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Treatment of rheumatoid polyarthritis with synthetic D-peniWcllmine 'Ho-Bay 950'. A. Santamaria, P. Barcel6, M. Mench6n, R. Ruiz de la torre, and M. Ripolls G6mez Twenty patients affected with rheumatoid polyarthritis were treated from 6 to 14 months with synthetic D-penicillaminase (900 mg/d). Clinical improvement was evident, with the decrease of ESR beginning with the third month, thereby permitting the decrease and even the suspension in 7 cases of the dosage of steroids. The Cu and Fe decreased somewhat, but always within the normal physiological limits. Serological values decreased, attaining negativization in 10 cases. Similarly there was a decrease of IgG and IgM; serum Cl and C3 became normal. The 'R rosette' test showed an increase. Histological study of the synovial tissues showed favourable evolution of the inflammatory alterations. All of the changes became manifest beginning with the third or fourth month. The only side effects encountered were light proteinuria in one case, hypogeusia in 2, and skin rash with pruritus in another 2 which did not cause suspension of treatment.Neutrophil chemotaxis in patients with rheumatoid arthritis: mnisms responsible for impairment. A. G. Mowat (Nuffield Orthopaedic Centre, Oxford) The polymorphonuclear leucocyte (PMN) is vital for the control of bacterial infection and plays a major role in wound healing. Most of the phases of PMN activity in the extracellular space, including phagocytosis and cell killing, are normal in patients with rheumatoid arthritis but chemotaxis is impaired (Mowat and Baum, 1971). The low mean chemotactic index+ 1 SD in patients with rheumatoid arthritis (369 ± 87) compared with controls (544 ± 78) has been confirmed. One suggested mechanism of prior ingestion of immune complexes has been supported by the demonstration of a significant correlation between the amount of soluble immune complexes in the serum and the chemotactic index in 21 unselected inpatients (P < 0-01). Previous studies have suggested that phagocytosis of immune complexes by neutrophils produces metabolic and functional alterations of these cells which may be important in the inflammatory process occurring in rheumatoid arthritis. Studies from our laboratories have described an in vitro system for the study of neutrophil phagocytosis of immunoglobulin G-rheumatoid factor (IgG-RF) complexes (Turner and others, 1973) and a system for measuring the uptake of chromium-51 tagged complexes has been utilized (Turner and others, 1974) to further study this phenomonon. These studies are extended here utilizing the chromium tagged immunoglobulin G system and the measurement of hexose monophosphate shunt activity by the conversion of glucose 1-14 carbon CO2 to study the interactions between soluble and insoluble complexes, rheumatoid factor, and neutrophils.Results to date utilizing neutrophils incubated with various substances for 30 minutes at 37°C have shown:(1) neutrophil uptake of insoluble IgG complexes was not significantly affected by the addition of rheumatoid factor to ...

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