SUMMARY Pulmonary hypertension in systemic lupus erythematosus (SLE) in the absence of chronic parenchymal lung disease or pulmonary emboli is rare. We report such a case with an acute and rapidly progressive onset of symptoms in a patient who had started taking the contraceptive pill eight months previously.A 22-year-old woman presented with a three-week history of increasing dyspnoea, pleuritic pain, and a skin rash. Three years previously she had an isolated episode of acute arthritis affecting some of the small joints of the hands and feet, which terminated spontaneously after one week. She remained well and had a normal first pregnancy, after which she started taking the contraceptive pill Eugynon 30 (ethinyloestradiol 30 gg, levonorgestrel 250 Rg) for the first time.Nine months later she was admitted to hospital looking extremely ill, dyspnoeic, centrally cyanosed, pyrexic, and she had a widespread vasculitic rash. Marked right ventricular hypertrophy and failure were evident, and on auscultation there was a loud pericardial rub.Haematological investigations showed: Hb 13-6

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The pharmacokinetic disposition of sulfasalazine and its metabolites was studied in 8 young and 12 elderly patients with active rheumatoid arthritis. Equal numbers of slow and fast acetylators were included in each age group. Patients received enteric-coated sulfasalazine 2g daily for 21 days; specimens of serum and urine were collected for 96 h after administration on days 1 and 21. The elimination half-life of sulfasalazine was greater in the elderly patients. Many disposition parameters of sulfapyridine differed in slow and fast acetylators; of greatest significance were the increased values of steady-state serum concentration in the slow acetylators. There was no effect of age on any sulfapyridine disposition parameters. Values for the steady-state serum concentrations of N-acetyl-5-acetylsalicylic acid were greater in elderly than in young patients. The metabolism of sulfapyridine was markedly affected by acetylator phenotype and this was reflected in the composition of sulfapyridine-related material in the urine. Thus, age is a determinant of the steady-state concentrations of salicylate moieties but acetylator phenotype plays a greater role in determining the serum concentration of sulfapyridine, which has greater therapeutic implications in rheumatology.

SUMMARY A 34 year old man is described with systemic lupus erythematosus and recurrent massive pleural effusions. Systemic treatment with corticosteroids and azathioprine controlled all other manifestations of the disease apart from the pleural effusions. These were finally, successfully treated by pleurectomy.

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