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Controlled trial of medical treatment of active chronic otitis media Active chronic otitis media is a common condition affecting 0 6%,' of adults in the United Kingdom. Initial management is usually by general practitioners, who annually prescribe systemic and topical antibiotics on at least 178 000 and 73 000 occasions respectively (unpublished observations). Despite this there have been few studies of the efficacy of antibiotics,'-4 and no study has included a control group of untreated patients or of patients treated solely by aural toilet. We undertook a controlled study comparing appropriate systemic or topical antibiotic treatment with weekly aural toilet and insufflation of boric acid and iodine powder.

Context Accelerated atherosclerosis has been described in antiphospholipid syndrome, but the vascular abnormalities and the underlying mechanisms remain unclear.Objectives To compare vascular structure and function in patients with positive antiphospholipid antibodies (aPL) with controls and to assess their relationship with paraoxonase activity. Design, Setting, and ParticipantsA cross-sectional study of 77 women with positive antiphospholipid antibodies from a lupus outpatient clinic in London, England (90% of the eligible population) and 77 controls matched on frequency basis for age and cardiovascular risk factors between June 2006 and April 2009. Carotid intima media thickness (CIMT), flow-mediated dilatation, pulse wave velocity, and paraoxonase activity were measured in all patients. Anti-inflammatory and antioxidant properties of high-density lipoprotein (HDL) were examined.Main Outcome Measures CIMT, pulse wave velocity, flow-mediated dilatation, and paraoxonase. ResultsWomen with aPL had greater CIMT and pulse wave velocity compared with controls (mean [SD], 0.75 [0.16] vs 0.64 [0.

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Background. Autoantibodies to citrullinated peptides have been shown to be valuable in the diagnosis of rheumatoid arthritis (RA). The expanding repertoire of antibodies to citrullinated peptide antigens (ACPA) has been a topic of great interest in recent reviews and research studies, as has the ability of these autoantibodies to predict disease outcome. Objectives. The aim of this review was to provide an update on the relevance of ACPA as prognostic markers in RA. The ability to identify patients predisposed to an aggressive outcome at the time of initial diagnosis greatly facilitates the selection of appropriate and cost-effective treatment. Methods. A systematic review of the literature was carried out. Studies from 1967 up to June 2014 with data on prognostic value of ACPA were included. Quality assessment was done by using the modified Hayden list for prognostic studies. Meta-analysis was performed using BioStat software. Results. The results of 25 studies were selected for the final review. A total of 6421 patients with RA were included, mainly in inception cohorts, with follow-up duration ranging from one year to ten years. All studies carried prognostic data on all available isotypes of anticyclic citrullinated protein (CCP), while four had data on antimutated citrullinated vimentin (MCV). There was a single relevant study each on anticitrullinated enolase peptide 1 (CEP1) and antichimaeric fibrin/filaggrin citrullinated peptide 1 (CFFCP1). All studies showed ACPA to be strong predictors of joint erosions in RA. Other factors, particularly baseline erosions, showed an additive effect. Anti-MCV appeared to be a marker of a more aggressive form of disease. Ten studies had data on which a meta-analysis could be performed. This gave an overall odds ratio of 4.85 for ACPA (anti-CCP/MCV) positivity being predictive for the development of joint erosions. Two studies with data on anti-CEP1 and anti-CFFCP1 also showed this positive predictive role of ACPA for joint erosions. Conclusions. ACPA are strong predictors of severity in RA. Their use should be part of routine rheumatology practice.

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Two common cross-reacting anti-DNA antibody idiotypes designated 1616 and 32/15, previously identified in the serum of patients who have systemic lupus erythematosus, were found in 24% and 7%, respectively, of 147 first-degree relatives. These findings imply that high-frequency germ-line genes exist among lupus relatives, as well as patients. These dominant or public anti-DNA antibody idiotypes are not likely to be pathogenic factors, but are probably a genetically associated phenomenon.Evidence of a genetic basis for systemic lupus erythematosus (SLE) has been accumulated in a variety of studies. Population studies have indicated a particular predominance of black females (I), while [61). Recently, the frequency of the Gm allotype 1,17; 5,6,13 was shown to be significantly increased in black American SLE patients (7). Inherited complement deficiency states, notably those of the classical pathway and terminal sequence (C5-C9), have also been noted (8). In a recent study, more than 80% of white SLE patients were found to have a silent or null allele of C4A or C4B (and, in 1 patient, C2), compared with 40% of a matched normal control group (9). Finally, many asymptomatic relatives of lupus patients have hypergammaglobulinemia (lo), serum autoantibodies (1 I), raised circulating immune complex levels (12), and decreased suppressor T cell function (13).We now report a study of anti-DNA antibody idiotypes detectable in the serum of lupus patients and their first-degree relatives. The sharing of idiotypes by antibodies obtained from different patients would suggest that they are the products of germ-line genes that are dispersed throughout the population (14). There is clear evidence that the germ-line controls and limits the available and expressed idiotypic repertoire in newly arising B cells (15). The demonstration of shared idiotypes among lupus patients and their relatives would further support the concept of the importance of genetic influences in SLE.