Fifty-seven patients took part in a controlled double-blind trial between tiopronin and D-penicillamine as basic treatment for rheumatoid arthritis. Thirty-nine (19 receiving tiopronin, 20 receiving D-penicillamine) completed the trial after 1 year. Both drugs resulted in a decrease of the erythrocyte sedimentation rate, Ritchie index, and Lee index and in a sparing effect on symptomatic antiinflammatory therapy. Improvement in these variables was statistically highly significant at any interval with tiopronin, but was sometimes less or not at all significant with D-penicillamine. Nevertheless, the difference in effects between the 2 drugs never reached statistical significance. Six patients receiving tiopronin and 6 receiving D-penicillamine were taken out of the experiment because of side effects.

In this study we tried to value the frequency and the characteristics of the physiological abnormalities affecting the lungs in Sjögren’s syndrome (SS). We studied 18 female nonsmokers (average age 53 years). The diagnosis has been made on the presence of at least two of the following abnormalities: keratoconjunctivitis sicca (Schirm-er’s test), xerostomia (scanning of the salivary glands, lip biopsy) and collagen vascular disease. We made the following tests: clinical examination, chest roentgenogram, spirometry, TGV, RAW and SGAW valuation, study of the flow-volume curves, diffusion capacity test, bronchoalveolar lavage, bronchial biopsy. The physiological results have demonstrated the presence of a restrictive syndrome affecting above all the small airways (MEF25 -32.7%) and a decrease of the diffusion capacity (DLCO -25%). There is, moreover, a constant lymphocitic infiltration of the bronchial mucosa and of the lung’s interstitium. In conclusion the pulmonary involvement in SS seems to be constant, unpredictable and of remarkable clinical-physiological importance

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Some parameters (serum antioxidant activity, -SH groups, ceruloplasmin, copper) involved in the mechanisms of defence against oxygen free radicals were investigated in 25 rheumatoid patients and in 15 control subjects, matched for sex and age. When comparing the results obtained in the two groups, there is in rheumatoid arthritis a marked increase in the serum-specific antioxidant activity, related to ceruloplasmin, ESR, haemoglobin and Ritchie's index and a net decrease in the -SH groups inversely related to Ritchie's index and to ceruloplasmin. On analysing the sensitivity of the various parameters in discriminating between rheumatoid and healthy subjects, it is found that the -SH groups are the most sensitive, followed by the specific antioxidant activity, copper content, and ceruloplasmin. The evaluation of the same parameters in a group of 14 rheumatoid patients before and after 6 months of therapy with an antioxidant drug, viz. Tiopronin, confirms their usefulness in providing information regarding response to the treatment and on the recovery from the disease.

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