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ID PMID Title PublicationDate abstract
11028886 Past incidence and future demand for knee arthroplasty in Sweden: a report from the Swedis 2000 Aug By combining data from the Swedish Knee Arthroplasty Register and Swedish census registers we have calculated the past age-specific incidence of primary knee arthroplasties and predicted the demand. During the last 20 years, osteoarthrosis has accounted for the largest increase in number of knee arthroplasties while operations for rheumatoid arthritis remained constant. The mean yearly number of operations between the periods 1976-1980 and 1996-1997 increased more than five-fold, while only 6% of that increase could be explained by changes in the age-profile of the population. Most operations were performed on persons of 65 years and older who also had the largest increase in incidence. By using the incidences for 1996 and 1997 and taking into account the expected future changes in the age profile of the Swedish population, we estimate that, in the absence of an effective preventive treatment, the number of knee arthroplasties will increase by at least one third until 2030.
10844388 Atrial ejection force in systemic autoimmune diseases. 1999 Systemic autoimmune disorders may affect several organs, including the heart. We analyzed two-dimensional and pulsed Doppler echocardiograms of patients (n = 37) with systemic lupus erythematosus (SLE, n = 24) or rheumatoid arthritis (RA, n = 13) to determine whether atrial ejection force (AEF) could represent a suitable parameter for detecting left ventricular filling abnormalities in SLE and RA. In both patient subgroups, AEF was significantly higher than in healthy controls (n = 40) matched for gender and age (14.0 +/- 5.4 vs. 11.0 +/- 3.5 kdyn, p < 0.01). Because conventional echocardiographic parameters of left ventricular function failed to detect such a difference, AEF might serve as an additional sensitive parameter for detecting left ventricular diastolic filling abnormalities early in the course of a systemic autoimmune disease.
9133966 Quantitative liver function in patients with rheumatoid arthritis treated with low-dose me 1997 Mar The objectives were to determine quantitative liver function prospectively in patients with rheumatoid arthritis (RA) treated with low-dose methotrexate (MTX), to search for risk factors for a loss of quantitative liver function and to assess the relationship between quantitative liver function and histological staging. A total of 117 patients with RA (ACR criteria, 85 women, mean age 59 yr) had measurements of galactose elimination capacity (GEC), aminopyrine breath test (ABT) and liver enzymes [aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (AP), 7-glutamyl transferase (GGT), bile acids, bilirubin, albumin] before treatment with weekly i.m. MTX injections and every year thereafter. In 16 patients, liver biopsies were performed. Before the introduction of MTX, mean GEC was 6.6 mg/min/kg [5th to 95th percentile (5-95 PC) 5.1-8.5; reference range 6.0-9.1] and mean ABT was 0.80% kg/mmol (5-95 PC 0.42-1.30: reference range 0.6-1.0). During treatment with MTX [mean weekly dose 11.8 mg (5-95 PC 5.4-20.2), mean observation period 3.8 yr (5-95 PC 0.4-6.9)], significant declines of GEC (-0.12 mg/min/kg per year. t = 3.30, P < 0.002) and ABT (-0.06% kg/mmol per year, t = 4.81, P < 0.001) were observed. Negative correlations were found between the annual change in GEC and GEC at baseline (Rs = -0.40, P < 0.0001), and the annual change in ABT and ABT at baseline (Rs = -0.43, P < 0.0001). No correlations were found between the annual change in GEC or ABT and weekly MTX dose, age or percentage of increased liver enzymes, and no effect of a history of alcohol consumption > 30 g/week became evident. Two patients with Roenigk grade III had impaired quantitative liver function, while 14 patients with Roenigk grades I and II exhibited a high variability of GEC and ABT from normal to abnormal values. The continuous declines in GEC and ABT observed deserve attention in patients with prolonged treatment. Patients with a low GEC or ABT at baseline seem not to be at increased risk for a further loss of quantitative liver function. An impaired GEC or ABT does not necessarily concur with hepatic fibrosis on histological examination.
11109616 [Effects of low-intensity infrared impulse laser therapy on inflammation activity markers 2000 AIM: To evaluate effects of low-intensity infrared impulse laser therapy (IRILT) on concentration of immunity activation [not readable: see text] (soluble receptors of TNF-alpha and neopterin) and indicator of the inflammation activity (concentration of C-reactive protein) in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: Enzyme immunoassay, radioimmunoassay, enzyme immunoassay and radial immunodiffusion were used to measure soluble receptors of TNF-alpha, neopterin and C-reactive protein in 38 females with verified RA receiving IRILT or sham procedures. RESULTS: IRILT induced lowering of neopterin, TNF-alpha soluble receptors (p < 0.01) and C-reactive protein (p < 0.01). CONCLUSION: The findings give pathogenetical grounds for IRILT use in RA as this treatment suppresses functional activity of macrophages which serve the main source of neopterin and the receptors synthesis.
9716260 Inhibitory effects of anti-rheumatic drugs containing magnosalin, a compound from 'Shin-i' 1998 May This study was undertaken to examine the effects of magnosalin, a compound isolated from 'Shin-i' (Flos magnoliae) on proliferation of synovial cells isolated from MRL/1pr and collagen-induced arthritis (CIA) mice, and rheumatoid arthritis (RA) patients. Magnosalin (2.39-23.9 microM) inhibited 5% fetal bovine serum (FBS)-stimulated [3H]-thymidine incorporation into the synovial cells in the MRL/1pr mice. The effect of magnosalin was greater than that of hydrocortisone, bucillamine and magnoshinin (another compound from 'Shin-i'), but weaker than that of corticosterone. The effects of magnosalin for FBS-induced thymidine incorporation into the cells of the CIA mice and the RA patients were significantly greater than those in the corresponding control mice and osteoarthritis patients. Interleukin (IL)-1alpha increased the incorporation of thymidine into the synovial cells in the C57BL/6J mice to a greater degree than did basic fibroblast growth factor (bFGF) or platelet-derived growth factor BB-homodimer (PDGF-BB). The inhibitory effect of magnosalin on the submaximal action of IL-1alpha was significantly greater than that of bFGF, PDGF-BB or FBS. These results offer evidence that magnosalin suppresses the proliferation of synovial cells in RA models by inhibiting IL-1alpha-stimulated action.
10665738 The prevalence of rheumatoid arthritis in Sweden. 1999 The aim of this study was to ascertain the prevalence of rheumatoid arthritis (RA) in a Swedish general adult population. A questionnaire about chronic pain was mailed to a total of 3928 subjects who were chosen as a random sample of the population in two communities in the county of Halland. All persons answering affirmatively to questions intended to identify patients with RA were invited to a clinical examination. X-rays of hands and feet, and analyses of rheumatoid factor and C reactive protein were performed provided that the patients fulfilled two or more of the five clinical items of the 1987 ARA criteria. Furthermore, non-participants were searched for in a patient register and in medical records from the local rheumatology unit in an attempt to identify further cases. Using the modified 1987 ARA criteria for population studies the prevalence rate of RA was calculated to 0.51% (95%, CI = 0.31-0.79).
9563189 [Comparison of functional outcome in implantation of Natural Knee knee prostheses with and 1998 Jan PROBLEM: Despite the great progress in knee arthroplasty made within the previous decade the problem of patellar resurfacing is still unsolved. MATERIAL AND METHODS: In a retrospective matched-pairs study in 62 patients with Natural Knee endoprostheses including one group with and another without patella resurfacing were compared. Results were assessed according to the American Knee Society Score and the patients subjective assessments. RESULTS: At an average follow-up time 2 years there were no differences in the clinical findings and the patients subjective opinions between both patient groups. However, patients with rheumatoid arthritis and patella resurfacing showed significantly better results in both categories than those rheumatoid patients without patella resurfacing. CONCLUSION: Summing our results up we cannot give a general advise towards the use of patella resurfacing in knee replacements. In patients with severe arthrosis of the femoro-patellar joint and in patients with rheumatoid arthritis, however, the patella replacement is considered to be the therapy of choice at our department.
10744657 A novel murine anti-human Fas mAb which mitigates lymphadenopathy without hepatotoxicity. 2000 Apr Defects in Fas-mediated apoptosis are implicated in autoimmune diseases including rheumatoid arthritis (RA). Although induction of Fas-mediated apoptosis could have therapeutic effects on these diseases, it might cause deleterious effects in liver as Fas ligand or an agonistic anti-murine Fas antibody Jo2 causes severe hepatic injury in mice. We report here on the interesting characteristics of the newly obtained anti-Fas mAb, HFE7A, which cross-reacts with the Fas molecules of various species ranging from human to mouse and mitigates autoimmune symptoms without hepatotoxicity in mice. The administration of HFE7A to mice induced apoptosis in the thymocytes, although administration of HFE7A to mice or to marmosets did not induce any sign of hepatitis. The effect of HFE7A on liver is different from that of anti-murine Fas antibody Jo2, which causes acute and lethal hepatic injury to mice. Administration of HFE7A reduced lymphadenopathy and abnormal T cells in MRL-gld/gld mice. HFE7A induced apoptosis in synovial cells prepared from RA patients. Surprisingly, HFE7A protected mice from fulminant hepatitis induced by Jo2. Therefore, HFE7A is a potential therapeutic antibody not only for autoimmune diseases including RA but also for fulminant hepatitis.
11595970 Magnetic resonance imaging of soft tissue changes in rheumatoid arthritis wrist joints. 2001 Sep An increasingly aggressive therapeutic strategy, improved treatment options, and encouraging preliminary results have attracted growing attention to the potential of magnetic resonance imaging (MRI) in the diagnosis, prognostication, and monitoring of rheumatoid arthritis (RA). MRI offers multiplanar imaging with unprecedented soft tissue contrast and high spatial resolution. Synovitis, the primary joint lesion in RA, can be detected and monitored. By contrast, conventional radiography shows only the late signs of preceding synovitis. Other soft tissue changes, such as tenosynovitis, tendonitis, enthesitis, joint effusions, and ligament and tendon tears, can be visualized. Unfortunately, the image resolution in most clinically available MR units is insufficient for evaluation of wrist joint cartilage. Preliminary data suggest that MRI is a valuable tool in the diagnosis and prognostication of RA. The superior sensitivity of MRI may be of major significance in both clinical trials and practice. In trials, MRI may allow reductions in the trial size and length because of its more sensitive separation of responders from nonresponders. Thus, although thorough validation is awaited, particularly concerning the reproducibility and prognostic value, MRI seems to be a very promising method for assessment of both established and early RA.
9014404 Rheumatoid arthritis and the pulmonary nodule. 1997 Jan The potential difficulties offered by the presence of a solitary pulmonary nodule in a patient with rheumatoid arthritis are illustrated by a male non-smoker with clinical, serologic and radiographic rheumatoid arthritis, active and fibrosing alveolitis and a new lung nodule. This nodule proved to be squamous cell carcinoma without the typical risk factors. The findings of a solitary pulmonary density or nodule in a patient with rheumatoid arthritis provides no assurance that the lesion is benign. Both necrobiotic nodules and lung cancer may present as solitary pulmonary nodules in patients with this autoimmune disease.
10773966 Multidrug resistance-1 (MDR-1) in rheumatic autoimmune disorders. Part I: Increased P-glyc 2000 Jan BACKGROUND: Multidrug resistance (MDR) is characterized by overexpression of P-glycoprotein, a pump molecule that decreases intracellular drug concentrations by increasing drug efflux from cells. OBJECTIVE: To look for correlations between clinical status and P-glycoprotein activity and/or TNF-alpha mRNA levels in patients with rheumatoid arthritis. METHODS: Sixteen patients were studied. Based on response to therapy, eight were refractory and eight nonrefractory to treatment. Findings were compared to those in 24 healthy controls. Flow cytometry was used to evaluate P-glycoprotein activity in peripheral blood mononuclear cells isolated by gradient centrifugation and incubated with the P-glycoprotein substrate daunorubicin. TNF-alpha mRNA levels were determined using quantitative PCR. RESULTS: Patients with rheumatoid arthritis showed an increased number of lymphocytes with high P-glycoprotein activity (p = 0.0001) as compared to the normal controls. P-glycoprotein activity was higher in the refractory than in the non-refractory patient subgroup (p = 0.006). Also, TNF-alpha mRNA levels were markedly higher in the refractory subgroup than in the nonrefractory subgroup, and were undetectable in the normal controls. CONCLUSIONS: Enhanced P-glycoprotein activity may be closely related to an unfavorable clinical course and a poor response to treatment. Increased TNF-alpha expression and chronic exposure to various drugs, including glucocorticoids, may contribute to increase P-glycoprotein activity. Both high P-glycoprotein activity and excessive amounts of TNF-alpha seem associated with poor outcome in rheumatoid arthritis.
9134244 Elevated incidence of hematologic malignancies in patients with Sjögren's syndrome compar 1997 Mar The risk of hematologic malignancies was studied in Finnish patients with rheumatoid arthritis or Sjögren's syndrome, and the difference in the risk between those diseases was evaluated. The study cohorts comprised 676 patients with primary Sjögren's syndrome, 709 with secondary Sjögren's syndrome, and 9,469 with rheumatoid arthritis identified from the Finnish hospitals' national discharge register. The follow-up times were 5,336, 4,254 and 65,391 person-years, respectively. Data on the incidence of malignancies were collected from the files of the Finnish Cancer Registry. The incidence of hematologic malignancies was elevated in the study cohorts. The standardized incidence ratio (SIR) of non-Hodgkin's lymphoma was: 2.2 (95 percent confidence interval [CI] 1.5-3.1) for rheumatoid arthritis; 4.5 (CI = 1.5-11) for secondary Sjögren's syndrome; and 8.7 (CI = 4.3-16) for primary Sjögren's syndrome. The ratio of the SIR of primary Sjögren's syndrome cf rheumatoid arthritis alone was 3.9 (CI = 1.8-8.0) in non-Hodgkin's lymphoma, and 3.4 (CI = 1.2-8.1) in other hematologic cancers. The incidence of hematologic malignancies, especially that of non-Hodgkin's lymphoma, is elevated in patients with rheumatoid arthritis. It is higher in patients with secondary Sjögren's syndrome and highest in patients with primary Sjögren's syndrome. Differences in the immunologic aberration influence oncogenesis.
10515648 The effect of acupuncture on patients with rheumatoid arthritis: a randomized, placebo-con 1999 Sep OBJECTIVE: Acupuncture is commonly used by patients with chronic painful musculoskeletal disorders. There are, however, few well-designed studies of its efficacy. This paper describes a randomized placebo-controlled cross-over design to evaluate acupuncture as a useful treatment adjunct in the management of patients with rheumatoid arthritis (RA). METHODS: Sixty-four patients were centrally randomized from a hospital-based rheumatology out-patient clinic. Fifty-six patients were suitable for study, all were on second-line therapy and aged 18-75 yr. There had been no change in therapy for the preceding 3 months. Patients who had previous acupuncture, anticoagulation, fear of needles or infection were excluded. Single-point (Liver 3) acupuncture or placebo was given with an intervening 6 week wash-out period. The acupuncturist, patient and statistician were blinded as far as possible. The outcome measures included the inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), visual analogue scale of pain, global patient assessment, 28 swollen and tender joint count, and a general health questionnaire. RESULTS: The results demonstrated no significant effect of treatment or period and no significant interaction between treatment and period for any outcome variable. No adverse effects were reported. CONCLUSION: Acupuncture of this type cannot be considered as a useful adjunct to therapy in patients with RA. Possible reasons why this is the case are discussed.
10357118 Defective antibody production in patients with rheumatoid arthritis and bronchiectasis. 1999 Bronchiectasis (BR) occurs in about 3% of patients with rheumatoid arthritis (RA). Defective antibody production is a rare but well-recognised cause of both BR and inflammatory arthritis. We examined the hypothesis that subtle specific antibody defects might play a role in the pathogenesis of BR associated with RA. Identification of defects in antibody production is important because substantial benefits may be gained from immunoglobulin replacement. Specific antibody production was assessed in 20 patients with RA and BR, 20 with BR alone, 20 with RA alone and 20 healthy controls (all groups matched for age and sex). All had normal total IgG. IgA and IgM and IgG subclass levels. Specific antibody production was assessed by assay of antibodies to representative polysaccharide and protein antigens. Subjects with subprotective titres were challenged with the appropriate vaccine. Defective antibody production was defined as a subprotective level despite immunisation. Three out of 20 patients with RA and BR had a defective IgG2 response to the polysaccharide antigen, but normal responses to the protein antigen. All of the subjects in the BR alone or healthy control group had normal antibody production. Two out of 20 patients with RA alone had defective production of antibodies against both protein and polysaccharide antigens; both were receiving gold therapy, a recognised cause of functional antibody defects. It was concluded that some patients with RA and BR have functional antibody defects and may benefit from antibody replacement. An unexpectedly high proportion of patients with RA alone also have functional antibody defects, possibly secondary to gold therapy.
10982649 Apoptosis of articular chondrocytes in rheumatoid arthritis and osteoarthritis: correlatio 2000 To investigate the relationship of chondrocyte apoptosis and cartilage destruction, we performed in situ nick end labeling (ISNEL), electron microscopy, and immunohistochemistry against apoptosis-related proteins, p53 and c-myc, in the articular cartilages of patients with rheumatoid arthritis (RA; n = 12) and osteoarthritis (OA; n = 12), and in control articular cartilages from patients with femoral neck fracture (n = 8). The distribution of stained chondrocytes was evaluated semiquantitatively in relation to the degree of cartilage destruction. ISNEL-positive chondrocytes with apoptotic morphological features were identified in a relatively early phase of cartilage destruction, and correlated positively and significantly in a number with the degree of cartilage degeneration. Comparison of RA and OA revealed a significantly greater number of ISNEL-positive chondrocytes in RA cartilage. In contrast, the specimens of normal subjects contained few cells with apoptotic changes. Similarly to the distribution of ISNEL staining, the expression of p53 and c-myc proteins was observed in chondrocytes within the degraded lesions, and showed a positive correlation with the number of ISNEL-stained cells. These results suggest that the degree of chondrocyte apoptosis is closely related to cartilage destruction and that chondrocytes in RA more readily undergo apoptosis than those in OA. The expression of p53 and c-myc proteins in ISNEL-positive areas may reflect the involvement of these proteins in the apoptotic process in articular chondrocytes in inflammatory arthritis.
10233855 Expression of receptor tyrosine kinase Axl and its ligand Gas6 in rheumatoid arthritis: ev 1999 Apr Angiogenesis and synovial cell hyperplasia are characteristic features of rheumatoid arthritis (RA). Many growth and survival factors use receptors belonging to the tyrosine kinase family that share conserved motifs within the intracellular catalytic domains. To understand further the molecular basis of cellular hyperplasia in RA, we have used degenerate primers based on these motifs and RNA obtained from the synovium of a patient with RA to perform reverse transcriptase-polymerase chain reaction. We report detection of the receptor tyrosine kinase (RTK) Axl in RA synovium and we document the expression pattern of Axl in capillary endothelium, in vascular smooth muscle cells of arterioles and veins, and in a subset of synovial cells in RA synovial tissue. Gas6 (for growth arrest-specific gene 6), which is a ligand for Axl and is related to the coagulation factor protein S, was found in synovial fluid and tissue from patients with RA and osteoarthritis. Axl expression and function was studied in human umbilical vein endothelial cells (HUVECs). Gas6 bound to HUVECs; soluble Axl inhibited this binding. Exogenous Gas6 protected HUVECs from apoptosis in response to growth factor withdrawal and from TNFalpha-mediated cytotoxicity. These findings may reveal a new aspect of vascular physiology, which may also be relevant to formation and maintenance of the abnormal vasculature in the rheumatoid synovium.
10589366 Aim for remission or "personal best" using combination DMARD therapy with methotrexate and 1999 Nov Combination disease-modifying antirheumatic drug therapy with methotrexate and hydroxychloroquine has changed the course of rheumatoid arthritis. Better management requires "front of the line" care, effective drug combinations, and a goal of "Personal Best." The Pincus phenomenon--the discrepancy between subjective satisfaction and objective progression--may be minimized in clinical practice by questionnaires and Snapshot.
10769432 [Vitamin D metabolites in rheumatoid arthritis: findings--hypotheses--consequences]. 2000 Active vitamin D metabolites are not only involved in the regulation of bone metabolism but exerts immunomodulatory effects important in the regulation of inflammatory processes. The purpose of the present study was to evaluate the effects of a short-time treatment with 1 alpha-hydroxycholecalciferol on both disease activity and bone metabolism in patients with rheumatoid arthritis (RA). The effects of an adjuvant therapy with 1 microgram 1 alpha-hydroxycholecalciferol over eight weeks on conventional parameters of disease activity (Ritchie index, duration of morning stiffness, C-reactive protein, ESR), serum levels of cytokines and soluble cytokine receptors (TNF-alpha, IL-6, IL-4, sIL-2R, sIL-6R) and parameters of bone metabolism (bone-specific alkaline phosphatase, osteocalcin, renal excretion of pyridinolin- and desoxypyridinolin-collagen-crosslinks, serum levels of parathormon, 1,25-dihydroxycholecalciferol and calcium, daily urinary calcium excretion) were investigated in 20 patients with RA. The treatment with 1 alpha-hydroxycholecalciferol resulted in an insignificant decrease in the number of swollen and tender joints, morning stiffness, CRP and ESR. Furthermore, a non-significant decrease in serum levels of TNF-alpha and IL-6 and an increase in IL-4 was observed. The treatment led to a significant decrease of bone-specific alkaline phosphatase (p = 0.001), osteocalcin (p = 0.04) and renal excretion of pyridinolin-crosslinks (p = 0.022) and to an increase of both serum calcium (p = 0.01) and daily urinary calcium excretion (p = 0.004). The results of this pilot study in a small group of RA patients indicate that an adjuvant therapy with active vitamin D metabolites may not only have preventive effects on systemic bone loss but also may inhibit the inflammatory and destructive process in RA in a limited degree.
11578013 Changes in therapy of rheumatoid arthritis during the period 1979 to 1996. 2001 OBJECTIVE: To evaluate the use of disease modifying antirheumatic drugs (DMARDs), cytotoxic agents, and corticosteroid therapy in patients diagnosed with rheumatoid arthritis (RA) in two periods, 1979 to 1987, and 1988 to 1996. MATERIALS AND METHODS: Review of the records of 788 patients with RA diagnosed at the Department of Rheumatology, the University Hospital of Tromsø. RESULTS: We found a significant increase in the proportion of patients who started with auranofin, sulfasalazine, methotrexate, and corticosteroids in 1988 1996 compared to 1979 1987. The initiation of use of gold salts, antimalarials, and D-penicillamine declined significantly from the first to the second period. CONCLUSION: Patients diagnosed with RA between 1988-1996 were treated more actively than patients diagnosed in the period 1979-1987. During 1988 to 1996 auranofin, sulphasalazine, methotrexate, and corticosteroids replaced gold salts, antimalarials, and D-penicillamine.
11171680 Methotrexate and early postoperative complications in patients with rheumatoid arthritis u 2001 Mar OBJECTIVES: To determine whether continued methotrexate treatment increases the risk of postoperative infections or of surgical complications in patients with rheumatoid arthritis (RA) within one year of elective orthopaedic surgery. DESIGN: A prospective randomised study of postoperative infection or surgical complications occurring within one year of surgery in patients with RA who underwent elective orthopaedic surgery. SUBJECTS: 388 patients with RA who were to undergo elective orthopaedic surgery. Patients who were receiving methotrexate were randomly allocated to groups who either continued methotrexate (group A) or who discontinued methotrexate from two weeks before surgery until two weeks after surgery (group B). Their complication rates were compared with complications occurring in 228 patients with RA (group C) who were not receiving methotrexate and who also underwent elective orthopaedic surgery. MAIN OUTCOME MEASURES: Signs of postoperative infection were recorded, including rubor, discharge, systemic infection, and frequency of wound dehiscence as well as the incidence of any surgical complication requiring a secondary revision procedure that occurred within one year of surgery. The frequencies of flare up activity of RA at six weeks and six months after surgery were also recorded. A flare of rheumatoid disease was defined as an increase in joint pain in two or more joints notified by the patient as well as by an increase in articular index of at least 25% after surgery. RESULTS: Signs of infection or surgical complications occurred in two of 88 procedures in group A (2%), 11 of 72 procedures in group B (15%), and 24 of 228 (10.5%) procedures in group C. The surgical complication or infection frequency in group A was less than that in either group B (p<0.003) or group C (p=0.026). At six weeks after surgery there were no flares in group A, six flares in group B (8%), and six flares in group C (2.6%). Logistic regression analysis of the overall surgical complication rate in all the patients with RA studied showed that methotrexate, whether continued or discontinued before surgery, did not increase the early complication rate in the patients with RA who underwent elective orthopaedic surgery. Other drugs-penicillamine, indometacin, cyclosporin, hydroxychloroquine, chloroquine, and prednisolone-all did significantly increase the risk of infection or surgical complication after elective orthopaedic surgery. The risk of surgery was also increased in the presence of intercurrent chronic diseases-diabetes, hypertension, bronchiectasis, psoriasis, asthma, and ischaemic heart disease. CONCLUSION: Continuation of methotrexate treatment does not increase the risk of either infections or of surgical complications occurring in patients with RA within one year of elective orthopaedic surgery. Thus methotrexate treatment should not be stopped in patients whose disease is controlled by the drug before elective orthopaedic surgery.