Azathioprine in Rheumatoid Arthritis

Abstract

Reversal of Muscle Relaxants-Hannington-Kifjf MEDICAL JOURNAL to avoid increased secretion, which could be a serious handicap postoperatively. A study is necessary to establish whether there is an optimum interval by which atropine should precede neostigmine. It is suggested that such a study could well include assessment of the dose ratio of atropine to neostigmine, which appears to have become established largely on the basis of ampoule strength; for instance, the following average doses are commonly used: atropine 0-6 mg. (1 ampoule) to 2-5 mg. neostigmine (1 ampoule); atropine 12 mg. (2 ampoules) to 2 5 mg. neostigmine (1 ampoule); and atropine 1-2 mg. (2 ampoules) to 5 mg. neostigmine (2 ampoules).Any dose of atropine sufficient to inhibit peristaltic movements of the bowel is more than enough completely to have blocked secretion by the salivary glands (Innes and Nickerson, 1965), and the appearance of some secretion in all cases here, after the administration of neostigmine, suggests that the bowel was at liberty to react to the neostigmine in every case, but perhaps particularly so when atropine and neostigmine were given mixed. The integrity of an anastomosis of the bowel could well be endangered by vigorous peristalsis in the early postoperative period, and Bell and Lewis (1968) have drawn attention to the higher incidence of leaks from ileorectal anastomoses in patients who had been given neostigmine than in those who had not; furthermore, the neostigmine in every case had been given mixed with atropine.I ain grateful to Miss E. H. L. Duncan, senior lecturer in medical statistics, University of Bristol, for the use of a computer programme to calculate the regression lines in Fig. 2.

Failure of cytotoxic drugs to suppress immune responses of patients with rheumatoid arthritis.

“…It has been argued that their immunosuppressive properties justify the use of these drugs in the treatment of putative autoimmune diseases in man. As a result they have been used to treat chronic inflammatory diseases including rheumatoid arthritis (Mason, Currey, Barnes, Dunne, Hazleman, and Strickland, 1969). It is pertinent to ask, however, whether cytotoxic drugs do indeed suppress the immune response of patients with rheumatoid arthritis and to determine whether any such immunosuppression can be correlated with clinical improvement.…”

Azathioprine in rheumatoid arthritis: double-blind study of full versus half doses versus placebo.

“…The risk has not been shown to be clearly related to dose,3 but it nevertheless seems sensible to limit the dosage level to that which will achieve a satisfactory therapeutic effect. Early studies in rheumatoid arthritis4 used a dose of [2][3][4][5] mg/kg/day, based on the successful use of this drug in renal transplantation. Subsequent attempts to test the effectiveness of low doses have not given clear results.5-8 We have therefore tested the drug at 2 doses-2 5 and 1-25 mg/kg/day-against placebo the past 3 months.…”

New approaches to the treatment of rheumatoid arthritis

“…Methotrexate (MTX) is also mentioned as a third line approach to RA. The immunosuppressive drugs, azathioprine and cyclophosphamide, are suggested as a fourth line of approach for cases resistant to all other therapeutic regimes [7,17]. Finally, there is a fifth level consisting of experimental treatment regimens.…”