Rheumatoid arthritis continues to be a cause of significant morbidity and disability. Increased understanding of the immunopathogenesis of the disease, of its progression over time, and of patient characteristics which correlate with outcome, have allowed more appropriate therapy. However, currently available disease-modifying therapy fails to adequately control disease in many patients, and many combinations of these drugs have therefore been described. In this review, we critically evaluate the existing literature, identifying combinations for which reasonable evidence of efficacy exists, and highlighting important issues in interpreting such evidence as well as issues of drug monitoring in such patients.

Antirheumatic Agents↗

PubMedDate not supplied

Personality and keratoconus.

We studied personality traits of patients with keratoconus in a controlled prospective study using the Minnesota Multiphasic Personality Inventory (MMPI). Whereas four of 16 (25%) control patients with herpes simplex keratitis had scores indicative of psychological abnormality, 15 of 28 (54%) keratoconus patients had scores indicative of abnormality (P less than .05). Keratoconus patients who had undergone penetrating keratoplasty had a lower rate of abnormal scores (3 of 9; 33%) than unoperated keratoconus patients (12 of 19; 63%) (P less than .05). Patients who considered themselves moderate or severely limited by their eye condition were more likely to have abnormal scores (7 of 8; 87%) than patients who thought they were mildly affected (8 of 20; 40%) (P less than .05).

Adolescent↗

PubMedDate not supplied

Plasma exchange in rheumatoid vasculitis.

Plasma exchange (PE) was used to treat 9 patients with rheumatoid vasculitis. The immediate development of new lesions was arrested in 7 patients. Two patients continued to develop new lesions. One responded to additional cyclophosphamide plus methyl prednisolone but the other died within days from severe systemic vasculitis. Prolonged PE alone, or PE followed by cyclophosphamide plus methyl prednisolone was associated with healing of existing lesions without relapse. Short term PE, alone or followed by azathioprine, failed to heal existing lesions and relapses occurred within 3 months. IgG rheumatoid factor and anticomplementary activity fell with PE and correlated best with clinical response.

Adult↗