From Individual To Social Trauma: Sources Of Everyday Trauma In Italy, The US And UK During The Covid-19 Pandemic.

The heterogeneity of COVID-19 experience and response for each individual is irrefutable; nevertheless, similarities can be observed between countries with respect to people's psychological responses. The main aim of this Commentary is to provide a cultural perspective of the sources of trauma, at the individual and social level, in three different countries: Italy, US and UK. The evidence from previous outbreaks, such as SARS, H1N1 flu, Ebola, and the ongoing Italian, the US, and the UK experience of COVID-19 shows that COVID-19 has introduced not only an individual trauma but also a collective trauma, that researchers should attend to now and in future global emergencies. Future clinical interventions should aim to reconnect dissociated parts both in the individual and in society. This commentary discusses four potential sources of trauma: high-stakes decision fatigue in healthcare professionals, traumatic grief, and bereavement in people who have lost loved ones, loss of roles and identity, and social divisions related to economic shutdown.

Investigating the predictors of workplace embitterment using a longitudinal design.

BACKGROUND: Embitterment has been described as the emotion generated by an event experienced as unjust. Although clinicians working in occupational health services readily recognize features of embitterment in organizations, little attention has been given to workplace embitterment. Research is warranted to identify predictors and features of employees' embitterment. AIMS: To explore the predictors and the chronicity of workplace embitterment over 6 months. METHODS: A longitudinal study investigating the chronicity of workplace embitterment and its antecedents among employees from various occupations. Data were collected by online questionnaires including measures of workplace embitterment, organizational justice and employees' perceptions of supervisory control. RESULTS: The survey was completed by 352 employees at Time 1, and 169 at Time 2. The final sample (assessed at two time points) was 147 employees. The feeling of workplace embitterment appeared to be very stable during the 6-month period. Hierarchical regression analysis revealed that perceptions of distributive injustice, informational injustice and employees' perceptions on supervisory over-control in Time 1 significantly predicted embitterment in Time 2. Only the relationship between employees' perceptions of supervisory control and embitterment remained significant after controlling for baseline levels of embitterment. CONCLUSIONS: This study provides evidence for the negative impact perceived organizational injustice can have on employees' experience of workplace embitterment. Results indicate that employees who perceive their supervisor as being over-controlling are more likely to suffer from workplace embitterment. The finding that workplace embitterment is stable during a 6-month period highlights the need for effective interventions in ameliorating and preventing workplace embitterment.

From recovery to regulation: an attempt to reconceptualize 'recovery from work'.

The concept of 'recovery' (from work) has quickly gained in importance in the occupational health literature. However, we think that the conceptualization of 'recovery' needs some more attention. Although many authors acknowledge that 'recovery' refers to a 'process', the concept is often treated as a static construct. In this paper, we argue that recovery should be conceptualized as a dynamic construct related to changes in psychophysiological state of the person. We refer to two main theories that have provided a theoretical framework for research in this area: Meijman & Mulder's Effort-Recovery (E-R) model and Hobfoll's Conservation of Resources theory. In particular, the E-R model has been seminal in this area and stresses the element of changing psychophysiological states that has been used for reconceptualising 'recovery'. Various biological rhythms influence these changing psychophysiological states, and thus the level of energy (or effort) a person can mobilize or wants to mobilize. A distinction is made between 'physical fatigue' and 'mental fatigue' and its consequences for recovery. The discrepancy between 'actual state' and 'required state' has been suggested as the basis for 'recovery'. This emphasises that recovery is a dynamic and ongoing process, which also included motivational aspects, in particular as far as mental work is concerned. The capacity to maintain self-regulation of one's psychophysiological state is important in this respect. Thus, we propose that 'recovery' is the continuous process of harmonizing the 'actual state' with the state that is 'required' at that moment.

The acute effects of physical activity on cigarette cravings: exploration of potential moderators, mediators and physical activity attributes using individual participant data (IPD) meta-analyses.

RATIONALE: The effects of acute bouts of physical activity (PA) on Strength of Desire (SoD) and Desire to Smoke (DtS) using individual participant data (IPD) from 19 acute randomised controlled studies were quantified. However, there is a need to identify factors influencing this relationship. OBJECTIVES: To understand who most benefits from PA, whether changes in affect mediate these effects and whether any specific attributes of PA are associated with cigarette cravings. METHODS: IPD (n = 930) contributed to one-stage IPD meta-analyses. Participants engaging in PA were compared against controls, using post-intervention DtS and SoD (when DtS is not available) with baseline adjustments. The craving scales were linearly rescaled to 0-100 % (a mean difference between groups of -10 would indicate that post-intervention cravings were 10 % lower in the PA compared with the control group). Demographic, smoking and other characteristics were examined as predictors and potential moderators, whereas change in affect was considered as a mediator. PA was categorised according to type, duration and intensity, to determine PA attributes associated with cravings reduction. RESULTS: None of the included covariates were shown to moderate or mediate the effects of PA. Intensity of PA was significantly associated with a reduction in cravings; moderate and vigorous intensity PA offered the most benefits. A one-stage IPD meta-analysis yielded effect sizes of -9.22 (-15.24; -3.20) for light, -34.57 (-42.64; -26.50) for moderate and -31.29 (-38.00; -24.57) for vigorous intensity in comparison with controls. CONCLUSIONS: Moderate intensity PA could be recommended to all smokers regardless of demographic, smoking and other characteristics.

Psychosocial work characteristics, need for recovery and musculoskeletal problems predict psychological distress in a sample of British workers.

From an original sample of 2454 participants free of self-reported psychological distress, 1463 workers completed a 15-month follow-up. Baseline measures included exposure to job demands, decision latitude, social support and need for recovery. Psychological distress was assessed using the General Health Questionnaire at baseline and at follow-up. The findings showed that medium and high exposure to job demands and social support increased the risk of reporting psychological distress at 15-months (relative risk (RR) = 1.65, 1.45). The highest adjusted RR was observed for workers reporting a high need for recovery after work (RR 2.12, 1.90) and this finding was independent of the effects of job demands, decision latitude and social support. Neither decision latitude, nor low back problems increased the risk of reporting future psychological distress, although neck problems (RR = 1.66) and hand/wrist problems (RR = 1.45) did. It was concluded that need for recovery appears to be an important indicator of individual workers who are at risk of developing psychological distress long term. STATEMENT OF RELEVANCE: This paper reports the findings of a longitudinal study showing that need for recovery from work was the strongest predictor, relative to psychosocial work characteristics (job demands, decision latitude and social support), and musculoskeletal problems, of psychological distress 15 months later in individuals initially free from distress.

The differential role of mental rumination among industrial and knowledge workers.

The nature of work has been changing. It is becoming more and more uncertain, complex, cognitively demanding, disperse in space and in time, and diverse for the people involved. It requires diffuse decision making and responsibility. Knowledge and creative work, instead of industrial, currently occupies the majority of workforce. A recent NIOSH report (2002) claims that the changing nature of work asks for new research, tools and methods for evaluating the impact of its transformations on workers' health and safety. Following this claim, the current paper investigates the process of recovery from fatigue. Since it is known that the quality of recovery may be highly impoverished by the presence of persisting and pervasive mental activity, namely, by mental rumination, the investigation focuses on the possible differential characteristics of rumination among industrial and knowledge workers. The results from a field study shows evidence that industrial and knowledge workers are differentially affected by rumination. It is suggested that rumination can be a promising early indicator of stress in knowledge occupations.

People don't exercise because they can't think of reasons to exercise: an examination of causal reasoning within the Transtheoretical Model.

This study compared the accessibility of the pros (advantages) and cons (disadvantages) of exercise in a group of non-exercisers and regular exercisers, using the Transtheoretical Model of behaviour change as a theoretical framework. Pre-contemplators (n = 18), and maintainers (n = 25), were asked to generate a list of 'advantages to taking part in exercise' (pro reasons), and a list of 'disadvantages to taking part in exercise' (con reasons). The time to generate their first item was recorded as well as the total number of items generated within 60 s. The results showed that pre-contemplators provided more con reasons relative to pro reasons; and maintainers provided more pro reasons relative to con reasons for exercise. Pre-contemplators were also quicker to provide their first con reason, relative to their first pro reason, but there was no difference in pro and con latencies in the maintainers. It was concluded that one reason pre-contemplation individuals do not participate in regular exercise may be because they cannot think of reasons to exercise.

Effect of kava and valerian on human physiological and psychological responses to mental stress assessed under laboratory conditions.

This study investigated whether kava or valerian could moderate the effects of psychological stress induced under laboratory conditions in a group of healthy volunteers. Fifty-four participants performed a standardized colour/word mental stress task on two occasions 1 week apart. Blood pressure (BP), heart rate (HR) and subjective ratings of pressure were assessed at rest and during the mental stress task. Following the first session (time 1 = T1), individuals took a standard dose of kava (n = 18), or valerian (n = 18) for 7 days, while the remainder acted as controls (n = 18). Differences in BP and HR from resting levels were calculated as reactions to the stress task at both time points. At the second session (time 2 = T2) there was a significant decrease in systolic BP responsivity in both the kava and valerian groups relative to T1, but there were no significant reductions in diastolic BP. Between T1 and T2, the HR reaction to mental stress was found to decline in the valerian group but not in the kava group. Individuals taking kava or valerian reported less pressure during the task at T2 relative to T1. There were no significant differences in BP, HR or subjective reports of pressure between T1 and T2 in the controls. Behavioural performance on the colour/word task did not change between the groups over the two time points. The results suggest that kava and valerian may be beneficial to health by reducing physiological reactivity during stressful situations.

Effect of a short bout of exercise on tobacco withdrawal symptoms and desire to smoke.

RATIONALE: Previous research suggests that a long bout of vigorous intensity exercise may reduce tobacco withdrawal symptoms and desire to smoke during abstinence. OBJECTIVE: In the present study, we investigated whether a short bout of moderate intensity exercise reduced desire to smoke and withdrawal symptoms in abstaining smokers. METHODS: Seventy-eight smokers attended the laboratory in the afternoon having not smoked since the previous evening. They rated their desire to smoke and withdrawal symptoms immediately before, during and after 10 min of moderate intensity exercise on a stationary cycle (experimental condition), or after waiting passively (control condition 1) or watching a video (control condition 2). RESULTS: Ratings of desire to smoke and withdrawal symptoms decreased more in the experimental group than in both control groups, which did not differ from each other. The effect was evident at all measurement points and was maintained for at least 10 min following exercise. CONCLUSION: A single bout of 10 min of moderate intensity exercise has a rapid and measurable effect on desire to smoke and tobacco withdrawal symptoms in abstaining smokers. Short bouts of exercise may be useful in helping to reduce desire to smoke and withdrawal symptoms during smoking cessation.

Mental stress induces transient endothelial dysfunction in humans.

BACKGROUND: Mental stress has been linked to increased morbidity and mortality in coronary artery disease and to atherosclerosis progression. Experimental studies have suggested that damage to the endothelium may be an important mechanism. METHODS AND RESULTS: Endothelial function was studied in 10 healthy men (aged 50. 4+/-9.6 years) and in 8 non-insulin-dependent diabetic men (aged 52. 0+/-7.2 years). Brachial artery flow-mediated dilation (FMD, endothelium dependent) and response to 50 microg of sublingual glyceryl trinitrate (GTN, endothelium independent) were measured noninvasively by use of high-resolution ultrasound before and after (30, 90, and 240 minutes) a standardized mental stress test. The same protocol without mental stress was repeated on a separate occasion in the healthy men. In healthy subjects, FMD (5.0+/-2.1%) was significantly (P:<0.01) reduced at 30 and 90 minutes after mental stress (2.8+/-2.3% and 2.3+/-2.4%, respectively) and returned toward normal after 4 hours (4.1+/-2.0%). Mental stress had no effect on the response to GTN. In the repeated studies without mental stress, FMD did not change. The diabetic subjects had lower FMD than did the control subjects (3.0+/-1.5% versus 5.0+/-2.1%, respectively; P:=0.02) but showed no changes in FMD (2.7+/-1.1% after 30 minutes, 2.8+/-1.9% after 90 minutes, and 3.1+/-2.3% after 240 minutes) or GTN responses after mental stress. CONCLUSIONS: These findings suggest that brief episodes of mental stress, similar to those encountered in everyday life, may cause transient (up to 4 hours) endothelial dysfunction in healthy young individuals. This might represent a mechanistic link between mental stress and atherogenesis.

Persistent high job demands and reactivity to mental stress predict future ambulatory blood pressure.

OBJECTIVE: To test the hypothesis that work stress (persistent high job demands over 1 year) in combination with high reactivity to mental stress predict ambulatory blood pressure. DESIGN: Assessment of cardiovascular responses to standardized behavioural tasks, job demands, and ambulatory blood pressure over a working day and evening after 12 months. PARTICIPANTS: We studied 81 school teachers (26 men, 55 women), 36 of whom experienced persistent high job demands over 1 year, while 45 reported lower job demands. METHODS: Participants were divided on the basis of high and low job demands, and high and low systolic pressure reactions to an uncontrollable stress task. Blood pressure and concurrent physical activity were monitored using ambulatory apparatus from 0900 to 2230 h on a working day. RESULTS: Cardiovascular stress reactivity was associated with waist/hip ratio. Systolic and diastolic pressure during the working day were greater in high job demand participants who were stress reactive than in other groups, after adjustment for age, baseline blood pressure, body mass index and negative affectivity. The difference was not accounted for by variations in physical activity. CONCLUSIONS: Cardiovascular stress reactivity and sustained psychosocial stress may act in concert to increase cardiovascular risk in susceptible individuals.

Job strain and anger expression predict early morning elevations in salivary cortisol.

OBJECTIVE: The objectives of this study were to test the hypothesis that high job demands and low job control (job strain) are associated with elevated free cortisol levels early in the working day and with reduced variability across the day and to evaluate the contribution of anger expression to this pattern. METHODS: One hundred five school teachers (41 men and 64 women) classified 12 months earlier as high (N = 48) or low (N = 57) in job strain according to the demand/control model sampled saliva at 2-hour intervals from 8:00 to 8:30 hours to 22:00 to 22:30 hours on a working day. Anger expression was assessed with the Speilberger State-Trait Anger Expression Inventory, and negative affect was also measured. RESULTS: Free cortisol was significantly elevated at 8:00 to 8:30 hours in the high job strain group but not at later times of the day or evening. After adjustment for age and negative affect, cortisol was an average of 21.7% higher early in the working day in the high job strain group. This effect was significantly greater in high job strain teachers, who also reported high anger-out. The cortisol decline from morning to evening was greater in the high than low job strain individuals. Independently of job strain, women had a higher cortisol concentration at 8:00 to 8:30 hours than men, whereas cortisol concentration was greater in men than women in the middle of the working day between 12:00 and 16:30 hours. CONCLUSIONS: Job strain is associated with elevated free cortisol concentrations early in the working day but not with reduced cortisol variability. The interaction with outward anger expression suggests that individual characteristics modulate the impact of chronic work stress on the hypothalamic-pituitary-adrenocortical system.

Task demands and the pressures of everyday life: associations between cardiovascular reactivity and work blood pressure and heart rate.

Associations between cardiovascular stress reactivity and blood pressure and heart rate recorded in everyday life were hypothesized to depend on the stressfulness of the ambulatory monitoring period relative to standardized tasks and on activity levels at the time of measurement. One hundred two female and 60 male school teachers carried out high- and low-demand tasks under standardized conditions and ambulatory monitoring during the working day. Stress ratings during the day were close to those recorded during the low-demand task. Reactions to the low-demand task were significant predictors of ambulatory blood pressure and heart rate independent of baseline, age, gender, and body mass. Associations were more consistent for ambulatory recordings taken when participants were seated than when they were standing and when the ambulatory monitoring day was considered to be as stressful as usual or more stressful than usual, and not less stressful than usual. Laboratory-field associations of cardiovascular activity depend in part on the congruence of stressfulness and physical activity level in the 2 situations.

Gender, family structure and cardiovascular activity during the working day and evening.

This study applied psychophysiological methods to the investigation of social roles and well-being, using cardiovascular function over a working day and evening as an index of physiological activation. One hundred and sixty-two full-time school teachers (102 women and 60 men) were assessed using automated ambulatory blood pressure monitoring apparatus, with readings every 20 min through the working day (9.00 am-5.40 pm), and every 30 min in the evening (6.00-10.30 pm). The influence of gender, marital status and parenthood (defined as having at least one child living at home) on blood pressure during the working day and on day-evening differences was examined. There were no differences in blood pressure and heart rate across the working day in relation to marital roles or family structure. However, the decrease in blood pressure between working day and evening was greatest in parents, intermediate in married non-parents, and smallest in single participants without children. Differences in systolic pressure adjusted for age and body mass index averaged -4.46, -1.76 and +0.22 mmHg in the three groups, respectively. A similar pattern was observed for diastolic pressure but not heart rate. We also found that the day-evening fall in systolic pressure was moderated by social support, with the greatest change (mean adjusted difference -6.76 mmHg) in parents who reported high levels of social support. These blood pressure responses did not differ between men and women, and there was no indication of multiple role strain for full-time working mothers. The results were independent of concomitant physical activity, location during measurement, or reported job strain. We argue that findings are consistent with an enhancement model of multiple social roles, and with lower allostatic load on individuals who are working, married and parents. Psychophysiological studies of daily life can complement epidemiological and sociological investigations of social roles and health.

Ambulatory blood pressure monitoring is associated with reduced physical activity during everyday life.

OBJECTIVE: The objective of this study was to assess the impact on noninvasive ambulatory blood pressure monitoring on physical activity measured objectively by use of triaxial accelerometers. METHODS: Twenty-four working men and women performed ambulatory blood pressure plus activity monitoring for 1 working day and evening and activity monitoring alone for a separate day and evening. Blood pressure measures were taken at 20-minute intervals during the day and 30-minute intervals in the evening and were accompanied by diary assessments of mood, location, and posture. Comparisons were made of energy expenditure on the 2 days and of activity levels during the minutes surrounding each blood pressure reading and diary completion. RESULTS: Energy expenditure assessed in terms of activity calories per hour was significantly lower during blood pressure plus activity monitoring compared with activity monitoring alone (mean 37.3, SD = 16.3 vs. mean = 43.0, SD = 18.7 kcal, respectively: p = .02). Energy expenditure was lower during the 4 minutes surrounding each blood pressure reading than in the intervals between blood pressure readings. However, energy expenditure was also lower in the intervals between blood pressure readings than during comparable times on the activity only monitoring day. Blood pressure, heart rate, and physical activity were moderately correlated within individuals. CONCLUSIONS: Ambulatory blood pressure recording using automated sphygmomanometers is associated with reduced physical activity during the monitoring day. This is due partly to regular periods of immobility during cuff inflation and deflation and diary completion and partly to more general self-imposed restrictions on activity. This pattern has implications for the representativeness of ambulatory blood pressure monitoring, and the construction of ambulatory monitoring diaries.

The influence of abdominal obesity and chronic work stress on ambulatory blood pressure in men and women.

OBJECTIVE: To assess the influence of abdominal obesity and work stress (operationalised as low control over work) on ambulatory blood pressure on a working day and evening. PARTICIPANTS AND METHODS: 156 school teachers (58 men and 98 women) carried out ambulatory blood pressure and heart rate monitoring on a work day and evening. Cardiovascular activity was also measured under baseline conditions on another occasion, when body weight, height, waist and hip circumference were assessed. Perceived control over work was assessed by questionnaire, along with mental health, anger expression and social support. 126 participants repeated the protocol after 12 months. Waist/hip ratio was used as the index of abdominal obesity. RESULTS: Baseline blood pressure was positively associated with waist/hip ratio in men, but ambulatory blood pressure and heart rate were not independently related to waist/hip ratio or job control. However, blood pressure and heart rate recorded during the working day and evening were elevated in men with high waist/hip ratio who experienced low job control, independently of age and body weight. Effects for diastolic blood pressure and heart rate were replicated after 12 months. Body mass index was not related to blood pressure or heart rate during the day or evening after adjustment for age and waist circumference. Low job control was associated with poor psychological well-being, negative mood and lack of social support. CONCLUSIONS: The results are consistent with the hypothesis that abdominal obesity in men is characterised by a tendency towards heightened stress-induced physiological activation, but that this tendency will only be manifest in the presence of appropriate environmental challenges such as chronic work stress.

Job strain, blood pressure and response to uncontrollable stress.

OBJECTIVE: The association between cardiovascular disease risk and job strain (high-demand, low-control work) may be mediated by heightened physiological stress responsivity. We hypothesized that high levels of job strain lead to increased cardiovascular responses to uncontrollable but not controllable stressors. Associations between job strain and blood pressure reductions after the working day (unwinding) were also assessed. DESIGN: Assessment of cardiovascular responses to standardized behavioral tasks, and ambulatory monitoring of blood pressure and heart rate during a working day and evening. PARTICIPANTS: We studied 162 school teachers (60 men, 102 women) selected from a larger survey as experiencing high or low job strain. METHODS: Blood pressure, heart rate and electrodermal responses to an externally paced (uncontrollable) task and a self-paced (controllable) task were assessed. Blood pressure was monitored using ambulatory apparatus from 0900 to 2230 h on a working day. RESULTS: The groups of subjects with high and low job strain did not differ in demographic factors, body mass or resting cardiovascular activity. Blood pressure reactions to the uncontrollable task were greater in high than low job-strain groups, but responses to the controllable task were not significantly different between groups. Systolic and diastolic blood pressure did not differ between groups over the working day, but decreased to a greater extent in the evening in subjects with low job strain. CONCLUSIONS: Job strain is associated with a heightened blood pressure response to uncontrollable but not controllable tasks. The failure of subjects with high job strain to show reduced blood pressure in the evening may be a manifestation of chronic allostatic load.

Job strain and psychiatric morbidity.

BACKGROUND: This study examined the association between job strain and psychiatric morbidity using interview-based assessments of mental health. We assessed the prevalence of neurotic disorder in high job strain (high demand, low control) and low job strain (low demand, high control) school teachers, and compared these rates with data from individuals with similar educational qualifications from the National Psychiatric Morbidity Survey of Great Britain. METHODS: One hundred and sixty primary and secondary school teachers were selected from a larger survey on the basis of high or low job strain, and were assessed for psychiatric morbidity using the Revised Clinical Interview Schedule (CIS-R). The prevalence of neurotic symptoms and a total psychiatric morbidity score were calculated. RESULTS: After adjusting for age, gender and occupational grade, the prevalence of psychiatric morbidity was greater in high job strain than low job strain individuals. The prevalence of severe anxiety, worry and fatigue symptoms was significantly greater in the high job strain teachers. In comparison with the British psychiatric morbidity survey, the prevalence of neurotic disorders was greater in the high job strain, but not in low job strain teachers. Individuals in the low job strain group were more likely to report severe anxiety, irritability and fatigue in the week prior to interview, than comparably educated individuals in the national survey. CONCLUSION: Job strain is associated with psychiatric morbidity. The high levels of neurotic psychopathology among teachers is consistent with previous research that has found teaching to be a highly stressful occupation.

An investigation of coping strategies associated with job stress in teachers.

BACKGROUND: School teaching is regarded as a stressful occupation, but the perception of the job as stressful may be influenced by coping responses and social support. AIMS: To assess the associations between teacher stress, psychological coping responses and social support, taking into account the plaintive set engendered by negative affectivity. METHOD: Questionnaire survey of 780 primary and secondary school teachers (53.5% response rate). RESULTS: In stepwise multiple regression, social support at work and the coping responses behavioural disengagement and suppression of competing activities predicted job stress independently of age, gender, class size, occupational grade and negative affectivity. High job stress was associated with low social support at work and greater use of coping by disengagement and suppression of competing activities. CONCLUSIONS: It is suggested that behavioural disengagement and suppression of competing activities are maladaptive responses in a teaching environment and may actually contribute to job stress. Coping and social support not only moderate the impact of stressors on well-being but influence the appraisal of environmental demands as stressful.

Antiarthritic mechanisms of amyrin triterpenes.

The triterpenes, alpha-amyrin (AA) and its palmitate (AAP) and linoleate esters (AAL), were tested on models of inflammatory and destructive arthritic processes and their effects were compared with the clinical antiarthritic drugs indomethacin (IN) and methotrexate (MTX). The triterpenes had no effect on the prostaglandin phase of carrageenin pedal edema in rats, which was reduced 28% by 100 microM IN. AAL caused a considerable reduction in the synthesis by human neutrophils of 5-lipoxygenase products--5-HETE (IC50 = 70 microM), LTB4, (62 microM), isomer I (30 microM) and isomer II (24 microM). Rat osteosarcoma cell growth was inhibited by all triterpenes with IC50's (microM) of < 10 (AAP), 14 (AA) and 27 (AAL) and were more effective than IN (35). MTX caused 100% inhibition at a concentration of 10 microM compared with 64% inhibition by AAP. Tadpole collagenase digestion of type I (bone) native collagen was completely inhibited by all the triterpenes as well as IN and MTX at 100 microM. The results indicate that the principal point of antiarthritic intervention by amyrin triterpenes lies in their local inhibition of joint destruction.