Rheumatoid Arthritis

Rheumatoid Arthritis
  

• ME Weinblatt, JM Kremer, et al (Brigham and Women’s Hosp, Boston; Albany Med College, NY; Univ of New Mexico, Albuquerque; et al)
  A Trial of Etanercept, a Recombinant Tumor Necrosis Factor Receptor:Fc Fusion Protein, in Patients With Rheumatoid Arthritis Receiving Methotrexate.
  N Engl J Med 340: 253-259, 1999
   
  A Recombinant human tumor necrosis factor (TNF) given along with methotrexate produces excellent response in rheumatoid arthritis giving significant and sustained benefit.
       

• DT Felson, LaVelley, et al (Boston Univ; St Louis Univ; Rush-Presbyterian-St Luke’s Med Ctr, Chicago; et al )
  The Prosorba Column for Treatment of Refractory Rheumatoid Arthritis:  A Randomized, Double-blind, Sham-controlled Trial.
  Arthritis Rheum 42: 2153-2159, 1999.
    
  In patients with rheumatoid arthritis resistant to all other treatments and which is severe and rapidly progressive, Prosorba column has proved effective.
    
  Prosorba column is a device containing highly purified staphylococcal protein in a silica matrix. It combines with IgG and IgM, rheumatoid factor and allows these complexes to be removed.
     

• JR O’Dell, G Paulsen, et al (Univ of Nebraska, Omaha; Platte Valley Med Group, Kearney, Neb; Omaha, Neb; et al)
  Treatment of Early Seropositive Rheumatoid Arthritis with Minocycline: Four Year Followup of a Double-blind, Placebo-controlled Trial.
  Arthritis Rheum  2: 1691-1695, 1999.
   
  In early patients with rheumatoid arthritis, treatment with minocycline increases the periods of remission.
     

• X Puechal, J-N Fiessinger, et al (Hopital Broussais, Paris)
  Rheumatic Manifestations in Patients with Thromboangiitis Obliterans (Buerger’s Disease)
  J Rheumatol 26:1764-1768, 1999.
   
  Thromboangiitis  obliterans (TAO) should be considered in the differential diagnosis of all smokers with rheumatic symptoms.  Sometimes rheumatic symptoms may predate the vascular change by more than a decade.
       

• JD O’Duffy, WL Griffing, et al (Mayo Clinic, Rochester, Minn)
  Arthritis Rheum  42: 812-817, 1999.
      
  Whipple’s disease or Whipple’s arthritis is a due to infection with Tropheryma whippeli. The common clinical diagnosis typical in a middle age man is because of malabsorption syndrome, chronic diarrhoea and weight loss. There is lymphadenopathy, fever of unknown origin, dementia, uveitis, anemia, hyperpigmentation, ascites and arthritis. Diagnosis is by a PCR test.
      

• F C Breedveld
  Commentary – Is There a Place for Leflunomide in the Treatment of Rheumatoid Arthritis? 
  The Lancet October 13, 2001, Vol.358 (9289) Pg. 1198-1200
       
  The manufacturer of leflunomide was alerting prescribers to changes in the summary of product characteristics and package leaflet made because of reports of 15 cases of severe liver injury (including hepatitis and a few cases of acute hepatic necrosis), some of which were fatal.
       
  Randomised clinical trials of leflunomide for the treatment of rheumatoid arthritis showed that it was superior to placebo and similar to sulphasalazine or methotrexate in most measures.
      
  The frequency of side-effects leading to the discontinuation of leflunomide was similar to that for the control drugs in the trials. Diarrhoea, reversible alopecia, allergic reactions, and increased serum concentrations of hepatic enzymes are known side-effects, and special care should be taken in patients who drink alcohol or have a history of liver disease.