The efficacy and safety of the oral gold compound auranofin and intramuscular gold thiomalate have been compared in a placebo-controlled, double-blind, four-centre trial in 82 patients with psoriatic arthritis requiring remittive drug therapy. There were statistically significant falls in Ritchie articular index, visual analogue pain score and ESR at 12 and 24 weeks following i.m. gold but no significant changes in the auranofin group. Intramuscular gold was safe and more effective than auranofin as a second-line, suppressive antirheumatic agent for patients with psoriatic arthritis when followed for 6 months.

SummaryForty-seven patients presenting with acute chest pain had in vivo platelet activity assessed by measuring plasma levels of the platelet-specific protein beta thromboglobulin (BTG), and by screening for the presence of circulating platelet aggregates. Nineteen patients with transmural myocardial infarction (MI), 21 patients with acute coronary ischaemia (CI), and 7 patients with non-cardiac chest pain (NCCP) were investigated in a serial study and compared with a normal control group. The means of all BTG determinations in the MI (34, ± SD = 21-57) and CI (33, ± SD = 19-57) groups were significantly higher than those in the NCCP group (24, ± SD = 17-34; p Ã0.01) and normal subjects (22,5, ± SD = 14-37; p Ã0.001). There was no difference in BTG between those with MI or CI, nor between the NCCP group and normal subjects. Raised numbers of circulating platelet aggregates could not be detected in either MI or CI. The mean BTG levels in both MI and CI patients were significantly raised, compared to normal subjects, on the first day of admission to hospital and remained so on each of the subsequent nine days. Neither heparin plus warfarin nor sulphinpyrazone had any significant effect in lowering BTG levels. 15/40 patients (37.5%) following MI and CI had repeatedly raised BTG levels throughout the study period, and it is suggested that these patients represent an “at risk” group that may benefit from anti-platelet therapy in secondary prevention studies.

SUMMARY Appendicular bone mass was measured in a series of 50 patients with non-steroid treated rheumatoid arthritis, 20 with polyarticular seronegative psoriatic arthritis, and 30 with osteoarthrosis, and compared with that of 40 controls of similar age and sex. Distal forearm bone mineral content was reduced in patients with rheumatoid and psoriatic arthritis and increased in those with osteoarthrosis. The increase in bone mass in patients with osteoarthrosis was confined to those with isolated large joint disease and was not found in those with primary generalised osteoarthrosis.

Arthro-osteitis is an uncommon condition which can be associated with palmoplantar pustulosis. It forms part of a group of conditions which include the synovitis, acne, pustulosis, hyperostosis, osteitis syndrome (SAPHO) and sternocostoclavicular hyperostosis. We report four cases illustrating the clinical spectrum of this condition which occurred in the absence of concomitant skin lesions. One patient had extensive aortic calcification a feature not previously reported in this condition, which may represent a low grade inflammatory aortitis.

SUMMARY In a case of acute Reiter's syndrome with severe vulvitis the diagnosis was based on the presence of a vaginal discharge and dysuria, arthritis, conjunctivitis, buccal ulceration, keratodermia blenorrhagica, and HLA B27 tissue-typing antigen. The vulval lesions were similar in appearance to those of circinate vulvitis. The acute histological change were confined to shallow ulceration with an inflammatory infiltration of the subjacent dermis. Coincidential lichen sclerosus et atrophicus was present, which could have been masked by the acute lesions.

Beta thromboglobulin. a platelet specific protein liberated during the release reaction, has been measured in normal individuals (n=285),and in patients presenting with acute chest pain. The latter group consisted of those with acute myocardial infarction (n=19),those with acute myocardial ischaemia (n=21),and those with chest pain of non cardiac origin (n-7). In the patient groups beta thromboglobulin was measured on admission to hospital, and thereafter daily until the patient was discharged. There was no significant difference between the normal population (mean 22.5 ng/ml),and the patients with with non cardiac chest pain (mean .24 ng/ml). There was a significant difference between the normal population and the patients with acute myocardial infarction (mean 34 ng/ml),and acute myocardial ischaemia (mean 33 ng/ml), p<0.001. There was also a significant difference between these two groups and the patients with non cardiac chest pain, p<0.01.We would conclude that platelet activation occurs in acute myocardial infarction and ischaemia, but it is not clear if this is a primary or a secondary phenomenon.

A 36-year-old man, suffering from psoriatic arthritis from the age of 17 years, was found to have developed atlanto-axial dislocation at the age of 30. Spontaneous fusion took place over the next two years. An explanation for this finding is based upon a review of the literature regarding the nature of spinal involvement in psoriatic arthritis.

No abstract