Intestinal permeability changes were significantly more pronounced and frequent with the hypo-and hyperosmolar as opposed to the isoosmolar test. Sequential studies showed that four and nine patients (of 13) developed inflammation after three and six months treatment with NSAIDs, respectively. There was no significant diVerence (p>0.1) in the prevalence (54-72%) or severity of intestinal inflammation in the 286 patients taking the various NSAIDs apart from those on aspirin and nabumetone, these having no evidence of intestinal inflammation. There was no significant correlation between the inflammatory changes and age, sex, dose of NSAID, length of disease, or NSAID ingestion. Conclusions-Intestinal permeability test dose composition is an important factor when assessing the eVects of NSAIDs on intestinal integrity. All the conventional NSAIDs studied were equally associated with small intestinal inflammation apart from aspirin and nabumetone which seem to spare the small bowel. (Gut 1998;43:506-511)

We identified a novel phenotype of SF NK cells that is of potential significance in RA. Experiments are now under way to determine the function of these SF NK cells and their potential role in RA.

Summary Since their introduction for the treatment of rheumatoid arthritis, corticosteroids have become widely used as effective agents in the control of inflammatory diseases. Although there have been undoubted benefits upon mortality in diseases such as systemic lupus erythematosus, many patients survive only to suffer a high incidence of premature atherosclerosis. There is also evidence of increased rates of vascular mortality in other corticosteroid-treated diseases, such as rheumatoid arthritis, reversible airways obstruction and transplant recipients. Possible mechanisms of damage include elevated blood pressure, impaired glucose tolerance, dyslipidaemia, and imbalances in thrombosis and fibrinolysis. This paper reviews the clinical evidence supporting the contention that there is an excess cardiovascular mortality in steroid-treated patients and the underlying mechanisms, and points to further areas of research.

Background: Corticosteroids and non-steroidal anti-inflammatory drugs are widely used for the treatment of rheumatic conditions, but their gastrointestinal damage significantly limits their use. Sigmoid diverticular abscess perforation (SDAP) is a very serious complication of diverticular disease. Objective: To determine the aetiology of large bowel SDAP in rheumatic conditions. Methods: 64 patients with SPAD and 320 controls from a similar geographical area and of similar socioeconomic status were studied. Results:The results showed that independently of rheumatic diagnosis corticosteroid treatment is strongly associated with SDAP (OR 31.9 (95% CI 6.4 to 159.2; p,0.001), and nonsteroidal anti-inflammatory drugs only weakly associated (OR 1.8 (95% CI 0.96 to 3.4); p = 0.069). A rheumatic diagnosis is also strongly associated with the development of SDAP (OR 3.5 (95% CI 1.9 to 6.7); p,0.001). Conclusions: SDAP has serious implications for patients and consumes many healthcare resources. Patients and physicians should be warned of this potential complication.

ObjectiveTo develop a novel method for capturing the discrepancy between objective tests and subjective dryness symptoms (a sensitivity scale) and to explore predictors of dryness sensitivity.MethodsArchive data from the UK Primary Sjögren's Syndrome Registry (n = 688) were used. Patients were classified on a scale from −5 (stoical) to +5 (sensitive) depending on the degree of discrepancy between their objective and subjective symptoms classes. Sensitivity scores were correlated with demographic variables, disease‐related factors, and symptoms of pain, fatigue, anxiety, and depression.ResultsPatients were on average relatively stoical for both types of dryness symptoms (mean ± SD ocular dryness −0.42 ± 2.2 and −1.24 ± 1.6 oral dryness). Twenty‐seven percent of patients were classified as sensitive to ocular dryness and 9% to oral dryness. Hierarchical regression analyses identified the strongest predictor of ocular dryness sensitivity to be self‐reported pain and that of oral dryness sensitivity to be self‐reported fatigue.ConclusionOcular and oral dryness sensitivity can be classified on a continuous scale. The 2 symptom types are predicted by different variables. A large number of factors remain to be explored that may impact symptom sensitivity in primary Sjögrenʼs syndrome, and the proposed method could be used to identify relatively sensitive and stoical patients for future studies.

Near fatal eosinophilic gastroenteritis responding to oral sodium chromoglycate R J MOOTS, P PROUSE, AND J M GUMPEL From Northwick Park Hospital, Harrow, Middlesex SUMMARY Eosinophilic gastroenteritis (EG) is an uncommon disorder, characterised by cramping abdominal pain, diarrhoea and vomiting and histologically by eosinophilic infiltration of bowel wall.' We present a patient who developed EG during the course of a systemic, necrotising vasculitis, who became critically ill after failure of treatment with corticosteroids and cytotoxic drugs and responded only to oral sodium chromoglycate.Case report A 57 years old cachectic woman was admitted as an emergency, with a five months history of increasing epigastric pains, anorexia, bloody diarrhoea, and weight loss.Ten years earlier, she had been diagnosed as having a sero negative, non-erosive, symmetrical polyarthritis. A year before this admission she was investigated for a painful peripheral neuropathy, livedo reticularis skin rash and leg ulcers. Nonspecific vasculitis was present on a skin biopsy. Thereafter she became generally unwell developing mild diarrhoea with weight loss. Liver function was abnormal with mildly raised alkaline phosphatase and aspartate transaminase. Liver biopsy and colonic biopsy showed a granulomatous vasculitis, involving both arteries and veins. She had no history of food intolerance or allergy. Initial treatment was with prednisolone and azathioprine. There was little response and cyclophosphamide was substituted for azathioprine. After five months therapy which caused a drug induced lymphocytopaenia, the vasculitis had not improved, the patient's weight had dropped by a further 11 kg and she had developed severe diarrhoea with abdominal pains and rectal

No abstract

No abstract