Bolus intramuscular methylprednisolone acetate as a therapeutic adjunct in rheumatoid arthritis.

Eighty adult patients with classical or definite rheumatoid arthritis were given 200 bolus injections of intramuscular methylprednisolone acetate (MPA) over four years. This was used strictly as a therapeutic adjunct for polyarticular flares (greater than or equal to 5 swollen joints), not as a singular form of long-term treatment. Good clinical responses, lasting an average of eight weeks, were obtained in the vast majority of patients. Severe toxicity was minimal. Postbolus responses to intravenous ACTH stimulation were measured in 12 patients. We believe that intramuscular bolus injections, used cautiously in carefully selected patients with rheumatoid arthritis, are relatively useful, convenient, inexpensive, and safe.

Vertebral sarcoidosis: demonstration of bone involvement by computerized axial tomography.

We have reported a rare case of vertebral sarcoidosis, clinically manifested by myalgia and bone pain, and therapeutically responsive to glucocorticoid therapy. Although technetium polyphosphate bone scanning revealed diffuse uptake in the spinal column, conventional x-ray films were normal. Computerized axial tomography (CAT) of the lumbar spine revealed characteristic sclerotic-rimmed bone cysts at multiple levels. We believe this to be the first reported case of osseous sarcoidosis demonstrated by CAT scan in the face of normal conventional bone roentgenograms.

Monthly intravenous cyclophosphamide in the treatment of severe systemic lupus erythematosus.

An uncontrolled series of 10 patients with severe systemic lupus erythematosus (SLE), resistant to or intolerant of other medications, were treated with a monthly intravenous bolus of cyclophosphamide. Nine of 10 patients experienced some beneficial results, several of which were quite dramatic and associated with substantial and protracted reductions in steroid requirement. Significant drug toxicity was noted in several patients. This therapy can be a useful therapeutic adjunct in carefully selected cases; however, we are not attempting to liberalize therapeutic indications for cyclophosphamide administration in SLE.

Tuberculous sacroiliitis.

We have described an unusual case of tuberculous sacroiliitis associated with adrenal insufficiency, with details of radiologic studies and review of the literature concerning tuberculous sacroiliitis.

Intermediate-dose intramuscular methylprednisolone acetate in the treatment of rheumatic disease.

Treatment with a high-dose, intravenous bolus of methylprednisolone has been reported in numerous cases of rheumatic diseases. The optimal routes of administration, dosage, dosage interval, and other factors are unknown. This report describes uncontrolled clinical observations with a single dose of 320 mg of intramuscular methylprednisolone acetate in patients with rheumatic disease (12 with rheumatoid arthritis, 2 with spondyloarthropathy). This treatment may provide a useful therapeutic adjunct in selected clinical circumstances.

Recurrent painful calf swelling associated with gout.

A 30-year-old man had a recurrent painful calf swelling associated with gout that mimicked thrombophlebitis and possibly muscle tear. This painful calf swelling occurred in the absence of a subjective history of arthritis of the knee. A constellation of clinical signs was highly suggestive that gout was the cause of the painful calf swellings. Patients with similar conditions, after careful exclusion of thrombophlebitis, might be spared unnecessary and potentially dangerous anticoagulation or surgical intervention by early diagnosis of gout.