suggests some improvements for the system.

Use of palm mid-fraction in dark chocolate as base filling centre at different storage temperatures

Dark chocolates filled with palm mid-fraction (PMF) were stored at different temperatures to evaluate the physical and chemical changes. Storage at low temperature (18 degrees C) reduces the PMF migration to negligible extent. Higher storage temperatures (30 and 35 degrees C) increased the PMF migration from the filling centre into the chocolate coating. As a consequence of fat migration, fatty acid composition, triglyceride composition, hardness, solid fat content, melting point and polymorphic structure changed, leading to bloom formation, which started by fat migration and was influenced by recrystallization tendency within the chocolate coating.

The heliangolide dihydrohirsutolide from Arctotis fastuosa and dichloromethyldihydrohirsutolide

Three of ten sesquiterpene lactones isolated from the herb of Arctotis fastuosa (Asteraceae) belong to the heliangolide series. The first was identified as hirsutolide, the second is new and named dihydrohirsutolide, and the third, dichloromethyldihydrohirsutolide, is an artifact. The known degraded carotenoid loliolide was also isolated. Structures were established by spectroscopic methods including IR, 1D-/2D-1H-NMR, 13C-NMR, GHSQC, GHMBC, HREIMS and CD.

H-reflex changes under spinal loading and unloading conditions in normal subjects

OBJECTIVE

The soleus H- reflex is usually tested clinically in patients lying prone, with the H-latency always the criterion of choice for detecting abnormality. However, stresses on the spine vary during lying, standing, loading (weight lifting) and unloading. So the objective of this study was to measure changes in the H-reflex under 4 different loading conditions and to investigate whether mechanical loading of the spine would affect the H-reflex parameters.

METHODS

Twenty healthy volunteers (22-46 years) with no history of significant low back pain or radiculopathy participated in the study. A Cadwell Excel electromyography unit was used to elicit and record the soleus H-reflex. The tibial nerve was stimulated at the popliteal fossa using 1 ms pulses at 0.2 pps of H-max. Each subject was tested under 4 different conditions: prone lying, free standing, standing while lifting 20% of his or her body weight, and standing while unloaded by 25% of his/or her body weight by a ZUNI II unloading system. For each subject, the peak-to-peak amplitudes of the maximum obtained H- reflex and the onset latencies of 8 separate traces were averaged for both lower extremities. Two-factor, repeated-measures ANOVAs were used to test the effect of the condition and side on the H-reflex amplitude and latency with ( approximately =0.025).

RESULTS

The H-reflex was inhibited during standing, loading and unloading as compared with prone lying. The H-reflex was recovered during loading as compared with during standing. There were no significant changes in the H-reflex latency under the 4 different conditions. Both lower extremities showed similar pattern of changes in the H-reflexes.

CONCLUSIONS

These results imply a significant interplay between peripheral and central mechanisms and their effects on the spinal motoneurons. This in turn suggests that testing of the H-reflex amplitude and latency under functional conditions, such as standing may be useful in detecting subtle changes in root impingement.

Dual renal transplant from a non-heart beating donor

In September 1998, a 48 year old male underwent bilateral renal transplantation from a 51 year old non-heart beating donor (NHBD) with ischemic heart disease. The grafts exhibited delayed graft function, otherwise short term results have been good, with a three month serum creatinine of 80 mumol/l, three month GFR of 79 ml/min per 1.73 m2 BSA, and no episodes of acute rejection. We advocate dual transplantation when sub-optimal NHBD kidneys are otherwise in danger of being discarded.

Ventrally emigrating neural tube cells differentiate into vascular smooth muscle cells

A multipotential cell population originating in the ventral part of the hindbrain neural tube, the ventrally emigrating neural tube cells (VENT cells), has recently been shown to migrate into the craniofacial mesenchyme. Because vascular smooth muscle cells develop from this mesenchyme, we sought to determine if the VENT cells contributed to their differentiation. VENT cells were tagged with replication-deficient retroviral vector with LacZ by microinjection into the lumen of the rostral hindbrain of chick embryos on day 2. Embryos were processed for the detection of LacZ positive cells on day 7. LacZ-positive cells were present in the wall of craniofacial arteries and veins. Immunostaining with the smooth muscle alpha-actin confirmed the labeled cells to be smooth muscle cells. It is concluded that some vascular smooth muscle cells differentiate from neural tube cells. the developmental and functional significance of which remains to be established.

Ventrally emigrating neural tube cells contribute to the formation of Meckel's and quadrate cartilage

A population of multipotential neuroepithelial cells originating in the ventral portion of the hindbrain neural tube has been shown recently to emigrate at the site of attachment of the trigeminal nerve. These ventrally emigrating neural tube cells populate the mesenchyme of the first pharyngeal (branchial) arch. Because the Meckel's and the quadrate cartilage develop from this mesenchyme, we sought to determine whether these ventrally emigrating neural tube cells contributed to their development. The ventral neural tube cells were tagged with a replication-deficient retroviral vector containing the LacZ gene. This method permanently labels the descendents of the neural tube cells; thus, they can be subsequently tracked during development. The viral concentrate was microinjected into the lumen of the rostral hindbrain of chick embryos, after the emigration of neural crest is finished, on embryonic day 2 (stage 14). In control embryos, the virus was placed on top of the neural tube. Embryos were killed on days 3, 4, and 7 and processed for the detection of LacZ-positive cells. By day 7, the Meckel's and the quadrate cartilage can be easily recognized. LacZ-positive cells were seen in both cartilages. They were located in perichondrium and in the cartilage. Immunostaining with the neural crest cell marker HNK-1 indicated that the LacZ-positive cells were HNK-1 negative. The HNK-1-positive neural crest-derived cells were located in the cartilage but not in the perichondrium. These results indicate that the chondrocytes in the Meckel's and the quadrate cartilage differentiate from two sources of cells; the ventrally emigrating neural tube cells and the neural crest. The developmental significance of differentiation of cartilage from the ventral neural tube cells and of the heterogeneous origin of chondrocytes in morphogenesis remains to be established. Dev Dyn 1999;216:37-44.

Distribution and relationships of selected trace metals in molluscs and associated sediments from the Gulf of Aden, Yemen

Concentrations of Cd, Pb, Zn, Cu, Ni, Co, Cr, Mn and Fe in the soft tissue of Turbo coronatus, Acanthopleura haddoni, Ostrea cucullata and Pitar sp., as well as in associated surface sediments (bulk and bioavailable metal concentrations) from the Gulf of Aden, Yemen, were determined by atomic absorption spectrophotometry method. Large differences between size-classes of molluscs in metal concentrations were recorded. Significant spatial differences in metal concentrations in both the soft tissue of the molluscs and associated sediments studied were mostly identified. Statistically significant correlations (p<0.01) between concentrations of selected metals were observed. A slope of the linear regression is significantly higher than unity for Fe (9.91) and Cd (3.45) in A. haddoni and for Ni (4.15) in T. coronatus, suggesting that the bioavailability of these metals is disproportionally increased with a degree of enrichment of the sediments in Fe, Cd and Ni, respectively. A slope constant approximating to unity (1.14) for Cu in A. haddoni relative to its concentration in sediment extract implies that bioavailability of this metal proportionally increased with growing concentrations of its labile forms in the associated sediment. The degree of contamination of Gulf of Aden waters by the metals studied is discussed and the potential ability of molluscs, especially A. haddoni and T. coronatus, as biomonitors of metallic pollutants is postulated.

Ventrally emigrating neural tube cells differentiate into heart muscle

A population of ventrally emigrating neural tube cells has been shown to migrate along the vagus nerve and contribute to the development of the gastrointestinal tract. Since the vagus also goes to the heart, we sought to determine if these cells migrated into the heart. Neural tube cells were tagged with replication-deficient retroviral vectors containing the LacZ gene, to permanently label their progeny. The virus was microinjected into the lumen of the caudal hindbrain of chick embryos on day 2. Embryos were later processed for the detection of LacZ positive cells. Labeled cells were initially confined to the neural tube. Later, they migrated in association with the vagus nerve into the heart, where they were located in the myocardium. Labeled cells were identified as cardiac muscle cells of non-neural crest origin, with specific markers. It is concluded that some cardiac muscle cells differentiate from the neural tube cells.

Chemical and Genetic Evaluation of Somaclonal Variants of Egyptian Garlic (Allium sativum L.)

Garlic (Allium sativum L.) is used in the household and as an ingredient in many pharmaceutical products. Tissue culture technique provides an excellent source for induction of both chemical and genetic variation in garlic. A callus was induced on root meristem cultured on Murashige and Skoog (MS) medium in the presence of kinetin, indole acetic acid, and 2,4-dichlorophenoxyacetic acid. Shoots with a small bulb were produced on medium containing MS salts, B vitamins, and naphthalene acetic acid. Regenerated plants were transplanted into soil, and a nondivided bulb was formed in the first somaclonal generation (SCI). Plants were normal in their phenotypes in SC2. After four cycles of field cultivation, the selected somaclones (variants) in the fourth generation showed significant differences in bulb character compared with the original plants. Mitotic division and chromosomal abnormalities were investigated in meristimic root tip cells of regenerated plants for the first and fourth regeneration and for control plants. Somaclonal variant metaphase cells had the same chromosome number (2n = 16) as those of the controls. Allicin was measured quantitatively in the regenerated clones by high-performance liquid chromatography. The results showed that some clones contained as much as 14.50 mg/g allicin, compared with 3.80 mg/g in the control plant. This finding suggests that this technique may be useful to improve the allicin content of Egyptian garlic, which could be utilized as a good source for garlic-containing pharmaceutical preparations.

Ventral neural tube cells differentiate into hepatocytes in the chick embryo

A population of ventral neural tube cells has recently been shown to migrate out of the hindbrain neural tube via the vagus nerve and contribute to the developing gastrointestinal tract. Since liver is also innervated by the vagus nerve, we sought to determine if these cells also migrate into the liver. Ventral neural tube cells in the caudal hindbrain of chick embryos were tagged with a replication-deficient retroviral vector containing the LacZ gene on embryonic day 2. Embryos were processed for detection of labeled cells on embryonic day 5 and 11. Labeled cells were seen in the liver on both days and identified as hepatocytes. Previously, it was believed that all hepatocytes develop from the gut endoderm. Results of the present study show an additional source for the formation of liver cells.

Ventral neural tube cells differentiate into craniofacial skeletal muscles

Craniofacial skeletal muscle cells are believed to develop from mesoderm. A population of ventral neural tube cells has recently been shown to migrate out of the hindbrain and populate the craniofacial mesenchyme in chick embryos. Since skeletal muscle cells develop from this mesenchyme, we sought to determine if the emigrated neural tube cells contributed to their development. Ventral neural tube cells in the hindbrain of chick embryos were labeled on embryonic day 2 with replication-deficient retroviral vectors containing the gene LacZ, which provides a permanent marker for the progeny. On day 7 embryos were processed for the detection of labeled cells. Labeled cells were seen in craniofacial skeletal muscles. By using muscle-specific markers, the labeled cells were confirmed to be skeletal muscle cells. Thus, some muscle cells are derived from the ventral neural tube cells of the hindbrain.

Studies on Securigera securidacea (L.) Deg. et Dörfl. (Fabaceae) seeds, an antidiabetic Egyptian folk medicine

A new cardenolide(-)-14-methoxy-rcanoside (1) was isolated from the aqueous extract of the seeds of Securigera securidacea (L.) Deg. et Dörfl. (Fabaceae) together with five new dihydrobenzofuran derivatives named securigran I-V (2-6). Kaempferol and astragalin were also isolated from the aqueous extract of the flowers. (-)-14-Methoxyhyrcanoside and the total aqueous extract of the seeds showed marked chronotropic activity. The total aqueous extract also showed a marked diuretic and severe hypokalemic effects on the K(+)-level in serum. The hypoglycemic effect of the seeds was also confirmed.

Emigration of neuroepithelial cells from the hindbrain neural tube in the chick embryo

It is generally believed that after the emigration of neural crest, the neuroepithelial cells of the neural tube are committed to differentiate only as neurons and supporting cells of the central nervous system. Neural crest cells arise from the dorsal portion of the developing neural tube and contribute to the formation of the peripheral nervous system and a variety of non-neural structures. In contrast to this view we have recently shown, by focal application of the vital dye Dil in duck embryos, that an additional population of cells emigrates from the neural tube. By using an entirely different technique we confirm and extend these observations in the chick embryo. Replication-deficient retroviral vector LZ12 containing the gene LacZ was utilized to label the neural tube cells. The viral concentrate was microinjected into the lumen of the rostral hind-brain neural tube, considerably after the completion of emigration of neural crest cells. The labeled cells were monitored in whole mounts and histological sections. Initially, the labeled cells were restricted to the neuroepithelium of the hindbrain neural tube. Subsequently, they were seen in the neural tube and in the ganglion of the fifth cranial nerve (trigeminal ganglion). Later, they migrated beyond the trigeminal ganglion, i.e., into the mesenchyme of the first pharyngeal arch. Immunostaining with the neural crest cell marker, HNK-1, indicated that the emigrated neuroepithelial cells were HNK-1 negative. It is concluded that in the chick embryo some neuroepithelial cells emigrate at the site of attachment of the trigeminal nerve, migrate into the ganglion and then into the mesenchyme of the first arch. This cell population differs antigenically from the neural crest cells.

Urinary N-acetyl-beta-D-glucosaminidase in rheumatoid arthritis

Excretion of urinary N-acetyl beta-D-glucosaminidase (NAG) and its isoenzyme patterns were studied in two groups of patients with rheumatoid arthritis (RA) and in normal control subjects. Urine samples were collected from 30 seropositive RA patients, 19 seronegative RA patients, and 15 normal healthy subjects. All the patients and normal subjects were assessed to have normal liver and kidney functions. A small portion of the urine sample was dialyzed against 0.01 M phosphate buffer, pH 7.0 and NAG activity was monitored. Mean +/- SD values of urinary NAG in seropositive RA patients, in seronegative RA patients and in normal healthy subjects were found to be 4.20 +/- 3.73 U/g creatinine, 2.96 +/- 2.11 U/gm creatinine, and 1.71 +/- 0.6 U/g creatinine, respectively. The mean urinary, NAG value in RA patients was found to be significantly higher (P < 0.05) in seropositive RA compared to the mean NAG value in normal healthy subjects and patients with seronegative RA when analyzed by one way ANOVA and Tukey-HSD test. The mean proportion of isoenzyme form B to isoenzyme form A in seropositive RA patients was also found to be significantly different (P < 0.05) from the mean proportion of these forms in normal healthy subjects and seronegative RA patients. There also appears to be a correlation between the concentration of urinary NAG and severity of the disease in seropositive RA.

The relationship between perlecan and dystroglycan and its implication in the formation of the neuromuscular junction

Perlecan is a major heparan-sulfate proteoglycan (HSPG) within the basement membrane surrounding skeletal muscle fibers. The C-terminus of its core protein contains three globular domain modules which are also found in laminin and agrin, two proteins that bind to dystroglycan (DG, cranin) on the muscle surface with these modules. In this study, we examined whether perlecan can also bind to DG and is involved in signaling the formation of the neuromuscular junction (NMJ). By labeling cultured muscle cells with a polyclonal anti-perlecan antibody, this protein is found both within the extracellular matrix in a fibrillar network and at the cell surface in a punctate pattern. In Xenopus muscle cells, the cell-surface perlecan is precisely colocalized with DG. Both perlecan and DG are clustered at ACh receptor clusters induced by spinal neurons or by beads coated with HB-GAM, a heparin-binding growth factor. Blot overlay assays have shown that perlecan binds alpha-DG in a calcium and heparin-sensitive manner. Furthermore, perlecan is present in muscle lysate immunoprecipitated with an anti-DG antibody. Immunolabeling also showed colocalization between HB-GAM and perlecan and between HB-GAM and DG. These data suggest that perlecan is anchored to muscle surface via DG-dystrophin complex. Since DG is also a site of agrin binding, the neural agrin secreted by motoneurons during NMJ formation may compete with the pre-existing perlecan for cell surface binding. This competition may result in the presentation of perlecan-bound growth factors such as HB-GAM to effect synaptic induction.

Modified Salter's innominate osteotomy

Twenty paediatric patients with congenital dislocation of the hip were treated with a modification of the classic technique of Salter's osteotomy. Along with open reduction and femoral shortening osteotomy, the resected femoral segment, which measured 10-40 mm in width (mean 16 mm), was used to stabilize the Salter's osteotomy. The patients were aged between 2 and 9 years (mean 3.8 years). After a mean follow-up of 16 months (range 6-60 months) all patients had full bone healing and complete incorporation of femoral bone graft with the acetabulum. No patient had re-dislocation, subluxation or displacement of the graft.

Fermentation of milk permeate by proteolytic bacteria for protease production

Kinetics of cell growth and protease production by four proteolytic bacterial strains, namely, Bacillus subtilis EMCC 1020, Bacillus megaterium EMCC 1057, Serratia marcescens EMCC 1247, and Pseudomonas fluorescens EMCC 1221, in milk permeate, compared with other fermentation media, were studied. The pH values, lactose utilization, and biochemical oxygen demand (BOD) reduction in milk permeate also were investigated. The four strains were able to grow in milk permeate, and to produce considerable amounts of protease, reaching 289 (EMCC 1020), 252 (EMCC 1057), 263 (EMCC 1247), and 212 (EMCC 1221) U/mL after 30 h of fermentation. The growth and enzyme activity of the four strains were greater in milk permeate than those in other fermentation media. The protease-producing bacteria were able to utilize lactose in milk permeate with values ranging from 37.62 to 54.97% and to reduce the BOD of milk permeate by 50.59-63.65%. Milk permeate proved to be the best medium for enzyme production by all organisms examined.

The effects of non-steroidal anti-inflammatory drugs on the disposition of methotrexate in patients with rheumatoid arthritis

We have studied the pharmacokinetics of methotrexate in patients with rheumatoid arthritis concurrently taking the most commonly used non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, diclofenac, naproxen, indomethacin, and ibuprofen. The area under the curve, the total systemic clearance, the distribution volume, and the half-life of methotrexate in patients receiving concurrent NSAID therapy did not change significantly (at p < 0.05). Concurrent treatment with NSAIDs resulted in increased inter-patient variability of methotrexate concentration, possibly as a result of biochemical interactions; however, it does not appear clinically relevant. The data suggest that the NSAIDs do not significantly affect the disposition of methotrexate, contrary to some of the earlier reports.

Methotrexate in rheumatoid arthritis: a 2 year experience at a university hospital in Pakistan

In this study we report our two years experience of methotrexate (MTX) in the management of rheumatoid arthritis (RA) at the Aga Khan University Hospital, Karachi. We studied the clinical course of 124 RA patients. The mean age was 44 +/- 11 years (range 19-72) and mean duration of RA was 5 +/- 4 years (range 0.3-25). Female to male ratio was 10:2.4 (100F:24M). All of them were diagnosed according to the criteria set by American Rheumatism Association. The mean value of ESR was 60 +/- 30 (Range 3-128). Fifty one percent had severe disease (> 10 joints involved and evidence of erosions and deformities). Twenty-one patients had extra-articular manifestations. None of them had received MTX previously. Their kidney and liver functions were assessed to be normal. Patients were divided into two groups. One group (n = 92) received MTX (7.5-10 mg/week) as initial treatment, while the other group (n = 32) was given other disease modifying anti-rheumatic drugs (penicillamine, salazopyrin, gold, or chloroquine) followed by MTX. Assessment of the treatment outcome and development of any adverse reactions was carried out at 3-month interval over an average period of 1 year. Assessment of the treatment outcome in the group which received MTX as initial drug revealed the response to be excellent in 13%, good in 70%, fair in 11% and variable in 4%. In the group which received MTX as second-line of therapy, 59% of the patients had the response from good to excellent, while 25% of the patients exhibited poor to fair response. Regarding side-effects of MTX treatment, 57% exhibited none, while 35% had nausea and vomiting. Alopecia was the next common toxicity in these patients. Two individuals had abnormal liver function tests (value twice more than normal), while one developed lung fibrosis. MTX despite its adverse effects in some of the patients is still an effective, well tolerated and inexpensive disease modifying drug in RA.