270 consecutive patients with rheumatoid arthritis who had received chloroquine therapy were examined ophthalmologically for toxic retinal lesions. The total annual dose of chloroquine was 70-75 g. The maximum total dose given was 1330 g. The duration of treatment ranged up to 15 years. The primary material was divided into four groups according to total chloroquine dose received: greater than 100 g, 101-300 g, 301-600 g, and less than 600 g. Each dose group was arbitrarily split into two age groups, one with patients under 63 years of age and the other with patients over 63, in order to analyse the effect of age upon the ocular findings. In the present study, slight macular changes were included in the concept of maculopathy and were not thought to contra-indicate chloroquine therapy. Macular changes were found in about 25% of the patients, regardless of age in the lowest dosage group. The frequency of maculopathy increased with increasing total dose only in the older age group. It was also shown that the frequency of maculopathies and other eye diseases also increased with increasing age. This was evident even from the age of 50. The only patient with chloroquine retinopathy was an inadequately controlled 74-year-old woman. Chloroquine treatment of rheumatoid arthritis in the absence of any other disease which may cause retinopathy implies negligible risks in adult patients under 50 years of age. These patients could be less frequently checked. Older patients require regular ophthalmological checks. It is important to use the smallest effective dose possible, and never higher than 4 mg of chloroquine phosphate/kg body weight and day for 10 months annually; in elderly patients, preferably even lower doses.
Four cases of coli-sepsis, one with a fatal outcome have been observed after more than 14 000 transrectal aspiration biopsies (TAB) of the prostate performed at Karolinska Sjukhuset with Franzén's apparatus. A few cases of transient febrile reaction and urinary contamination after TAB of the prostate have also been recognised. One of the patients with sepsis and two with febrile reactions belonged to a relatively small group of patients referred from the Department of Rheumatology. These observations prompted the present study. The records of all the patients referred for TAB of the prostate from the Department of Rheumatology were reviewed. Four complications (three patients with febrile reaction and growth of E. coli in the urine and one case of sepsis) were observed after 63 biopsies in 51 patients (6.3%). The patient with sepsis and two other patients with complications belonged to a group of 32 patients with proven rheumatic disease (chronic polyarthritis): 42 biopsies had been performed in this particular group of patients, bringing the incidence of complication to 7.1%. For comparison the records of 294 patients from the Department of Urology submitted to TAB of the prostate were also reviewed. Complications in the form of transient febrile reactions were found in five cases after 508 biopsies (1.0%). In addition, three cases of coli-sepsis not belonging to the above-mentioned groups are briefly described as case reports. Patients with rheumatic disease (chronic polyarthritis) seem to run a higher risk of complications after TAB of the prostate. Sepsis from E. coli is a rare but serious complication which can develop into, often fatal, endotoxin shock. TAB of the prostate should therefore be restricted to cases with clinical suspicion of prostatic malignancy.
The present family investigation has shown that genes within the MHS are mainly responsible for the development of psoriasis or psoriasis-associated arthritic lesions (peripheral arthritis and sacroiliitis). We have hypothetically discussed the possibility that multiple genes, all located within the MHS, act in concert to increase the risk of developing disease to very high levels. This implies that at least two MHS linked genes act in complementary fashion for the development of disease, these genes seem to be able to operate both in the cis and in the trans position. One of these genes would be situated in the chromosomal portion of the MHS which carries the HLA-D locus.Families with a high incidence of disease would show inheritance according to the cis position of genes, when it can be shown that most of the carriers of the specific disease-associated haplotype are affected by disease, whereas in other families, complementarity between two distinct HLA haplotypes with genes acting in the trans position would result in disease.
Abstract. The effect upon the serum folic acid activity (SFAA) of age, acute illness and chronic illness has been studied in 173 persons. Old, healthy subjects getting proper meals from institutional kitchens have normal SFAA, while those preparing their own food have low SFAA. The SFAA is normal in acute illness (thyreotoxicosis, fractures, after operations). In chronic inflammatory diseases (pulmonary tuberculosis, rheumatoid arthritis) low or subnormal SFAA is common. In rheumatoid arthritis patients the SFAA is lower the more active the disease and the higher the erythrocyte sedimentation rate. Serum iron and serum cholesterol are also low and correlated to both SFAA and sedimentation rate. The intestinal absorption of folic acid is normal in patients with rheumatoid arthritis, while the plasma clearance of folic acid is greatly increased. The high frequency of subnormal SFAA in this group may be explained by inadequate diet and/or increased turnover of folic acid in the plasma.
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