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A previously-described documentation system for articular examination was applied to evaluate the results of spa treatment in 20 patients with rheumatoid arthritis during 3 separate treatment periods. Physical joint findings were documented and indices were compiled by means of a computer before, during and after treatment with thermal water the first year, normal water the second year (or vice versa) and without baths at all in the third year. These indices were compared statistically. Each kind of treatment produced a statistically-significant improvement in the disease, there being no significant difference in the results achieved by the 3 therapeutic regimens.

61 patients with rheumatoid arthritis received a total of 80 courses of immunosuppressive therapy with one or more of the following substances: azathioprine, chlorambucil, mannitolmustard, cyclophosphamide, procarbazine. The overall results were excellent or good in 50% of the patients. There was a significant correlation between the efficacy of the different substances and the rate of side effects. Azathioprine was best tolerated, but gave only medium results whereas procarbazine, as a very potent drug, had the highest rate of side effects (especially depression of bone marrow, infections, gastrointestinal manifestations etc.). Serious immediate side effects of the immunosuppressive therapy according to our experience and in literature are infections and leucopenia, whereas the most important late risk is the possibility of an occurrence of malignancy. In our series, which had been followed up to five years, no malignancies have been thus far detected. Also, in the literature, there are only very few patients with malignancies published. Therefore the risk of immunosuppressive therapy in rheumatoid arthritis with regards the incidence of malignancies, seems to be relatively small in contrast to the findings in patients with kidney transplants.

One hundred and fifty patients with rheumatoid arthritis received 6 mg of auranofin daily for 2-24 months. Thirty patients were withdrawn from the study, and 82 patients were observed for 12 months. Statistical evaluation was available for 74 patients at weeks 24, 38, and 48, respectively. The major side effects observed were diarrhea, rash, and alopecia. Significant improvement was noted in the articular index, ESR, pain, and morning stiffness.

Twenty-nine synovial fluids from patients with rheumatoid arthritis (RA) and 10 synovial fluids from patients with other joint diseases were investigated with regard to the presence of antibodies to denatured human collagen and of collagen-anticollagen immune complexes. 12 of the 29 RA synovial fluids showed anticollagen titres from 1:16 to 1:512 in passive haemagglutination. Only one patient in the group with no arthritis had a significant anticollagen titre of 1:32. Digestion of the synovial fluids with bacterial collagenase resulted in an anticollagen titre increase from two to four dilution steps in 9 of the RA fluids, while 6 previously negative RA synovial fluids showed anticollagen titres from 1:32 to 1:28 after digestion with collagenase. These results indicate the existence of collagen-anticollagen immune complexes in 15 of the 29 RA synovial fluids investigated.

The results of the radiosynoviorthesis with yttrium-90 silicate in 36 joints, are reported. In comparison to the radiogold therapy in 64 joint, yttrium-90 was a little more effective. Additionally, the body distribution of radioactive yttrium after radiosynoviorthesis of knee joints, was measured in 6 patients. It could be shown that the uptake of the regional lymphnodes was between 4 and 5% of the yttrium administered. The radiation dose of the regional lymphnodes certainly exceeds 1000 rad. The results point to the importance of a careful selection of patients for radiosynoviorthesis.

The clinical features of 6 patients with symptoms of various connective tissue diseases and rheumatoid arthritis are reported. The frequency of symptoms corresponded to that of the syndrome, which Sharp et al. (1971) termed mixed connective tissue disease. The antibodies to an extractable nuclear antigen are a characteristic feature. Moreover, one may detect a speckled staining pattern by indirect immunofluorescence. In addition, moderate immunoglobulin deposits were observed in the skin and kidneys of our patients. The pathomechanism of these deposits is discussed.

Non-steroidal antirheumatic drugs permit a nonspecific, symptomatic therapy of inflammatory rheumatic processes and may also be given for a limited period of time in patients with so-called activated osteoarthrosis. Their mode of action is a complex one. More recent knowledge on mediators in inflammation such as prostaglandins, leukotriens and oxygen radicals have brought new insights on the mode of action of non-steroidal antirheumatic drugs.

By means of the exploration of patients suffering from an active, unequivocal rheumatoid arthritis it was possible to show the unequivocal, and antiinflammatory effect of 4-phenyl-1,2-diphenyl-3,5-pyrazolidinedione (feprazone, Zepelin). Moreover, it was documented that thermography is a very suitable medium to furnish proof of this effect and can be used to the advantage of the patients in clinical routine. The physiological processes of the production and distribution of heat must be taken into account to avoid false interpretation of thermograms.