Forty‐two patients with definite or classic rheumatoid arthritis entered a prospective 24‐week, double‐blind, parallel clinical trial, followed by an 18‐month open phase. All subjects had active synovitis that was unresponsive to nonsteroidal antiinflammatory medications and conventional slow‐acting antirheumatic drugs. Initial treatment with azathioprine (AZA), 100 mg/day, or methotrexate (MTX), 10 mg/week, orally, was adjusted at predefined intervals. Both treatment groups showed statistically significant improvement at week 24, compared with baseline status, in all 9 clinical outcome variables. There were no apparent statistically significant differences in these outcome variables between the 2 treatment groups. There was a trend toward a more marked and rapid improvement in the MTX‐treated group. Radiologic evidence of progression of joint damage was similar in both treatment groups at 24 and 52 weeks. Four of the 42 patients (2 receiving MTX and 2 receiving AZA) discontinued the study because of side effects, and 1 MTX‐treated patient withdrew because of personal reasons. Outcome measures at week 52 (open phase) were not statistically different from those at week 24. Twenty‐three patients were still taking the medication at week 104. We found that AZA and MTX were similarly effective in the treatment of rheumatoid arthritis, and that this beneficial effect was maintained for up to 2 years in most patients.

A patient with rheumatoid arthritis developed pulmonary symptoms and function test abnormalities consistent with asthma during methotrexate therapy. Assessments of airway responsiveness to methacholine during therapy revealed airway hyperreactivity that reverted to normal when the methotrexate was stopped. An extension of the methotrexate dosage interval from 7 to 10 days resulted in an abolition of the asthma, which remained in remission despite a return to a weekly cycle after a 3-month period of 10-day cycles.

An association between systemic lupus erythematosus (SLE) and common variable panhypogammaglobulinemia (CVP) has recently been reported (1,2). It is of particular interest that the 2 disorders represent the extremes of B cell dysfunction-SLE characterized by B cell hyperactivity, and CVP by B cell hypoactivity. The results of investigations of the 3 previous cases of SLE and CVP revealed the presence of circulating B cells exhibiting decreased responses to mitogens in all instances (1 ,2) and to vaccination in I case studied for this (2), as well as excessive T cell suppression and subnormal T cell help in the 2 cases studied in vitro (I). We report the fourth case: a patient with an association of SLE and CVP in whom an absence of circulating B cells was the most significant lymphocyte abnormality seen.Case report. A 61-year-old woman had polyarthralgias and dry eyes since the age of 33. She had had 7 pregnancies-6 ending in spontaneous abortions and 1 in a live birth.