Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A Department of Veterans Affairs Cooperative Study.

OBJECTIVE: To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective for the treatment of active ankylosing spondylitis (AS) that is not controlled with nonsteroidal antiinflammatory drug therapy. METHODS: Two hundred sixty-four patients with AS were recruited from 15 clinics, randomized (double-blind) to SSZ or placebo treatment, and followed up for 36 weeks. Treatment response was based on morning stiffness, back pain, and physician and patient global assessments. RESULTS: While longitudinal analysis revealed a trend favoring SSZ in the middle of treatment, no difference was seen at the end of treatment. Response rates were 38.2% for SSZ and 36.1% for placebo (P = 0.73). The Westergren erythrocyte sedimentation rate declined more with SSZ treatment than with placebo (P < 0.0001). AS patients with associated peripheral arthritis showed improvement that favored SSZ (P = 0.02). Adverse reactions were fewer than expected and were mainly due to nonspecific gastrointestinal complaints. CONCLUSION: SSZ at a dosage of 2,000 mg/day does not seem to be more effective than placebo in the treatment of AS patients with chronic, longstanding disease. SSZ is well tolerated and may be more effective than placebo in the treatment of AS patients with peripheral joint involvement. This effect is more pronounced in treatment of the peripheral arthritis in this subgroup of AS patients.

Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. A Department of Veterans Affairs Cooperative Study.

OBJECTIVE: To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective for the treatment of active psoriatic arthritis (PsA) resistant to nonsteroidal antiinflammatory drug therapy. METHODS: Two hundred twenty-one patients with PsA were recruited from 15 clinics, randomized (double-blind) to SSZ or placebo treatment, and followed up for 36 weeks. Treatment response was based on joint pain/ tenderness and swelling scores and physician and patient global assessments. RESULTS: Longitudinal analysis revealed a trend favoring SSZ treatment (P = 0.13). At the end of treatment, response rates were 57.8% for SSZ compared with 44.6% for placebo (P = 0.05). The Westergren erythrocyte sedimentation rate declined more in the PsA patients taking SSZ than in those taking placebo (P < 0.0001). Adverse reactions were fewer than expected and were mainly due to nonspecific gastrointestinal complaints, including dyspepsia, nausea, vomiting, and diarrhea. CONCLUSION: SSZ at a dosage of 2,000 mg/day is well tolerated and may be more effective than placebo in the treatment of patients with PsA.

Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A Department of Veterans Affairs Cooperative Study.

OBJECTIVE: To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective in the treatment of reactive arthritis (ReA) that has been unresponsive to nonsteroidal antiinflammatory drug (NSAID) therapy. METHODS: One hundred thirty-four patients with ReA who had failed to respond to NSAIDs were recruited from 19 clinics, randomized (double-blind) to receive either SSZ or placebo, and followed up for 36 weeks. The definition of treatment response was based on joint pain/tenderness and swelling scores and physician and patient global assessments. RESULTS: Longitudinal analysis revealed improvement in the patients taking SSZ compared with those taking placebo, which appeared at 4 weeks and continued through the trial (P = 0.02). At the end of treatment, response rates were 62.3% for SSZ treatment compared with 47.7% for placebo treatment. The Westergren erythrocyte sedimentation rate declined more with SSZ treatment than with placebo (P < 0.0001). Adverse reactions were fewer than expected and were mainly due to nonspecific gastrointestinal complaints. CONCLUSION: SSZ at a dosage of 2,000 mg/day is well tolerated and effective in patients with chronically active ReA.

Juvenile rheumatoid arthritis.

The nature and treatment of the three major types of juvenile rheumatoid arthritis--systemic, polyarticular, and pauciarticular--are presented.

Unloading the right ventricle in the CREST syndrome variant of progressive systemic sclerosis (scleroderma).

A patient with severe pulmonary hypertension secondary to the CREST syndrome variant of scleroderma is described. Acute reductions in both pulmonary artery pressure and total pulmonary resistance were seen with nifedipine and oxygen administration. Reductions in resistance were maintained for over one month with this combination. These results raise the possibility that some of the pulmonary hypertension seen in this condition is reversible.

Search for Epstein-Barr and type C oncornaviruses in systemic lupus erythematosus.

Lymphoblastoid cell lines were derived from patients with active systemic lupus erythematosus by allowing spontaneous transformation of peripheral B lymphocytes (B cells) harboring endogenous Epstein-Barr virus or by superinfecting peripheral lymphocytes with exogeneous Epstein-Barr virus. Results of extensive studies aimed at identifying type C oncornaviruses in these lymphoblastoid cells were entirely negative by electron microscopy, DNA-DNA hybridization, reverse transcriptase assays, and cocultivation experiments. These results do not support the postulated association of oncornavirus infection in human systemic erythematosus.

Ibuprofen in the treatment of acute gouty arthritis.

Ibuprofen is a nonsteroidal anti-inflammatory drug used in the treatment of rheumatoid arthritis and osteoarthritis. Ten patients with acute gouty arthritis were treated with daily doses of 2,400 mg of ibuprofen. All patients had rapid improvement and complete resolution within 72 hours; no adverse reactions were reported. Ibuprofen therapy may be an effective alternative in the treatment of acute gouty arthritis.

Experimental lens-induced granulomatous endophthalmitis.

Experimental lens-induced granulomatous endophthalmitis is an experimental autoimmune disease that is histopathologically identical to the human disease known as phacoanaphylactic endophthalmitis or lens-induced uveitis. The capacity to develop experimental disease after lens injury can be passively transferred to virgin animals with hyperimmune serum. Fluorescein-labeled anti-IgG and anti-C'3 antisera bind to the lenses of appropriately sensitized animals after lens injury but not to the injured lenses of unsensitized control animals. Cobra Venom factor which inhibits C'3 prevents the development of lens-induced granulomatous uveitis in appropriately sensitized animals. Hypersensitized animals develop a massive Arthus-like reaction. On the basis of these observations we feel that experimental lens-induced granulomatous endophthalmitis is an immune complex disease. Because the experimental disease is histopathologically identical to human lens-induced uveitis or phacoanaphylactic endophthalmitis we believe an immune complex mechanism of immunopathogenesis is important in phacoanaphylactic endophthalmitis.