We studied whether the high incidence of secondary amyloidosis (SA) is a consistent finding in patients with inflammatory joint disease. A total of 4508 biopsies of patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis were studied at the Rheumatism Foundation Hospital during 1987-1997. The results show that the annual number of findings of SA was reduced from 68 to less than 10. We suggest that a change in medication towards more frequent use of cytostatic agents is the reason for the reduction in incidence of SA.

In a 15-year follow-up examination, reactive secondary amyloidosis (RSA) was found by subcutaneous fat biopsy in six out of 74 still living patients (8.1%) of an original population of 102 with erosive and seropositive rheumatoid arthritis (RA). Five of the 24 deceased patients had had RSA. Thus the 15-year incidence of RSA in RA was at least 10.9% (11/102). To study early prognostic aspects of RSA, comparison was made of 14 entry variables and the initial treatment in the RSA group (n = 11) and the control group (n = 81) respectively. At onset (< or = 6 months) of RA only serum orosomucoid, but after three years morning stiffness, ESR, serum CRP and orosomucoid were significantly worse in patients whom later developed RSA. Three out of 48 patients treated with gold sodium thiomalate and seven out of 30 treated with chloroquine developed RSA (p = 0.04). It is concluded that continuously active disease was the risk factor underlying RSA. The role of early chloroquine therapy is discussed.

Objective. To study tumor necrosis factor ␣ (TNF␣) -308 gene promoter polymorphism and circulating levels of TNF␣ and soluble TNF receptor type I (sTNFRI) in rheumatoid arthritis (RA) patients with and without reactive amyloidosis.Methods. In a retrospective study, we examined 55 RA patients with biopsy-proven reactive amyloidosis and 55 control RA patients without amyloidosis (matched for age, sex, rheumatoid factor titer, and RA duration). Inflammatory activity was assessed by measuring the erythrocyte sedimentation rate and C-reactive protein level. TNF␣ gene promoter polymorphism was studied using polymerase chain reactionrestriction fragment length polymorphism assay. Cytokine and receptor levels were measured by enzymelinked immunoassays.Results. Patients with RA and amyloidosis had significantly higher TNF␣ and sTNFRI levels than did the control RA patients. The increased circulating levels of TNF␣ correlated with interleukin-18 levels, but not with the serum amyloid A protein levels or with TNF␣ -308 gene promoter polymorphism (reported to be associated with high TNF␣ levels and certain disease susceptibilities). In the patients with RA and amyloidosis, those with anemia had significantly higher TNF␣ and sTNFRI levels than did those without anemia, and circulating TNF␣ and sTNFRI levels correlated negatively with hemoglobin concentrations. In the patients with RA and amyloidosis, those with nephropathy had significantly higher TNF␣ and sTNFRI levels than did those without nephropathy; in patients with isolated proteinuria (but no creatinine elevation) the TNF␣ level was also significantly increased, indicating that the TNF␣ elevation was not merely a consequence of impaired renal function.Conclusion. This study shows that circulating levels of TNF␣ and sTNFRI are significantly increased in RA patients with amyloidosis as compared with control RA patients without amyloidosis and that the increased levels may be implicated in the pathogenesis of certain disease manifestations, including anemia of chronic disease and renal pathology in reactive amyloidosis.

The effect of 9 nonsteroidal anti-inflammatory drugs on the renal excretion of uric acid was studied in patients with normal renal function. Diflunisal, Azapropazone and Indomethacin caused an increase and Piroxicam a decrease in the uric acid excretion. Other drugs studied had no significant influence.

During 1973-75, a total of 446 patients with recent arthritis were examined. The diagnosis in 32 cases was non-classified monoarthritis. After the 3-9 years' follow-up of these 32 patients, two seropositive, definite rheumatoid arthritis cases (6%), and one ankylosing spondylitis case were noted. In the remaining patients the diagnosis was still non-specific arthritis. Of the 31 patients tested, 39% were HLA-B27-positive. The difference between this and the HLA-B27-positivity in the normal Finnish population (14%) is statistically significant (p less than 0.005). At the end of the follow-up the good prognosis of monoarthritis was confirmed: only one erosion developed in one patient's hands or feet.