Comparison between penicillamine and sulphasalazine in rheumatoid arthritis: Leeds-Birmingham trial.

Sulphasalazine was first formulated by Svartz in the early 1940s, specifically for use as a remission inducing drug in rheumatoid arthritis. After the publication of an unfavourable trial, however, the drug was restricted to patients with ulcerative colitis. In the late 1970s sulphasalazine was re-examined in rheumatoid arthritis and favourable results reported in "open" trials. A double blind controlled trial was therefore conducted comparing enteric coated sulphasalazine and D-penicillamine in patients with active rheumatoid arthritis. A total of 63 patients were recruited in two centres; 31 were treated with sulphasalazine and 32 received penicillamine. After 16 weeks'' treatment both drugs had produced significant improvements in clinical score, pain score measured on a visual analogue scale, grip strength, Ritchie articular index, erythrocyte sedimentation rate, and serum C reactive protein concentration. Nausea was the major side effect in the sulphasalazine treated group. No potentially dangerous effects of sulphasalazine were encountered in contrast with those seen in the penicillamine group. The results suggest that sulphasalazine is an effective and safe drug capable of producing remissions in active rheumatoid arthritis. They also lend confidence to the use of preliminary "open" trials as a means of screening for remission inducing drugs in rheumatoid arthritis.     

Myasthenia gravis and the thymus gland.

Six skin cancer detection clinics were held at a county fair booth in Turlock, California during August, 1973. Examination of sun-exposed skin areas in 605 people showed potential skin cancer in 28.6 percent of people 25 years of age or older. Of the people examined, 135 were referred to their own physicians for follow-up diagnosis and treatment of skin lesions.     

Diaphragmatic weakness and myositis associated with systemic juvenile rheumatoid arthritis.

An unusual presentation of systemic juvenile rheumatoid arthritis in a young adult is reported. Among the major manifestations were severe muscle weakness and dyspnea, which were found to be due to myositis and diaphragmatic weakness. The evolution of the disease and its response to therapy are described.