Randomized, placebo controlled trial of withdrawal of slow-acting antirheumatic drugs and of observer bias in rheumatoid arthritis.

Patients with rheumatoid arthritis, in stable treatment with methotrexate, penicillamine, or sulfasalazine, were randomized in a double-blind fashion either to continuation of their usual treatment or to placebo. 112 patients were included; 52 patients who refused participation had no more severe disease than the others. The patients felt worse on placebo than on active drug (p = 0.002). The mean differences in number of tender, painful and swollen joints after one month were 2.4 (p = 0.08), 3.0 (p = 0.12) and 2.2 (p = 0.03), respectively. Treatment failure occurred for 42 patients of whom 33 received placebo (p = 0.000,001). There was no difference in the severity of side effects (p = 0.91). The patients guessed their treatment correctly more often than expected (p = 0.02) because of the perceived effect. None of the two observers guessed better than chance, and there were no differences between the observers' evaluations of the joints. The effect of slow-acting antirheumatic drugs was unequivocal and no observer bias occurred.

[Radiological anomalies in the Noonan syndrome (author's transl)]. / Manifestations radiologiques du syndrome de Noonan.

In the Noonan syndrome various anomalies can be demonstrated radiologically. Of particular interest are cardiovascular lesions, such as atypical pulmonary stenosis, hypertrophic cardiomyopathy and the lymphangiectasias. Skeletal anomalies can be found, including retardation of bone maturation and sternal abnormalities. Other anomalies concern the urinary tract (pyeloureteral stenosis) and the digestive system. Radiological diagnostic procedures allow to disclose various elements of this polymalformative syndrome. They should be performed whenever suggestive clinical signs are present, e.g. hypertelorism, gonadal dysgenesis, down-slanting palpebral fissures and shield-like chest.