In rheumatoid synovium interleukin 6 (IL-6) is the most abundantly expressed cytokine. Increased serum levels have been previously reported in patients with rheumatoid arthritis (RA). In this study serum IL-6 levels were measured in a weli defined cohort using a bioassay (B9 celis) and levels were correlated with conventional clinical and laboratory indices of disease activity.Levels were significantly higher in serum from patients with RA (median 55 IU/ml; interquartile range 28-139) compared with serum from disease (median 7 IU/ml; 1-23) and normal controls (median 10 IU/ml; 7-12). No difference was observed between men and women. Levels did not correlate with disease duration. Significant associations were observed between IL-6 and C reactive protein and between the Ritchie articular index and duration of morning stiffness. No other correlations were observed. The value of these findings in the monitoring ofRA and as an indicator of response to second line treatment needs to be established.

Analysis of thiopurine methyltransferase genotype is a quick way to identify patients at risk for acute toxicity from azathioprine.

Objective-To determine the eVect of intramuscular gold and oral hydroxychloroquine(HCQ) on the lipid profile of patients with rheumatoid arthritis (RA). Method-A prospective randomised clinical trial of 12 months' duration was performed in 100 RA patients. Data on clinical and laboratory parameters of disease activity, and fasting serum lipid samples was collected at baseline and at three monthly intervals over one year. Results-The expected second line response was seen with no significant diVerence in eYcacy between the groups at 12 months. The HCQ group had a significant overall improvement in their lipid profile while there was a trend for lipid profiles in the gold group to worsen. Conclusions-HCQ is an eVective second line agent that has beneficial eVects on serum lipids. This should be taken into account when choosing a disease modifying anti-rheumatic drug in patients who suVer from RA and who have significant cardiovascular risk factors.

One in four patients attending our rheumatology clinic had searched the Internet for medical information in the last 12 months. Almost one-third found it easier than asking their health-care professional. Further studies are required to explore the wider application of this resource and to determine the validity and reliability of the information obtained.