The specific antibody production in patients with rheumatoid arthritis in response to three antigen-heep cell stroma, Brucellin and Limulus polyphemus hemocyanin-was examined. Several antigens were used in expectation that an abnormality in antibody production might be selective and not uniform for all , antigens. Patients with rheumatoid arthritis were deficient in their IgM response to sheep cell stroma and Brucellin, especially the latter. This deficiency was limited to the primary response and to secondary responses characterized by only slight increases in antibody levels. More intensive stimulation resulted in equal production of IgM antibody in both groups. Antigenic competition may explain the deficiency in IgM antibody production. Levels of rheumatoid factor increased after repeated stimulation paralleling, in general, the specific antibody responses.The presence of rheumatoid factor (RF), an IgM antibody reacting with autologous and heterologous IgG (1,2) , and the frequent increase in the concentrations of immunoglobulins in patients with rheuFrom the Mayo Clinic and Mayo Foundation, Rochester, Minn and

Transient osteoporosis of the hip is a syndrome that does not seem to be widely known; this is also true for its radiological appearance. It is often mistaken for avascular necrosis of the femoral head, metastatic or inflammatory disease. These differential diagnoses lead to more or less invasive procedures, although transient osteoporosis does not require more than immobilisation for complete remission. MRI was done in 38 patients with acute hip pain, 13 had femoral head necrosis and 8 transient osteoporosis. Follow-up studies via MRI in patients with transient osteoporosis revealed 3 stages (diffuse, focal, residual) during the clinical course of which stage II is similar to femoral head necrosis but always without the typical sclerotic rim.

The results of longterm therapy with the oral gold preparation auranofin in patients with rheumatoid arthritis (RA) were evaluated based on the following data: 1) Two multicenter open uncontrolled studies (MTC06) and (162EMUA-RA), 2) the reevaluation of these data for the MTC06 study after 4 years from the beginning of the study and 3) the results of a postmarketing surveillance program (PMSP) of patients on auranofin therapy. The specific rheumatologic documentation and information system (IKR inhaltkodierte rheumatologic) serves as the basis of the follow-up studies and longterm observations. The first year data on 207 patients (MTC06) indicating that duration of the disease less than 2 years was the only discriminating factor regarding a positive treatment outcome were confirmed by the two-year (151 patients). Patients, who responded favourably to Auranofin did usually well for the four-year or longer observation period. The data base of these two studies and the PMSP failed to outline any new severe or threatening side effects. Diarrhea and loose stools were more common at the beginning of the treatment. The overall withdrawal for untoward events was 11.2%. Patients who did or did not respond to previous DIMARD therapy either on i.m. gold, D-Penicillamine or Chloroquine, did usually well when treated with Auranofin, even if severe side effects leading to withdrawal had occurred on previous therapy. The favourable safety profile was confirmed by the PMSP data.

Quantitative sacroiliac (SI) scintigraphy was performed 3 h after an i.v. injection of 16 mCi 99mTc-EHDP. The resulting images were recorded and processed and on an ON data system 150. Five technical approaches for objective digital assessment of abnormal uptake of the tracer at the sacroiliac joints were employed. SI indexes from the ratio of radioactivity in the SI joints and in the os sacrum, determined either by a region-of-interest technique or by a profile-scan technique measuring the maxima of the curve over a defined base line, proved to be the best parameters in discriminating normal from abnormal uptake of the radiotracer in the SI joints. The quantitative scan technique appears to be useful as an objective tool in interpreting SI scans.

The bursa suprapatellaris, infrapatellaris, the patella tendon, condylar cartilage, menisci and fossa poplitea were examined sonographically in 56 healthy persons in defined sections. References for normal findings are given. The examination of 22 patients with rheumatoid arthritis revealed joint effusions, Baker cysts, synovial hypertrophy, intraarticular septae and changes in the echogenicity of the synovial fluid.