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RA-ILD is an important and early feature of RA. It is related to disease activity and has a poor prognosis. Further studies are required to determine whether screening for pulmonary disease would identify these patients at an earlier stage.

Objectives: To assess the occurrence and prognostic factors for the ability to maintain paid work in patients with rheumatoid arthritis (RA). Setting: Inception cohort of patients with RA recruited from rheumatology departments in nine NHS Hospital Trusts in England. Patients: All consecutive patients with RA of less than two years' duration, before any second line (disease modifying) drug treatment, and followed up for five years. Methods: Clinical, laboratory, and radiological assessments, and all treatments were recorded prospectively using a standardised format at presentation and yearly. Outcome measures: Changes in, and loss of paid work by five years' follow up. Results: 732 patients completed the five year follow up. 353/721 (49%) were gainfully employed at the onset of RA, 211 (60%) were still working at five years, 104 (29%) stopped because of the disease, and 31 (9%) retired for reasons other than RA. Work disability at five years was more likely in manual workers (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.4 to 3.8) and worse baseline Health Assessment Questionnaire (HAQ>1.5, OR 2.26, 95% CI 1.38 to 3.7). In combination with other baseline variables (erythrocyte sedimentation rate, sex, age of onset, and radiological erosions), employment outcome was predicted in 78% using multivariate analysis. Conclusions: Nearly half of the patients with RA were in paid employment at onset, work disability was an adverse outcome for a third of these patients by five years, and manual work and high baseline HAQ were important predictors for this. These details are likely to be useful to clinicians, health professionals, and patients in order to plan medical, orthopaedic, and remedial treatments in early RA. Future disease modifying treatments could be compared with this cohort of patients who were treated with conventional second line drugs.

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Clinical profiles of RA patients treated with conventional drug therapy over 5 yr showed that a small proportion of patients (around 16%) do badly functionally and in terms of life events, whereas around 40% do relatively well. The details and exact figures of cumulative disability are likely to be useful to clinicians, health professionals and patients. The rate of progression and outcome in these patients can be compared against future therapies with any disease-modifying claims.

1. A variety of bioassessment metrics were tested using family‐level macroinvertebrate data, gathered by standard colonization units, and associated physicochemical data from pollution gradients in three rivers in developing countries. 2. Graphical methods of evaluation were used to evaluate the metrics with respect to these pollution gradients. 3. In general, the macroinvertebrate communities sampled displayed a similar response to pollution to that observed in well‐studied temperate areas. 4. Of the twenty metrics tested seven described the pollution gradients adequately. Four of these seven metrics, which do not supply duplicate information, were selected for use in a multimetric system of bioassessment. 5. A multimetric system is proposed and tested using the original macroinvertebrate data. It performs well in the assessment of the pollution status of the study sites and the description of the pollution gradient. However, local modifications are likely to enhance its performance.

SUMMARY Intestinal permeability was estimated in healthy subjects after ingestion of aspirin (1.2+1*2 g), ibuprofen (400+400 mg) and indomethacin (75+50 mg) at midnight and an hour before starting a 51chromium labelled ethylenediaminetetraacetate absorption test. Intestinal permeability increased significantly from control levels following each drug and the effect was related to drug potency to inhibit cyclooxygenase. Intestinal permeability increased to a similar extent after oral and rectal administration of indomethacin showing that the effect is systemically mediated. Prostaglandin E2 decreased intestinal permeability significantly but failed to prevent the indomethacin induced increased intestinal permeability. These studies show that non-steroidal anti-inflammatory drugs disrupt the intestinal barrier function in man and suggest that the morphological correlates of the damage may reside at the level of the intercellular junctions.Several non-steroidal anti-inflammatory drugs (NSAIDs) induced characteristic intestinal damage in various animal species.' This is particularly severe in the rat where subcutaneous indomethacin leads to small bowel inflammation with ulceration, perforation, and ultimately death within 72 hours. 5 The precise mechanism underlying this sequence of events is unknown but there is substantial data to implicate both reduced synthesis of mucosal prostaglandings and the presence of intestinal bacteria in the pathogenesis of the lesions.6 7 Thus the macroscopic damage is preceded by a period of profound inhibition of mucosal cyclooxygenase activity8 and damage can be prevented by the simultaneous administration of a variety of prostaglandins.5 9 10 The role of intestinal bacteria is suggested by findings that intestinal ulceration after NSAIDs is rarely seen in germ free animals and the damage is greatly reduced after the coadministration of various antibiotics by a mechanism which appears to differ from their 'cytoprotective' properties. 112Until recently the human small intestine was thought to be relatively unaffected by NSAIDs.

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