[Changes in the blood picture in sulfasalazine therapy of rheumatoid arthritis]. / Blutbildveränderungen unter Sulphasalazintherapie bei rheumatoider Arthritis.

Out of 160 patients with confirmed resp. classical rheumatoid arthritis, according to the ARA criteria, six patients under treatment with sulfasalazine granulocytopenias, in association with thrombocytopenia in one case, and with a decrease in erythrocytes in two cases, have been observed. Remarkably, in all six cases the relatively early hemogram alterations appear as soon as the start of therapy and prompt normalization of blood counts occurs after instant termination of sulfasalazine therapy. Possible mechanisms for the occurrence of these sulfasalazine-induced hematological complications are discussed. These observations, also described by other authors, should be a cause for more frequent blood count tests during sulfasalazine therapy, at least during the first 3 months on a weekly basis. Sulfasalazine represents an asset among the rather limited number of basic therapies available for chronic rheumatoid arthritis. Despite the fact that it is comparatively well tolerated, a close follow-up of the therapy, especially during the initial phases of treatment, is of utmost importance in order to seize upon these reversible hematological disorders at an early stage and thus avoid more serious complications.

[Erythropoietin--therapeutic option in chronic polyarthritis-induced anemia]. / Erythropoietin--therapeutische Option bei c.P.-bedingter Anämie.

Twenty-three patients with rheumatoid arthritis and relevant anemia (hemoglobin < 11 g/dl) received recombinant erythropoietin (epo) in a therapy study; 90% were responders. A positive correlation of the total epo dose and the amelioration of parameters of red cell line and a negative correlation of the effect of epo and the systemic activity of the rheumatoid arthritis was found. The effect of the treatment was improved if higher serum iron and serum ferritin values were preexistent. Using appropriate doses of epo even patients with very active disease could be treated successfully. Especially in these cases epo is a valuable expansion of the therapeutic spectrum.

[Cauda equina syndrome in ankylosing spondylitis]. / Cauda-equina-Syndrom bei Spondylitis ankylosans.

A 55-year-old man who has had ankylosing spondylitis for over 20 years developed gradually increasing pain and sensory disorders in the legs, as well as mild foot and toe elevator weakness. There was no evidence of inflammatory activity. Clinical, neurophysiological and neuroradiological examination revealed a cauda equina syndrome as a late complication of ankylosing spondylitis. There is no known causal treatment.

[Assessment of the risk of occipitocervical dislocation in inflammatory rheumatic diseases]. / Zur Risikobeurteilung occipito-cervicaler Dislokationen bei entzündlich-rheumatischen Krankheiten.

In this mainly retrospective study we examined by means of tomographic and computer tomographic findings various manifestations and courses of cranio-cervical subluxations in chronic inflammatory rheumatic diseases and the resulting neurological complications. Even in marked cranio-cervical subluxations neurological complications are rarely observed. More serious anterior atlanto-axial subluxation represents the highest risk for spinal cord injury as a result of the mobility of the atlas. A subsequent vertical (upward) atlanto-axial subluxation occurring particularly in serious courses of illness reduces this risk since it is generally to be found together with a fixation of the atlas. This also applies to a possible pseudobasilar invagination. As a result of our studies we found ways of using CT to achieve further information. We could also derive guidelines for the indication of operative treatment. In view of the further development of surgical methods and variations in operative risk dependent on the preoperative situation, these recommendations can only be provisional.