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ID PMID Title PublicationDate abstract
11117303 Differential expression of transforming growth factor-alpha and macrophage colony-stimulat 2000 Sep The immunologic response to prosthetic biomaterial particles is characterized by macrophage-rich inflammatory infiltrate, formation of multinucleated giant cells, and aseptic loosening at the site of arthroplasty. We investigated the in vivo expression and tissue distribution of transforming growth factor alpha, macrophage colony-stimulating factor, and the receptor for colony-stimulating factor-1 at the site of bone erosion in patients with clinically failed orthopaedic implants (n = 30). The expression was further compared with that detected in the inflamed synovial membranes from patients with rheumatoid arthritis or osteoarthritis (n = 15) and one patient with osteoclastoma (giant cell tumour of bone). Immunostaining of the tissue demonstrated positivity for transforming growth factor alpha within the inflammatory macrophage and multinucleated giant cell infiltrate in the diseased synovial membrane and the bone-implant interface. A comparative analysis between the synovium and retrieval interface membranes (pseudosynovium) revealed a high level of expression of transforming growth factor alpha, with intense membrane staining on multinucleated giant cells in all failed arthroplasties with pseudosynovium. In addition, the frequency, antigenic phenotype, and pattern of transforming growth factor alpha expression on multinucleated giant cells in the interface were markedly similar to those observed for multinucleated giant cells in osteoclastoma. Multinucleated giant cells within the interface lacked the expression of macrophage colony-stimulating factor and colony-stimulating factor-1 receptor, whereas those at the bone surfaces exhibited strong immunoreactivity. The predominant expression of transforming growth factor alpha by multinucleated giant cells in the bone-implant interface and its similarity to osteoclastoma highlight the importance of assessing transforming growth factor alpha as a possible contributor to the development of bone-resorbing giant cells at the site of failed orthopaedic implants.
9113539 Three-dimensional polyethylene wear of a press-fit titanium prosthesis. Factors influencin 1997 Apr Between 1985 and 1990, 108 consecutive Harris-Galante I (Zimmer, Warsaw, IN) total hip arthroplasties were performed by four surgeons at a single hospital. At the time of follow-up evaluation, 80 hips were available for review. The mean rate of linear wear was 0.15 mm/y, mean rate of three-dimensional femoral head displacement was 0.21 mm/y, and mean rate of volumetric wear was 121 mm3/y. Eight hips (10%) in this series had radiologic osteolysis around either the femoral or acetabular component. A significantly greater volumetric wear rate was found in patients who were younger, those with a higher activity level, those who received a 32-mm-diameter femoral head, and those with vertical orientation of their acetabular component. No relationship could be made with patient weight, gender, Harris hip score, or cup diameter.
9757341 [Use of the CCD (Sofamor-Danek) rod plates for instabilities of the craniospinal junction] 1998 Apr We report our experience with the CCD material (Sofamor-Danek) for the treatment of cranio-cervical instability. In this method, rod-plates are fixed to the occipital bone and to the cervical spine with hooks. This technique is mainly indicated for the treatment of patients with severe osteoporosis or with significant thinness of the occipital bone. Four cases are presented. Three of them suffered from a inflammatory rheumatism. The fourth patient had been previously treated by an occipito-cervical fixation with a Roy-Camille plate for a C2 metastasis and presented a failure of the occipital screws fixation. In all cases, no post operative complications were observed and all patients had a significant improvement of their cervicalgia. We confirm the interest and the fiability of the CCD method which has simplified the procedure and is specially suitable for the treatment of all types of cranio-cervical instability, even in the most adverse conditions.
11288043 Serum interleukin-6 and thyroid hormones in rheumatoid arthritis. 2001 Apr Using rheumatoid arthritis (RA) as a model, we have investigated whether the activation of the cytokine system, in particular, activation of interleukin (IL)-6 production, is a major cause of the depressed serum T(3) seen frequently in the nonthyroidal illness syndrome (NTIS). RA was chosen because it is a chronic autoimmune disease leading to increased serum IL-6 concentrations. We studied 16 untreated RA and 35 treated RA patients. Twenty-seven treated and 27 untreated patients with noninflammatory musculoskeletal symptoms served as controls. The patient groups displayed similar age distribution and nutritional status. Untreated RA patients displayed elevations of serum IL-6 (mean, 37.5 pg/mL) and C-reactive protein (CRP; mean, 41.3 mg/L), consistent with the inflammatory nature of their disease. Treated RA patients had significantly reduced serum IL-6 (mean, 9.9 pg/mL) and CRP (mean, 13.3 mg/L) compared with untreated RA patients, while untreated and treated patients with noninflammatory musculoskeletal symptoms had near normal serum IL-6 (mean, 2.5, 6.6 pg/mL, respectively) and CRP levels (mean, 5.8, 8.1 mg/L, respectively). However, there were no significant differences in serum concentrations of free T(3) (FT(3)) and free T(4) (FT(4)) between groups, and thyroid indices were in the normal range in RA patients. Moreover, no significant correlations between serum concentration of IL-6 and any of the thyroid hormones were demonstrated for any of the patient groups. In conclusion, we have been unable to confirm in RA that IL-6 activation leads to the low T(3) state of NTIS.
9706421 Effect of cyclosporin on apoptosis in human cultured monocytic THP-1 cells and synovial ma 1998 Jul OBJECTIVE: Cyclosporin A (CyA) is an immunosuppressant drug used for the treatment of rheumatoid arthritis (RA), that might affect programmed cell death (apoptosis) of the cells involved in the synovial inflammatory reaction. The effects of CyA on apoptosis were evaluated on cultured human monocytic myeloid cells (THP-1 cell line) and on RA synovial macrophages. METHODS: In order to induce THP-1 cell differentiation into adherent cells, an amount of these was treated with human recombinant IFN-gamma before incubation with CyA. Primary cultures of synovial macrophages were obtained from RA patients and treated in vitro with CyA. RESULTS: CyA, at the pharmacological range (100-300 ng/ml) employed in the treatment of RA, seems to induce, after 48-96 hrs, programmed cell death in differentiating THP-1 cells, whereas cultured synovial macrophages (fully differentiated monocytic cells) do not show any apoptosis at the same time. CONCLUSION: Short-term CyA treatment may induce increased apoptosis in immature and differentiating cultured monocytes. Cultured synovial macrophages (resident monocytic-derived and differentiated cells) seem to be resistant to the treatment as far as apoptosis is concerned.
9870691 Localization of vascular endothelial growth factor in synovial membrane mast cells: examin 1998 Dec Mast cells are believed to play a novel part in the development of destructive synovial pannus in rheumatoid arthritis (RA). This study was undertaken to investigate the localization of vascular endothelial growth factor (VEGF) in the synovial membrane using a unique immunostaining technique. Synovial specimens of RA patients were examined immunohistochemically and were compared with specimens from non-RA controls. Multi-labelling subtraction immunostaining, a modification of double- and triple-labelling immunostaining, revealed that the VEGF-positive cells were identical to tryptase-positive cells (mast cells). No other cell types were found to be positive for VEGF. The synovium of RA patients showed a larger number of VEGF-positive mast cells than that of non-RA controls (P<0.001). The study suggests that mast cell-derived VEGF may contribute to the development of synovial pannus in RA.
10836526 Bone marrow CD34+ progenitor cells from rheumatoid arthritis patients support spontaneous 2000 We show that bone marrow (BM) CD34+ progenitor cells from rheumatoid arthritis (RA) patients have the capacity to support spontaneous transformation of peripheral blood B cells. CD34+ cells purified from BM blood from eight RA patients and eight osteoarthritis (OA) patients were expanded with granulocyte/macrophage colony stimulating factor (GM-CSF) for 4-6 weeks. GM-CSF-stimulated BM CD34+ cells from three of eight RA patients, but none from seven OA patients, gave rise to spontaneous transformation of highly purified B cells of Epstein-Barr virus (EBV)-seronegative healthy donors. GM-CSF-stimulated BM CD34+ cells from four of six RA patients and from one of four OA patients also supported the spontaneous transformation of peripheral blood B cells from EBV-seropositive healthy donors. All the transformed B cell lines were positive for EBV-DNA as determined by PCR. Neither GM-CSF-stimulated BM CD34+ cells alone nor highly purified B cells alone gave rise to spontaneously transformed B cell lines. These results suggest that the capacity of BM CD34+ cells to support survival of B cells might contribute to the pathogenesis of RA by sustaining abnormal B cell responses.
9433875 Evidence for autoantigens of Env/Tax proteins in human T cell leukemia virus type I Env-pX 1998 Jan OBJECTIVE: To examine T cell clonotypes infiltrating into arthritic joints and to investigate whether human T cell leukemia virus type I (HTLV-I) env-pX gene products act as autoantigens in HTLV-I env-pX transgenic mice. METHODS: Complementary DNA (cDNA) encoding the V-D-J (third complementarity-determining region [CDR3]) region of T cell receptor beta chain was amplified by Vbeta family polymerase chain reaction. T cell clonotypes were detected by a single-strand conformational polymorphism method, and sequence analysis of the CDR3 region was performed. RESULTS: Distinct oligoclonal T cell expansion was observed in arthritic joints, and a conserved amino acid motif in the CDR3 region was found in T cells infiltrating joints. Moreover, several intraarticular T cells recognized HTLV-I Env and Tax proteins. CONCLUSION: Our results suggest that HTLV-I Env and Tax proteins act as autoantigens that are recognized by autoreactive T cells in inflamed arthritic lesions in the HTLV-I env-pX transgenic mouse. Thus, some T cells infiltrating the joint recognize Env or Tax protein. These cells may trigger chronic arthritis in HTLV-I env-pX transgenic mice.
11300743 Studies on YKL-40 in knee joints of patients with rheumatoid arthritis and osteoarthritis. 2001 Apr OBJECTIVE: The presence of YKL-40 (human cartilage glycoprotein 39) in synovium, cartilage and synovial fluid (SF) from knee joints of patients with rheumatoid arthritis and osteoarthritis (OA) were related to histopathological changes in synovium and cartilage and to serum YKL-40 and other biochemical markers. METHODS: The localization of YKL-40 in synovium and cartilage was determined by immunohistochemistry. Synovial inflammation was estimated histologically and by magnetic resonance imaging (MRI). Biochemical markers of inflammation, neutrophil activation and cartilage metabolism were analysed. YKL-40 concentrations in serum and SF were determined by RIA and ELISA. RESULTS: In the synovium YKL-40 positive cells were found in lining and stromal cells (macrophages) and the number of YKL-40 positive cells was related to the degree of synovitis. In arthritic cartilage, YKL-40 was located to chondrocytes. YKL-40 levels in SF were higher in RA patients with moderate/severe or none/slight synovitis of the knee joint compared to OA patients with moderate/severe or none/slight synovitis. SF YKL-40 correlated with the synovial membrane and the joint effusion volumes determined by magnetic resonance imaging (MRI) and with other biochemical markers of intercellular matrix metabolism. SF YKL-40 was higher than serum YKL-40, and a relationship existed between the YKL-40 levels in SF and serum. Intraarticular glucocorticoid injection was followed by clinical remission and a decrease in serum YKL-40, which increased again at clinical relapse. CONCLUSIONS: YKL-40 in SF is derived from cells in the inflamed synovium, chondrocytes and SF neutrophils. Joint derived YKL-40 influences serum YKL-40. YKL-40 may be involved in the pathophysiology of the arthritic processes and reflect local disease activity.
10220834 Anti-IL-8 autoantibodies and complexes in rheumatoid arthritis: polyclonal activation in c 1999 The chemokine interleukin-8 (IL-8) is frequently associated with inflammatory diseases, and autoantibodies against IL-8 are present in the periphery at elevated levels in such conditions as rheumatoid arthritis (RA). Circulating free anti-IL-8 IgG autoantibodies correlate with inflammatory parameters and disease severity in RA. In this study, correlations were sought between these disease parameters and other antibody subclasses. We assayed IgM, IgA and IgG anti-IL-8 antibodies and IL-8 immunoglobulin immune complexes in the serum of 29 healthy controls and 56 patients with defined RA, and compared the results with clinical and humoral disease parameters. IgG and IgM antibodies directed against IL-8 were present in all samples. In the disease groups, all isotypes of free anti-IL-8 antibodies correlated with increasing humoral disease parameters like CRP and CIC and their related anti-IL-8 immune complexes. Samples which contained high titers of anti-IL-8 antibody subclasses and complexes were RF subclass-positive, while IgM RF-negative sera showed low levels of anti-IL-8 and complexes. Detectable levels of IgG and IgA RF were found in all sera. Patients with extra-articular organ manifestation showed significantly increased free IgA and IgA/IL-8 complexes, with no correlation to the IgA RF titer or IgA hypergamma-globulinemia. The highest titers were seen in two RA cases with vasculitis and in one patient with colitis. Polyclonal activation of the humoral antibody system, which normally precedes the resolution of an inflammatory response, can itself lead to secondary stimulation of inflammatory processes via immune complex formation. In the immune pathology of RA, it degenerates into a persistent chronic inflammation accompanied by progressive joint destruction. The presence of elevated IgA subclass anti-IL-8 autoantibodies in RA patients with extra-articular manifestations suggests these autoantibodies as a clinically useful marker of disease severity and extra-articular manifestations.
9547794 Antibodies to OX-40 (CD134) can identify and eliminate autoreactive T cells: implications 1998 Feb Autoantigen-specific CD4+ T cells have been implicated as the causative cell type in: multiple sclerosis, rheumatoid arthritis, autoimmune uveitis, diabetes mellitus, inflammatory bowel disease and graft-versus-host disease. The pathology of a number of experimentally induced autoimmune diseases is also mediated by autoantigen-specific CD4+ T cells. Ideally, treatment of CD4+ T-cell-mediated diseases would eliminate the autoantigen-specific cells, while sparing the remainder of the T-cell repertoire. We have developed an effective therapy that deletes the autoreactive T cells at the site of autoimmune tissue destruction. This approach uses an antibody directed against a cell-surface protein (OX-40, also known as CD134) that is selectively upregulated on activated autoantigen-specific T cells within the inflamed tissue.
9022114 Delay of corneal wound healing in patients treated with colchicine. 1997 Jan BACKGROUND: Colchicine has a known adverse effect on wound healing through its inhibitory effect on tubulin-dependent cell functions and through collagenase activation. In the cornea, it has been shown in animal and in vitro studies to inhibit epithelium mitosis, fibroblast mitosis and migration, as well as to reduce collagen deposition. The authors report on two patients with corneal ulcers refractory to conventional treatment while the patients were undergoing oral colchicine therapy. CASE REPORTS: The first patient was an 86-year-old woman who had been treated with oral colchicine because of rheumatoid arthritis. She was admitted to the authors' department with a deep corneal ulcer in the right eye for which she had been treated for 3 weeks with local antibiotics without any improvement. The second patient, a 60-year-old woman, was hospitalized because of a corneal ulcer in her left eye. She had been receiving oral colchicine therapy for mixed connective tissue disease. Treatment with local antibiotics was initiated but the condition of the eye worsened, ultimately resulting in corneal perforation. RESULTS: Withdrawal of oral colchicine therapy was followed by rapid corneal wound healing in both patients. CONCLUSION: The findings in these two patients suggest that colchicine may delay corneal wound healing. The authors suggest that in patients with corneal ulcers refractory to conventional treatment who are receiving colchicine, cessation of colchicine therapy should be considered.
9145039 Leflunomide and malononitrilamides. 1997 May Leflunomide is a new immunomodulatory drug that is effective in experimental models of autoimmune diseases and in allo or xenotransplantation. In a phase II clinical trial, leflunomide showed high tolerability and efficacy in patients with advanced rheumatoid arthritis. The immunomodulatory activity of leflunomide is attributed to its primary metabolite A77 1726, which is a malononitrilamide. The in vitro and in vivo mechanisms of action of this class of compounds are not defined completely. Several malononitrilamide analogues and A77 1726 inhibit T- and B-cell proliferation, suppress immunoglobulin production, and interfere with cell adhesion. Although no central molecular mechanism of action has been proposed to explain all the effects of the malononitrilamides, the inhibition of de novo pyrimidine biosynthesis and of cytokine- and growth factor receptor-associated tyrosine kinase activity are leading hypotheses for the effects of A77 1726 on T- and B-cell proliferation and function. Leflunomide is effective when administered in daily dosages of 10 mg and 25 mg to patients with active rheumatoid arthritis. The improved efficacy of a 25 mg dose is associated with a higher incidence of adverse effects (gastrointestinal symptoms, weight loss, allergic reactions, skin rash, and reversible alopecia). Because of the long plasma half-life of A77 1726 (11 to 16 days), loading doses are necessary to achieve steady state concentrations. Phase III randomized, placebo-controlled trials that use daily dosages of 10 mg or 20 mg are under way in the United States and Europe to confirm and extend the results of the phase II study. Malononitrilamide analogues of A77 1726 are being evaluated for immunosuppressive efficacy in preclinical models of transplantation. If these analogues show efficacies and therapeutic indexes that are similar to leflunomide in these models and that have shorter half-lives than A77 1726 in phase I trials, the preclinical and phase I data will be used to select the analogues for phase II trials in organ transplant recipients.
11404386 Proinflammatory properties of the human S100 protein S100A12. 2001 Jun S100 proteins represent a new class of chemoattractants. Here we extend earlier evidence for the proinflammatory properties of human S100A12. A12 induced migration of monocytoid cells, with optimal activity at 10(-10) M and potency of >10(-9) M C5a. Neutrophils were poorly responsive, and lymphocyte migration was not affected. Actin polymerization in monocytoid cells was accompanied by a sustained [Ca(2+)]i flux of a magnitude comparable with C5a. A12 elicited a transient infiltration of neutrophils (4-8 h) and more delayed recruitment of monocytes (8-24 h) in vivo. A12 (approximately 70 nM) was present in synovial fluid (SF) from rheumatoid arthritis patients, and synovium contained A12-positive neutrophils in the sublining and interstitial region, often surrounding the perivasculature but rarely in the synovial lining layer, although some macrophages were positive. The A12 gene was transiently up-regulated in monocytes by tumor necrosis factor alpha (6 h); induction by lipopolysaccharide (LPS) was sustained (12-48 h). A12 may contribute to leukocyte migration in chronic inflammatory responses.
11269727 Immunodominant region of Actinobacillus actinomycetemcomitans 40-kilodalton heat shock pro 2001 Jan Bacterial heat shock proteins have been implicated in the pathogenesis of several diseases, and the immunological relationship between rheumatoid arthritis (RA) and Escherichia coli DnaJ has been reported. Since there are similarities in the tissue destruction process of RA and periodontitis, we examined the reactivities of antibodies in sera from RA patients to the DnaJ protein from Actinobacillus actinomycetemcomitans. An enzyme-linked immunosorbent assay showed that IgG titers to the N-terminal conservative region of the DnaJ are significantly higher in RA patients compared with the healthy controls (p < 0.05). Furthermore, we examined IgG titers of disease controls to determine the specificity of the immune responses to this region in RA patients. The difference between RA and infectious disease patients was also significant (p < 0.05). These results suggest that the N-terminal region of DnaJ from A. actinomycetemcomitans may contribute to the etiologic analysis of RA.
10575926 [The development of non-Hodgkin's lymphoma during the course of autoimmune diseases. Five 1999 The development of five of non-Hodgkin lymphomas during the course of autoimmune diseases was presented. The treatment methods of autoimmune disease included: irradiation steroids, non-steroidal anti-inflammatory drugs or immuno-suppressive drugs. The time interval between diagnosis of autoimmune disease and lymphoma was from 2 to 28 years. High-grade lymphoma was observed in all cases. After treatment (irradiation with or without combination with multidrug chemotherapy) the complete regression was observed and disease-free survival between 16 and 48 months after treatment was obtained.
10491366 Superinduction of interleukin 8 mRNA in activated monocyte derived macrophages from rheuma 1999 Oct OBJECTIVE: Synovial inflammation in patients with rheumatoid arthritis (RA) is characterised by the presence of large numbers of highly activated monocytes and macrophages. The importance of these cells in the aethiopathogenesis and prognosis of RA is increasingly recognised. The object of this report is to determine whether monocytes and monocyte derived macrophages of RA patients produce increased cytokine mRNA levels. METHODS: Monocyte derived macrophages from RA patients and healthy controls were cultured either in the absence or presence of lipopolysaccharide. The expression levels of the mRNAs encoding GAPDH, interleukin 1beta (IL1beta), IL8, and alpha(2) macroglobulin in these cells were analysed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: Activated monocyte derived macrophages from RA patients produce significantly higher IL8 mRNA levels than activated macrophages from healthy controls. By contrast, resting RA and control macrophages produce similar levels of IL8 mRNA. Culturing of activated macrophages in the presence of RA or control sera has no effect on the expression levels of IL8 mRNA. No significant differences between RA and control macrophages were observed in the expression levels of IL1beta and alpha(2) macroglobulin mRNAs. CONCLUSION: These data indicate that the increased IL8 mRNA production capacity of RA macrophages upon activation is an intrinsic property of these cells, and is not attributable to factors present in the circulation. Based on these observations, it is postulated that this innate hyper-responsiveness of RA macrophages contributes to the high IL8 levels present in the synovial fluid of rheumatoid joints, and is implicated in the chemotactic gradient leading to the homing of leucocytes to the joints.
9194208 A comparison between bucillamine and D-penicillamine in the treatment of rheumatoid arthri 1997 In order to compare the clinical effect and the frequency of side effect of D-penicillamine and bucillamine, we conducted a randomized, controlled clinical trial. Twenty-two and 24 patients were allocated to each section of the study, respectively. Bucillamine was at least as effective ad D-penicillamine in terms of improvement in the swollen joint count, tenderness score, morning stiffness, modified health assessment questionnaire, and Westergren erythrocyte sedimentation rate (ESR), and more effective in terms of improvement in the tender joint count, grip strength, C-reactive protein (CRP), and rheumatoid factor (RF) titer. In all, 27% of the bucillamine group and 33% of the D-penicillamine group responded; the response rate did not differ significantly between the two groups. The frequency of side effects tended to be lower in the bucillamine group. In conclusion, bucillamine was as effective as D-penicillamine in the treatment of rheumatoid arthritis, and with the former the frequency of side effects tended to be lower.
11703413 Glycoprotein V-specific platelet-associated antibodies in thrombocytopenic patients. 2001 Oct In autoimmune thrombocytopenia, platelet-associated IgG (PA-IgG) frequently displays specificity against glycoprotein (GP) IIbIIIa and/or GP IbIX. Because in a high proportion of patients positive PA-IgG may not be explained by these GP specificities, studies on other target proteins are needed. We studied the presence of GP V-specific PA-IgG by direct monoclonal antibody-specific immobilization of platelet antigens (MAIPA) with the monoclonal antibody SW16. We focused on 69 consecutive random patients with histories of thrombocytopenia who were strongly positive for PA-IgG detected by the direct platelet immunofluorescence test (PIFT). PA-IgG against GP V (ratio > or = 1.5) was noted in 15 (22%) patients. The degree of PA-IgG measured by PIFT, and of GP IIbIIIa-and/or GP IbIX-specific PA-IgG measured by direct MAIPA, correlated directly with the GP V-specific PA-IgG (P < 0.001). In one patient, GP V-specific antibodies were associated with quinidine-induced thrombocytopenia. Although this patient had strongly positive GP V-specific PA-IgG, she remained negative in GP IIbIIIa- and GP IbIX-specific direct MAIPA. Two patients studied because of thrombocytopenia associated with gold therapy had strongly positive GP V-specific PA-IgG. In one patient with rheumatoid arthritis and severe gold-induced thrombocytopenia, the amount of GP V-specific PA-IgG decreased during the recovery phase. Thus, GP V may represent an important target antigen in autoimmune-mediated thrombocytopenia, especially in drug-induced thrombocytopenia.
10606361 Inpatient treatment of rheumatoid arthritis with synacthen depot: a double blind placebo c 1999 Dec OBJECTIVE: To assess the additional benefit of synacthen depot over standard inpatient care for patients hospitalized with active rheumatoid arthritis (RA). METHODS: All patients admitted to our unit with active RA without exclusion criteria were invited to participate and randomized to subcutaneous synacthen depot 0.5 mg on alternate days for 2 injections or 2 injections of saline. Patients, staff, and assessors of response were blinded to the intervention. Assessment [OMERACT set, American College of Rheumatology (ACR) global improvement, dose of intraarticular (IA) or intramuscular (IM) methylprednisolone] was performed at admission to hospital, at discharge, and at 3 and 6 months. Oral prednisone use constituted a protocol violation. RESULTS: Of 137 patients with RA admitted over the period of recruitment, 36 (26%) were enrolled; 31 completed followup. There were no between-group differences in the change from admission of any individual disease activity measure at any time point. However, using a rigorous global response measure (ACR 50%), a difference was detected in favor of synacthen depot at discharge (52.6% of the intervention group improved vs. 17.6% of controls; p = 0.029, number-needed-to-treat 2.86). Patients treated with synacthen depot showed a trend toward more IA or IM corticosteroid between discharge and 3 months (mean dose 56 vs. 31 mg; p = 0.19) and a trend toward more patients requiring a change in slow acting antirheumatic drug after discharge (4 vs. 1; p = 0.27). CONCLUSION: There is some additional benefit of synacthen depot in the hospital treatment of RA, but the effect is lost by 3 months, with a suggestion of rebound worsening in these patients. We postulate that oversuppression of corticotrophin releasing hormone by exogenous adrenocorticotrophic hormone in patients who already have a hypothalamic deficit may contribute to the rebound worsening of disease activity seen in these patients.