Sulphasalazine, sulphapyridine or 5-aminosalicylic acid--which is the active moiety in rheumatoid arthritis?

Sulphasalazine is cleaved into 5-aminosalicylic acid and sulphapyridine by colonic bacteria. The bulk of evidence favours sulphapyridine rather than 5-aminosalicylic acid as the active moiety (as well as the main producer of side-effects) though a therapeutic action from the 30% of sulphasalazine that is absorbed unaltered also cannot be excluded.

Family psychiatric screening instruments for epidemiologic studies: pilot testing and validation.

Family history, a risk factor for psychiatric disorders, is infrequently assessed in epidemiologic studies due to time and cost constraints. We designed a brief computer-scorable instrument, the Family History Screen for Epidemiologic Studies (FHE), which collects a pedigree and screens for 15 DSM-III diagnoses in an informant and in his family members. The FHE was administered to one informant in 77 families in which we had collected pedigrees, interviewed 77 informants and 239 relatives using the Lifetime Anxiety version of the schedule for Affective Disorders and Schizophrenia or the Epidemiologic version of the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, and performed best-estimate diagnoses.

Bone alkaline phosphatase in rheumatic diseases.

A double monoclonal immunoradiometric assay specific for bone alkaline phosphatase (BAP) was used to determine whether the raised total alkaline phosphatase (TAP) often found in patients with active rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is derived from bone or liver. Fifty-eight patients with RA were compared to 14 with AS and 14 with non-inflammatory rheumatic diseases (NI). None had clinical liver disease and only one had a slightly elevated aspartate transaminase activity.

The effect of sleep and nocturnal movement on stiffness, pain, and psychomotor performance in ankylosing spondylitis.

Objective: This study was carried out in order to assess whether AS patients are adversely affected by a "good" night's sleep accompanied by little nocturnal movement.

Methods: Objective and subjective nocturnal movement, flexibility, stiffness, pain and psychomotor performance were measured in 22 subjects, 11 with ankylosing spondylitis and 11 controls.

Results: A better sleep integrity with little nocturnal movement was related to a decrease in lumbar flexibility.

Polymorphic acetylation: lack of influence of rheumatic disease activity and concomitant drug administration.

Acetylation polymorphisms have been linked with a tendency to develop rheumatic diseases. We investigated the effect of changes in the disease activity of patients with rheumatoid arthritis (RA) during disease-modifying antirheumatic drug (DMARD) treatment, and on the capacity of these patients to acetylate the sulphonamide sulphadimidine. Fifty-four patients with RA treated with gold, sulphasalazine or D-penicillamine, 12 patients with AS and 16 patients with non-inflammatory arthritis (NI) were investigated over a 24-week period.

Asymmetrical osteoarthritis in a patient with Ehlers-Danlos syndrome and poliomyelitis.

The case is reported of a 71 year old man diagnosed as having Type I Ehlers-Danlos syndrome, a condition associated with the premature development of osteoarthritis, who contracted poliomyelitis as a young man as a result of which he has developed asymmetrical osteoarthritis involving the limbs unaffected by the poliomyelitis. This observation lends further support to the hypothesis that an intact neural pathway may be necessary for the development of arthritis.

Phenotype/genotype relationships for the cytochrome P450 enzyme CYP2D6 in rheumatoid arthritis: influence of drug therapy and disease activity.

Objective: To determine whether particular genotypes for the cytochrome P450 enzyme CYP2D6, a polymorphic enzyme, are associated with susceptibility to rheumatoid arthritis (RA) and whether CYP2D6 enzyme activity is altered as a result of the disease or its treatment.

Methods: CYP2D6 genotypes and metabolic phenotypes were determined for 53 patients with RA and 73 healthy controls. Genotyping was carried out by restriction fragment length polymorphism analysis with the restriction enzyme XbaI and by 2 separate polymerase chain reaction assays; phenotyping was by analysis of in vivo metabolism of the probe drug debrisoquin.

A clinical and biochemical assessment of methotrexate in rheumatoid arthritis.

Low-dose methotrexate has gained widespread acceptance as a second-line agent in rheumatoid arthritis (RA). The Leeds Human Model Screening System (LHMSS) is a validated screening mechanism allowing the rapid evaluation of compounds for their potential as anti-rheumatic agents, the results of which have been confirmed in longer term studies. We have evaluated methotrexate in patients with RA using the LHMSS at a maintenance dose of 10mg/week.

A comparative study of the efficacy and toxicity of etodolac and naproxen in the treatment of osteoarthritis.

In a two-period, double-blind, crossover study, patients with osteoarthritis of the knee and/or hip received etodolac 300 mg twice daily for 4 weeks and naproxen 500 mg twice daily for 4 weeks in random order. The assessment of efficacy showed that naproxen and etodolac were equally effective in the management of pain and stiffness in osteoarthritis. However, a significantly higher proportion of patients preferred naproxen to etodolac for the relief of pain intensity.

An evaluation of the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic.

Seventy patients with RA were randomly allocated to either a Rheumatology Nurse Practitioner (RNP) or Consultant Rheumatologist (CR) clinic. They were seen on six occasions in 1 year. Effectiveness and safety were assessed by biochemical, clinical, psychological and functional variables; patient knowledge and satisfaction were measured by questionnaire.

Urinary excretion of pyridinium crosslinks of collagen correlated with joint damage in arthritis.

The urinary excretion of the collagen crosslinking compounds pyridinoline and deoxypyridinoline have been determined in patients with morphologically different subgroups of OA and RA. There was no significant difference in pyridinoline or deoxypyridinoline excretion when patients with four grades of severity of OA were compared, although the median excretion of pyridinoline and deoxypyridinoline for the OA group as a whole was raised above values found in a healthy control population. Patients with severe or late (burnt-out) RA were found to have a significantly greater excretion of pyridinoline and deoxypyridinoline than patients with early (< 6 months duration) or mild RA.

The topical NSAID felbinac versus oral NSAIDS: a critical review.

Musculoskeletal disorders such as soft tissue injuries have traditionally been treated with oral NSAIDs, despite the significant side-effects associated with their clinical use. However, four separate multicentre, double-blind, double-dummy clinical trials have shown that the efficacy of the topical NSAID, felbinac, is equivalent to that of the oral NSAID, ibuprofen, in the treatment of soft tissue injuries, and to that of oral ibuprofen or fenbufen in mild to moderate osteoarthritis. In general practice the incidence of side-effects with felbinac is low, while oral NSAIDs have been associated with significant problems, particularly in the gastrointestinal system.

Joint hyperlaxity and its long-term effects on joints.

The range of movement at a joint varies between individuals. Reasons for this include inherited collagen structure in the joint capsule and ligaments, inherited shape of the bony articulating surfaces and neuromuscular tone which may be acquired and is modified by training. Methods for quantifying the range of movement at joints are described and compared, including the hyperextensometer and the Carter and Wilkinson score.

Sulphasalazine in the management of psoriatic arthritis.

There are few 'second-line' drugs available for the treatment of PSA and their use is often limited by toxicity. Thirty-nine patients with active PSA recruited from two rheumatology units were randomly allocated to either enteric-coated sulphasalazine (SASP) or placebo and followed for 24 wk. Six patients in the SASP group and 11 on placebo discontinued therapy before 24 wk.

Symptoms of attention-deficit hyperactivity disorder in an Italian school sample: findings of a pilot study.

Objective: The objective of this study was to complete a teacher questionnaire on a sample of children (N = 232) in nine fourth grade classes in schools in two regions of central Italy to assess the frequency of occurrence of symptoms of attention-deficit hyperactivity disorder (ADHD) and the rates of probable cases in the sample.

Method: Each ADHD symptom was rated by the teacher as either absent (0), sometimes present (1) or frequently present (2).

Results: Of the children 3.

Sequential study of bacterial antibody levels and faecal flora in rheumatoid arthritis patients taking sulphasalazine.

Faecal and serum samples were collected from 31 patients with active RA during treatment with DMARD sulphasalazine (SASP). These were examined for changes in faecal flora and antibodies to bacterial antigens respectively. Faecal counts of Clostridium perfrigens but not Escherichia coli or total aerobic or anaerobic counts fell significantly after 2 weeks of treatment, this decrease being maintained throughout the treatment period.

Correspondence between statistically derived behavior problem syndromes and child psychiatric diagnoses in a community sample.

The correspondence between Diagnostic and Statistical Manual (3rd ed.) (DSM-III) diagnoses and statistically derived syndromes was examined within a community sample of children and adolescents in Puerto Rico. Specifically, the extent to which behavior dimensions, derived from the Child Behavior Checklist and the Youth Self-Report, corresponded to psychiatric diagnoses, derived from parent and child versions of the Diagnostic Interview Schedule for Children, was examined.

Optimizing the assessment of disease activity during treatment with anti-rheumatoid drugs.

Clinical trials in RA usually involve the use of several laboratory assessments of disease activity. Their use is not universal and the relative value of many novel assessments has not been determined in relation to existing clinical and laboratory methods. This study attempts to investigate the value of established and novel assessments of disease activity during treatment with accepted DMARDs.

Physiological variations in the urinary excretion of pyridinium crosslinks of collagen.

To further validate measurements of the pyridinium crosslinks of collagen as indices primarily of bone resorption in arthritis and other diseases, the effects of day-to-day and nyctohemeral parallel variations, and of renal impairment have been studied. Day-to-day variations measured over 3 weeks were between 16 and 24% for a group of post-menopausal women. Nyctohemeral variations in crosslink excretion of 10-15% were recorded.

Patterns of diagnostic comorbidity in a community sample of children aged 9 through 16 years.

Secondary analyses of the data from the Puerto Rico Child Psychiatry Epidemiologic Study were done to provide information on the comorbidity of four major diagnostic domains (attention deficit disorders, conduct/oppositional disorders, depression and anxiety disorders). A high level of comorbidity was found among these four domains of child and adolescent psychopathology. In general the patterns of comorbidity were not affected by whether the data was put together by a clinician or by means of a computer algorithm scoring a structured interview.