. (1976). Annals ofthe Rheumatic Diseases, 35,[267][268][269][270]. Clinical diagnosis of ankylosing spondylitis in women and relation to presence ofHLA-B27. Thirty-nine Caucasian women with definite or probable ankylosing spondylitis were tissue typed and the radiographic and clinical features were correlated with the presence of B27 (formerly W27). This investigation showed that the same strong positive correlation observed in men obtains in women between B27 and unequivocal radiographic changes. As such changes develop slowly in women, clinical and laboratory features were identified which were sufficiently characteristic to enable the diagnosis to be reached in advance of decreased spinal mobility. Immobility pain and stiffness and bilateral sacroiliac pain are the most characteristic features, but additional support is provided by the presence of any of the following: onset by age 30, a raised sedimentation rate, peripheral joint involvement, circumthoracic pain, family history, and iritis.

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The use of penicillamine in rheumatoid arthritis (RA) is limited by the incidence of adverse effects, some o f which are potentially hazardous. However, adverse effects are dose-related and the advantages and disadvantages of different fixed and flexible dose regimes are discussed. The incidence of adverse effects is significantly greater in patients previously treated with gold who developed toxicity to that drug-no such increase king found in gold treated patients whose only reason for stopping gold was ineffectiveness. Rashes which develop after several months of treatment are variants of pemphigus and their variouS presentations are described. Fatal reactions, fortunately rare, are predominantly associated with aplasia of the bone marrow. Monthly haemtological checks coupled with meticulous charting of the results may reveal trends as well as numerical changes and serve as an early warning of marrow damage. 1 017 014o/ 1 Retween mealsScand J Rheumatol Downloaded from informahealthcare.com by Nyu Medical Center on 11/03/14For personal use only.

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