Forty patients with definite or classical active rheumatoid arthritis were stratified by the minimization procedure to auranofin (6 mg/day) or penicillamine (go slow and low regime). This investigation is a prospective planned 3 year patient and 'doctor-open' as well as 'doctor-blind' clinical trial. This article describes the results after 12 months. Both drugs decreased disease activity and improved the functional capacity in a similar way. Two patients in the auranofin group and 5 in the penicillamine group stopped treatment due to major side effects. Four other patients in the auranofin group left treatment: 2 due to death from unrelated cause and 2 according to the Helsinki II Declaration. After one year a further patient in the auranofin group and 2 in the penicillamine group stopped treatment due to lack of clinical effect. Side effects due to auranofin were statistically more frequent distal in the gastrointestinal tract (loose stools/diarrhoea) than with penicillamine. In contrast, penicillamine produced significantly more side effects in the oral cavity (mainly taste disturbances) than auranofin. Other side effects were about equal in the two groups, but 2 cases of severe proteinuria and one with obstructive lung disease were observed in the penicillamine group. Only 3 patients did not complain of any untoward effect during the 12-month period. We conclude that on the basis of this one year investigation it is an open question whether one should select auranofin or penicillamine for the treatment of clinical active rheumatoid arthritis.

One hundred patients with juvenile chronic arthritis (JCA) were studied with respect to granulocyte-specific and organ-nonspecific antinuclear antibodies (GS- and ON-ANA) in relation to clinical features of disease. Seventy-two were girls and 28 boys. Sixty-seven patients had IgG ANA, 31 IgM, 10 IgA, 6 IgD, 19 IgE and 35 had ANA, which fixed complement C3. Sixteen of 17 sera containing IgG GS-ANA were from girls. The prevalence of IgG GS-ANA increased with the number of joints affected. No patient with the acute febrile type of the disease had IgG GS-ANA or CS fixing ANA. The prevalence of IgG ON-ANA did not differ significantly in the mono-, pauci-, polyarticular and acute febrile types of JCA. Patients showing clinical activity more frequently had IgG and IgM ANA and C3 fixing ANA. The high titers of ANA were most often seen in girls. Chronic uveitis occurred in 10 of the patients and IgG ANA were present in sera from all of these.

SummaryEleven patients, median age 38 years, with spinal cord lesion (SCL) and urinary tract infection (UT 1) caused by multiply resistant bacteria entered an open clinical trial of peroral ciprofloxacin 250 mg b.i.d. for 6 days. P. aeruginosa was the most prevalent bacteria. Ciprofloxacin was clinically effective in all patients who had symptoms of UTI at entry. Bacterial eradication was achieved in 9 out of 11 patients immediately after treatment. At 4 weeks post-treatment 5 patients had relapse of bacteriuria with the initial micro-organism and only 2 had long term eradication. One patient had transient elevation of transaminases, but no other adverse reactions were noted. Pharmacokinetic analysis showed that ciprofloxacin was readily absorbed with a terminal half life of 2·5 hours and considerable non renal elimination. The urinary concentration of ciprofloxacin was high during the whole dosing interval. Oral treatment with ciprofloxacin is an alternative to pa renteral antibiotics in SCL-patients with urinary tract infection caused by resistant bacteria.

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Sixty-two patients, 48 children and 14 adults, with juvenile rheumatoid arthritis (JRA) and 62 age and sex matched controls were studied for anti-IgG antibodies of the classes IgG, IgM and IgA by an indirect immunofluorescence method. IgG anti-IgG occurred in 88% of 48 children less than or equal to 16 years and in 64% of 14 patients greater than 16 years with JRA against 2% of the controls. IgM anti-IgG occurred in 4% of the children, in 24% of the adults and in 2% of the controls. IgA anti-IgG occurred in 2% of the patients and in none of the controls. The prevalence of IgG anti-IgG was the same in pauciarticular, polyarticular and systemic cases, whereas the titres were higher in polyarticular than in pauciarticular cases, and higher in children with a disease duration of more than 5 years. Higher titres were related to higher ESR and lower hemoglobin values. The relationship of higher titres to clinically active disease was not statistically significant. No relationship was found to age, sex, age at onset, or to the duration of disease. The titres were not related to the concentrations of serum IgG or to the titres of antinuclear antibodies. IgG anti-IgG are common to all the clinical types of JRA, whereas antinuclear antibodies separate the systemic type from pauci- and polyarthritis. Their possible pathogenic significance must therefore be different.

The activities of five clinically important enzymes of purine metabolism have been determined in lymphocytes from 62 patients with various types of solid tumors. The activity of purine nucleoside phosphorylase was increased in all patient groups studied, i.e. small cell bronchogenic carcinoma (n=30), carcinoma of the breast (n=17) and other tumors (n=15), compared to cells form normal donors. Activities of adenosine deaminase, adenine phosphoribosyltransferase (APRT), hypoxanthine (guanine) phosphoribosyltransferase (HGPRT), and 5′‐nucleotidase (5′‐NUC) vary little from control values, except for lower levels of APRT in lymphocytes from patients with carcinoma of the breast. In patients with small cell bronchogenic carcinoma, enzyme levels were also determined in granulocytes, where increased APRT activity was found. Following cytostatic treatment of these patients, significant decreases were seen in lymphocytic HGPRT and 5′‐NUC activities.