Treatment of early seropositive rheumatoid arthritis: a two-year, double-blind comparison of minocycline and hydroxychloroquine.

OBJECTIVE: To compare the efficacy of minocycline with that of a conventional disease-modifying antirheumatic drug (DMARD), hydroxychloroquine, in patients with early seropositive rheumatoid arthritis (RA). METHODS: Sixty patients with seropositive RA of <1 year's duration who had not been previously treated with DMARDs were randomized to receive minocycline, 100 mg twice per day, or hydroxychloroquine, 200 mg twice per day, in a 2-year, double-blind protocol. All patients also received low-dose prednisone. The primary end points of the study were 1) the percentage of patients with an American College of Rheumatology (ACR) 50% improvement (ACR50) response at 2 years, and 2) the dosage of prednisone at 2 years. RESULTS: Minocycline-treated patients were more likely to achieve an ACR50 response at 2 years compared with hydroxychloroquine-treated patients (60% compared with 33%, respectively; P = 0.04). Minocycline-treated patients were also receiving less prednisone at 2 years compared with the hydroxychloroquine group (mean 0.81 mg/day compared with 3.21 mg/day, respectively; P < 0.01). In addition, patients treated with minocycline were more likely to have been completely tapered off prednisone (P = 0.03). Trends favoring the minocycline treatment group were seen when outcomes were assessed according to components of the ACR core criteria set, with the differences reaching statistical significance for patient's global assessment of disease activity (P = 0.004). CONCLUSION: Minocycline is an effective DMARD in patients with early seropositive RA. Patients treated with minocycline were more likely to achieve an ACR50 response and did so while receiving less prednisone. In addition, minocycline-treated patients were more likely to have discontinued treatment with prednisone at 2 years.

Intra-articular milk of calcium in saturnine gout.

Radiographs of two patients with saturnine gout (lead gout) demonstrated radio-opaque material which resembled milk of calcium within several joints. A histochemical examination of knee aspirate of one of the patients revealed a combination of monosodium urate and calcium pyrophosphate dihydrate. Subsequently, the authors suspected that the findings of intra-articular milk of calcium were due to the coexistence of saturnine gout and calcium pyrophosphate dihydrate deposition disease rather than intra-articular calcified tophus.

Sural nerve biopsy in systemic necrotizing vasculitis.

This study of 17 patients with vasculitic neuropathy (polyarteritis nodosa in 11, rheumatoid arthritis in five, and systemic lupus erythematosus in one) revealed the following: (1) Polyneuropathy is the most common manifestation of peripheral neuropathy in polyarteritis nodosa. (2) Peripheral neuropathy is more common in systemic necrotizing vasculitis than physical evaluation alone suggests. Adequate electrophysiologic tests can detect asymptomatic peripheral neuropathy in a substantial number of patients. (3) Abnormal sural nerve condition is a prerequisite to the demonstration of vasculitis on biopsy of this nerve. Thus, in using abnormal sural nerve conduction as a guide in nerve biopsy, the diagnostic yield of sural nerve biopsy will be greatly enhanced.