Ten patients with rheumatoid arthritis unresponsive to conventional therapy participated in a double-blind cross-over trial in which they randomly received either a "pulse" or 1 g of methylprednisolone or placebo, intravenously, once a month for 6 months. Both the drug-first and placebo-first groups had the same mean American Rheumatism Association functional classification, 2.5. During the study patients on methylprednisolone "pulses," compared to placebo, showed significantly better mean tender-joint counts, walking times, and grip strength (p < 0.05). The drug-treated patients also had significantly lower levels of immune complexes (p < 0.01) and IgG (p < 0.01). Effects could still be measured an average of 2.9 +/- 0.4 months after the last dose of methylprednisolone. No significant side effects were noted during the therapy. Despite these findings, "pulse" methylprednisolone did not appear to significantly retard radiologic progression of the arthritis.
The lack of transfer of 2 learning effects, acquisition and extinction, between phenobarbital-induced state (PhS) and normal, nondrug, state (NDS) were studied in an escape-from-shock response in Experiment 1 and in an immobility or "freezing" response in Experiment 2. 6 groups of 6 rats each were used in each experiment. Acquisition effects transferred in the immobility response but not in the escape response; extinction effects transferred in the escape response but not in the immobility response. Since both the extinction of immobility and the acquisition of escape require movement, these instances of dissociation may be said to involve an impairment of the processes concerned with the initiation of movement.
A 25-year-old woman had systemic lupus erythematosus manifested primarily by severe cutaneous vasculitis that was unresponsive to oral prednisone and azathioprine. She was treated with thoracic duct drainage (TDD). Her course was followed by serial photographs, skin biopsies, and serum immunoglobulin, antinuclear antibody, and complement levels. After 1 week of drainage there was obvious clinical improvement. During the remainder of her drainage, the vasculitis continued to improve. It was possible to taper oral corticosteroids and to discontinue azathioprine during TDD without any clinical or laboratory evidence of exacerbation. The patient had no recurrence of vasculitis 22 weeks after the termination of TDD.We report a patient with systemic lupus erythematosus (SLE) with severe cutaneous vasculitis who was treated with prolonged thoracic duct drainage. To our knowledge this is the first reported case of SLE with cutaneous vasculitis successfully treated with thoFrom the
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