Clinical and laboratory measurements taken at the onset of rheumatoid arthritis in 149 patients were compared with the severity of radiological changes seen at 3 years in the hands and feet, and cervical spine. The strongest association with the severity of peripheral radiological damage was rheumatoid factor (p less than 0.0001 for both the latex titre and RAHA titre). Subluxation of the cervical spine was associated only with the presence of HLA-Dw2 (p less than 0.02) and HLA-B7 cross-reacting group (p less than 0.02). Discriminant function analysis utilizing latex titre, RAHA titre, haemoglobin level, and platelet count predicted the development of erosive or nonerosive disease in 79%. This method was less successful in predicting the actual severity of erosive damage and was not improved by the addition of HLA data. Radiological outcome in the cervical spine was successfully predicted in 82% using HLA-Dw2, HLA-B27 and age of onset of disease. It is concluded that the best predictors of erosive disease were standard laboratory features measured at onset, but that more powerful discriminant factors are needed if these are to influence clinical practice. Further prospective studies will establish whether rheumatoid involvement of the cervical spine is an expression of the influence of HLA determinants in this disease.

It has been previously demonstrated that RYGB surgery is associated with an increased incidence of fractures, and with reduction in bone mineral density. Patients undergoing bariatric surgery are frequently vitamin D deficient pre-operatively and show variable responses to vitamin D supplementation in the post-operative period. With particular reference to the RYGB procedure, there is evidence from several studies that bone mineral density is reduced at 12 and 24 post-operative months. To the best of our knowledge, this case may be the first time that multiple vertebral fractures have been documented so soon after weight loss surgery. It therefore highlights the growing conclusion that early consideration must be given to the maintenance of bone health in patients undergoing weight loss surgery.

Duodenal biopsies from control subjects, patients with iron-deficiency anaemia and rheumatoid arthritic patients with anaemia of chronic disorders (ACD) were investigated for their ability to take up 59Fe from iron ascorbate. Additionally, duodenal tissues were analysed for iron and immunoreactive ferritin and transferrin. Biopsies from iron-deficient subjects showed a 2- to 3-fold increase in the apparent Vmax for 59Fe uptake, compared to control values. Uptake was inversely related to body iron stores. ACD patients showed similar rates of 59Fe uptake to controls; the rates were independent of the degree of anaemia or serum ferritin levels. Tissue analysis showed reductions in mucosal iron and ferritin levels in iron-deficient patients, whilst transferrin levels were within the normal range. ACD patients also exhibited lower mucosal iron levels, but had iron protein levels within the normal range. It is suggested that factors distant from the intestinal mucosa influence iron absorption in ACD.

Summary A 42–year‐old woman with long‐standing psoriasis developed arthralgias and stiffness after 1 year of etretinate therapy. There was no clinical or radiological evidence of psoriatic arthropathy, but X‐rays demonstrated hyperostosis of the thoraco‐lumbar spine. Her symptoms resolved on discontinuing etretinate therapy.

IgG contains two major glycosylation sites in the CH2 domains at which complex biantennary oligosaccharides are attached at asparagine residues. A current interest is based on the finding that, compared to normal individuals. RA patients have increased levels of IgG oligosaccharide side chains lacking galactose and terminating in Nacetylglucosamine [ 11. Not only is the agalactosylation of IgG detectable prior to the onset of RA. 121 but the effect is also associated with a highly progressive disease course 131. Consequently. I@ agalactosylation shows potential for use in the RA field.Currently these changes in IgG glycosylation are detected by chemical means or by using lectin-binding assays 141 whilst identification of oligosaccharides attached to a glycoprotein involves their release from the protein by chemical or enzymatic means followed by radioactive or fluorescent labelling and separation by gel filtration or HPLC [ I . 51. The availablity of the enzyme PNGase and the introduction of FACE 161 provide alternative means of releasing N-linked oligosaccharides and the separation of their fluorescent labelled derivatives by polyacrylamide gel electrophoresis.We have investigated the use of PNGase and FACE in a preliminary study of IgG oligosaccharides in rheumatoid arthritis.IgG was prepared from the sera of seven definite RA patients and five healthy normal individuals using the combined G251DEAE-C column procedure of Sumar et al. 131. Pooled human and bovine IgG preparations and other glycoproteins (ovalbumin. fetuin) were also used. 1-5 mg of glycoprotein were digested at pH 2 for 48 h. followed by treatment with PNGase at pH 5 for I6 h according to Takahashi et al. 141. The digests were then desalted on G25 columns and after concentration by freeze-drying the oligosaccharides present were labelled at their reducing ends using either ANTS or AMAC in the presence of NaCNBH3 according to Jackson 161. ANTS and AMAClabelled products were separated by non-SDS Laemmli polyacrylamide gel electrophoresis; AMAC-labelled products were also subjected to polyacrylamide gel electrophoresis in the presence of Tris/borate buffer 161. Gels were viewed and photographed under LJV light. Oligosaccharide s e e standards were prepared by ANTS and AMAC labelling of amylase digests of wheat starch.Initial experiments using the FACE technique showed that pooled human and bovine IgCs gave five/six ANTSlabelled oligosaccharide components in the range 7-10 CUE. The major components were of 7. 9 and 10 CUE and were of approximately equal intensity of fluorescence. These patterns differed significantly from those given by fetuin and ovalbumin. Control experiments showed that the IgG pattern was dependent on the presence of the immunoglobulin and the action of both enzymes. whilst fluorescent components of GLJE less than 5 were not derived from the glycoprotein. Similar experiments using AMAC labelling showed a range of fluorescent components in both the presence and absence of borate in the electrophoresis buffer. Of these, only a larg...