Objective. Osteoporosis is a frequent complication of rheumatoid arthritis (RA). We therefore investigated the effect of oral pamidronate therapy as a specific bone‐sparing agent in RA. Methods. The study design was a 3‐year randomized, double‐blind trial of 300 mg oral pamidronate/day compared with placebo in 105 RA patients. Bone mineral density (BMD) measured at 12‐month intervals was the primary efficacy parameter. Results. In 3 years, lumbar spine and forearm BMD increased significantly in the pamidronate‐treated group (by 8.4 ± 6.9% [mean ± SEM] [P < 0.0001] and 5.2 ± 6.5% [P < 0.005], respectively), compared with nonsignificant changes in the placebo‐treated patients (increase of 0.6 ± 5.2% and decrease of 1.2 ± 5.8%, respectively). Femoral neck BMD increased in the pamidronate‐treated group (by 2.6 ± 8.6%) and decreased significantly in the placebo‐treated group (by 4.0 ± 1.3% [P < 0.005]). The changes in BMD with time at all 3 measurement sites were significantly different between the treatment groups (P < 0.0001). Changes in radiographic signs of joint damage and in disease activity were similar in the 2 groups. Conclusion. The present study provides the first evidence that long‐term treatment with an orally administered bisphosphonate overcomes bone loss and increases bone mass when compared with placebo. This finding may have significance with regard to the treatment of patients with RA.

No abstract

(Westergren). A full blood count and biochemical profile were normal. The Waaler-Rose and latex fixation tests were negative. A chest radiograph was normal. Radiographs of hands and feet showed minimal degenerative changes. The patient was considered to have early rheumatoid arthritis and was treated with rest, physiotherapy, and non-steroidal antirheumatic drugs.Eleven months after the onset of his joint symptoms the patient noted a swelling of the neck. A diagnostic work up, including a laryngoscopy, showed a supraglottic tumour. A laryngectomy was performed and at pathological examination the tumour was classified as a T2 N3 MO squamous cell carcinoma. Postoperative regional radiotherapy was given to a total dose of 60 Gy. Within a month all signs and symptoms of arthritis had disappeared.Eight years later, in February 1990, he returned to the department with a nine month history of joint complaints. He had experienced pain in his hands, wrists, elbows, shoulders, and knees, an early morning stiffness of half an hour, but no history of general malaise, fever, or weight loss. General physical examination showed no abnormalities. Examination of the joints showed a synovitis of the left elbow, both wrists, several metacarpophalangeal and proximal interphalangeal joints of both hands, and several metatarsophalangeal joints of the left foot. Laboratory tests showed an erythrocyte sedimentation rate of 53 mm in the first hour. A full blood count and biochemical profile were normal. Waaler-Rose and latex fixation tests were negative. Radiographs of chest, hands, and feet were unchanged. Repeated fibre endoscopies of the upper respiratory tract showed no signs of tumour recurrence. In June 1990, however, 13 months after the recurrence of the joint symptoms, a new swelling was discovered in the operation area. An excisional biopsy showed a squamous cell carcinoma, similar to the former tumour. Radical surgery, including dissection of the oesophagus, was performed. Two weeks after the operation all signs and symptoms of arthritis had again disappeared. DiscussionCancer of the larynx represents about 1-2% of the total cancer risk and is 10 times more common in men than in women." The peak incidence is between 40 and 70 years of age.'2

Biochemical parameters of bone metabolism were investigated in 105 ambulant, non-steroid treated patients with RA and compared with parameters of disease activity. Urinary calcium (Ca) and hydroxyproline (OHP) excretions, as parameters of bone resorption and serum alkaline phosphatase (AP), as a parameter of bone formation, were positively related to parameters of disease activity. Serum osteocalcin, another parameter of bone formation, was not related to parameters of disease activity. Patients with active disease (ESR > or = 28 mm and Ritchie articular index > or = 8) had a significant higher urinary Ca and OHP excretion (62 and 42% higher, respectively) than patients with inactive disease. Serum AP and OC were slightly higher (19 and 16%, respectively) in patients with active disease. These results suggest that in RA patients bone metabolism is related to disease activity. In active disease bone resorption seems to be increased more than bone formation, suggesting that prolonged disease activity may contribute to generalized and/or localized osteopenia.

In a cross-sectional study of 124 patients with definite or classical rheumatoid arthritis (RA) and negative agglutination assays, rheumatoid factor (RF) isotypes were measured using an ELISA technique. Elevated levels of IgA-RF were found in 55 patients (44%), IgG-RF in 99 (80%), and IgM-RF in 20 (16%). The levels of IgA- and IgM-RF correlated with each other (P less than 0.001). Elevated levels of IgM-RF were associated with a more severe disease course. Elevated levels of IgA-RF correlated with the occurrence of bone erosions. The results of this study suggest that in patients with RA and negative agglutination assays, both IgM- and IgA-RF are markers of disease severity.