An elemental diet for 2 weeks resulted in a clinical improvement in patients with active rheumatoid arthritis, and was as effective as a course of oral prednisolone 15 mg daily in improving subjective clinical parameters. This study supports the concept that rheumatoid arthritis may be a reaction to a food antigen(s) and that the disease process starts within the intestine.

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The most appropriate assessment of phenytoin in RA may be by its long term effects on bone assessed radiographically and to our knowledge this has not been examined. Although 'phenytoin is unlikely to become a first choice second line agent',' it should not now be dismissed.

In a disease such as rheumatoid arthritis, a new treatment must be submitted to a formal clinical trial involving placebo and drugs known to be effective, or else the results obtained may be misleading.