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We determined serum alpha 1-antitrypsin phenotypes and levels in 281 patients with classical or definite rheumatoid arthritis (RA). The prevalence of the MZ phenotype in our patients with RA was not increased, as there were only 3 MZ cases (1.1% of all cases and 1.4% of seropositive cases) compared to the 3% prevalence in controls. The FM phenotype was detected in 6 cases, a prevalence rate of 2.1%, significantly higher than in controls (prevalence less than 0.4%). Increased serum levels of alpha 1-antitrypsin were independently associated (p less than 0.01) with the presence of wrist joint erosions and the use of gold and/or penicillamine for treatment; this association may represent a serum antitrypsin response to more severe disease.

HL-A antigens were determined in Haida and Bella Coola native Indians, two communities known to have a high prevalence of ankylosing spondylitis. Tests were conducted on those with x-ray evidence of sacro-iliitis and on a sample of the community at large. Sacro-iliitis was found to prevail in approximately 10 per cent of adult Haida males and in over two per cent of Bella Coola adult males. Of 20 Haidas with sacro-iliitis, 17 were HL-A 27 positive. Fifty per cent of the Haida community at large were HL-A 27 positive. Three Bella Coolas known to have sacro-iliitis were all HL-A 27 positive, while 25 per cent of the community sampled at large were HL-A 27 positive. About one in five adult Haida males who were HL-A 27 positive showed evidence of sacro-iliitis, a proportion close to that ascertained in Caucasian communities. It would appear, therefore that the risk of disease in HL-A 27 positive Bella Coola males is considerably lower.

HL-A antigens were determined in Haida and Bella Coola native Indians, two communities known to have a high prevalence of ankylosing spondylitis. Tests were conducted on those with x-ray evidence of sacroiliitis and on a sample of the community at large. Sacroiliitis was found to prevail in approximately 10% of adult Haida males and in over 2% of Bella Coola adult males. Of 20 Haidas with sacroiliitis. 17 were HL-A 27 positive. Fifty percent of the Haida community at large were HL-A 27 positive. Three Bella Coolas known to have sacroiliitis were all HL-A 27 positive, while 25% of the community sampled at large were HL-A 27 positive. About one in five adult Haida males who were HL-A 27 positive showed evidence of sacroiliitis, a proportion close to that ascertained in Caucasian communities. It would appear, therefore that the risk of disease in HL-A 27 positive Bella Coola males is considerably lower.

PA radiographs of hands and wrists from a randomized 6 month study of auranofin (AF) vs placebo followed by 6 months of open AF were scored for progression of erosive disease by 2 independent readers. The readers were blinded both to treatment and sequence (month 0 vs month 12) of the films. The results of our study demonstrate a reduction in the advancement of erosive disease during AF therapy compared to placebo.

Patients with low back pain who were found to have a leg length discrepancy were treated with a lift to the shoe on the short side. A small group of such patients with longstanding pain had major or total relief over a long period of followup. Clinical characteristics of the low back pain symptoms were distinctive. A useful method to establish leg length discrepancy clinically is described.