Twelve patients with vertebral fracture osteoporosis were recruited into a trial of treatment with hPTH 1-34 by daily injection for 1 year combined (from the 5th month) with an anti-resorptive agent (oestrogen, n = 9; nandrolone, n = 3). Treatment outcomes were monitored by biochemical and radiotracer measurements together with histomorphometry of transiliac biopsies before and at the end of treatment following double in vivo pre-labelling with demethylchlortetracycline. Indices of whole body bone formation, obtained from the analysis of 85Sr data, showed substantial increases (P less than 0.005) for all three indices measured) while biochemical (hydroxyproline) and kinetic measurements of bone resorption showed modest and equivocal changes only. As a result calcium balance improved. Gastrointestinal calcium absorption showed a tendency to improve, while urine calcium decreased; but these changes were statistically not significant except for radiocalcium absorption in the oestrogen treated subgroup. Histomorphometry revealed substantial increases in cancellous bone volume as reported previously with hPTH 1-34 given alone. However, iliac (as distinct from whole body) indices related to bone formation and resorption appeared to have returned towards pre-treatment values by the time of the second biopsy under the influence of the anti-resorptive agent given with the hPTH 1-34. It is confirmed that hPTH 1-34 therapy can increase iliac cancellous bone mass (as well as spinal cancellous bone mass as reported earlier) without a long-term increment in whole body bone resorption, providing the hPTH is combined with an anti-resorptive agent.
Objective. To investigate possible mechanisms of growth impairment in children with juvenile rheumatoid arthritis (JRA).
Methods.Eighteen prepubertal children with JRA and growth retardation received recombinant human growth hormone (rHuGH) for 1 year. Growth hormone profiles over 24 hours were obtained before treatment in 12 patients; the levels did not differ from those in "short normal" children. Levels of insulin-like growth factor 1 (IGF-1), IGF binding proteins (IGFBPs) 1 and 3, insulin, osteocalcin, and C-reactive protein (CRF'), as well as the erythrocyte sedimentation rate were measured serially. Pretreatment levels were compared with control levels.Results. In JRA patients, IGF-1, IGFBP-3, and osteocalcin levels were significantly lower and insulin levels significantly higher than those in controls, but there was no significant difference in the level of IGFBP-1. With rHuGH treatment, height velocity and mean levels of IGF-1, osteocalcin, and insulin increased
SUMMARY Infection of a prosthetic knee joint with Peptostreptococcus magnus in an immunosuppressed patient with rheumatoid arthritis is described. The organism is a skin commensal, generally thought to be of low pathogenicity; the difficulty in making the diagnosis is emphasised.Key words: rheumatoid arthritis, pyrexia of unknown origin, immunosuppression.Case report A 54 year old man with erosive seropositive rheumatoid arthritis, unresponsive to gold, penicillamine, sulphasalazine and a course of intensive immunosuppression,1 underwent bilateral total knee replacement (TKR) under antibiotic cover, 10 years from onset. A right Stanmore TKR was performed in February 1985; the only complication was a small wound haematoma with sterile serosanguinous discharge, treated with flucloxacillin for 10 days. A kinematic TKR was inserted in the left knee the following June.Two months later, while taking 150 mg azathioprine and 7-5 mg of prednisolone daily, he developed fatigue and rigors. He was pyrexial; lymphadenopathy and splenomegaly, previously noted before intensive immunosuppression, persisted; and an ejection systolic murmur was heard. The knee joints were not painful and there were no clinical signs of septic arthritis. Eight sets of blood cultures were negative. An x ray of the prostheses was unremarkable; a bone scan showed increased activity in relation to the femoral component of the right TKR (Fig. 1), but this was difficult to interpret only nine months postoperatively. Lymph node and liver biopsy were performed: histology of each was
Acyclovir is a potent antiviral drug, of proven efficacy in the treatment of herpes simplex virus infection. Since this virus has been implicated in the aetiology of Behçet's syndrome, the effect of acyclovir on orogenital ulceration in this condition was determined in a randomized, double-blind, placebo-controlled, crossover trial. Eighteen of 22 patients entering the study completed the trial. Treatment with acyclovir failed to alleviate the frequency and severity of orogenital ulceration or other disease features.
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