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* Background.--Although temporal arteritis is a well-recognized syndrome, controversy still exists regarding the optimal approach to diagnosis and treatment of this condition. We undertook this review to further define the spectrum of presenting features and outcomes of patients undergoing temporal artery biopsy. Methods.--We reviewed the records of all patients undergoing temporal artery biopsy over a 5-year period. Presenting features were compared in biopsy-positive and biopsy-negative patients. In patients with positive biopsy specimens, treatment regimens, disease, treatment-related morbidity, and outcomes were recorded. Alternative diagnoses and therapy were reviewed in biopsy-negative patients. Results.--Of 98 patients, 30 had positive and 68 had negative biopsy specimens. Biopsy-positive patients had an increased incidence of headache (93% vs 62%), jaw claudication (50% vs 18%), and prior polymyalgia rheumatica (23% vs 3%), but the sensitivity and specificity of these indicators were relatively low. Other clinical and laboratory parameters, including prior steroids and erythrocyte sedimentation rate, were similar between the two groups. In 30 patients with positive biopsy specimens, response to initial high-dose steroid was excellent. Serious manifestations after initial treatment were not seen, but mild flares were common after 1 year of therapy. Steroid-related morbidity was common, and steroids were seldom discontinued (0/22 patients at 1 year, 6/19 patients at 2 years, 5/11 patients at 3 years). In 68 patients with negative biopsy specimens, alternative diagnoses included neurologic diseases (15 patients), 'pure' polymyalgia rheumatica (14 patients), and other inflammatory rheumatologic diseases (10 patients). Fourteen patients with negative biopsy specimens were treated for temporal arteritis, and were similar to biopsy-positive patients. Conclusions.--Temporal arteritis remains a challenging condition to diagnose and to treat. Presenting features are seldom helpful in predicting biopsy results. Initial treatment is effective but frequently toxic. Although late disease-related complications are rare, most patients continue to take long-term low-dose steroid therapy. (Arch Intern Med. 1992;152:1690-1695)

The drug methotrexate can prevent the growth of cells, regulate the immune system, and counteract inflammation. Low doses of methotrexate have been used to treat psoriasis (a chronic skin condition), connective tissue disease, rheumatoid arthritis, inflammatory bowel disease, inflammation and thickening of the bile ducts, vasculitis (inflammation of blood vessels), and corticosteroid-dependent asthma. Cases are described of three patients with cutaneous polyarteritis nodosa, an inflammatory disease of the medium and small-sized arteries, and of two patients with Behcet's disease, complicated by pustular vasculitis, or inflammation of blood vessels associated with pus-filled skin lesions. Behcet's disease is a chronic and recurrent condition characterized by formation of ulcers in the mouth and genital organs, inflammation of the iris, and joint pain. These patients were treated with low doses of methotrexate given orally each week. This drug regimen dramatically improved symptoms in all patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract In this retrospective clinical trial, we evaluated the effectiveness of low-dose oral methotrexate in the management of bilateral Meniere's disease of immune-mediated origin. At our tertiary-care referral center, we [...]

Fibromyalgia syndrome is a common, chronic musculoskeletal disorder of unknown aetiology. While available therapy is often disappointing, most patients can be helped with a combination of medication, exercise and maintenance of a regular sleep schedule. The objective of the present study was to determine if adding nutritional supplements derived from the unicellular green alga, Chlorella pyrenoidosa, produced any improvements in the clinical and functional status in patients with moderately severe symptoms of fibromyalgia syndrome. Eligible patients had 2+ palpable tenderness at 11 or more of 18 defined tender points and had a tender point index (TPI) of at least 22. Each day for 2 months, participants consumed two commercially available Chlorella‐based products, 10 g of ‘Sun Chlorella’ tablets and 100 mL of liquid ‘Wakasa Gold’. Any amelioration of symptoms was validated and quantified using semi‐objective and subjective outcome measures systematically administered at clinic visits on days 0, 30 and 60 of the diet therapy. Eighteen of the 20 patients enrolled completed the 2 month trial. The average TPI for the group which at onset was 32, decreased to a mean of 25 after 2 months. This decrease was statistically significant (p= 0.01), representing a 22% decrease in pain intensity. Blood samples taken on each occasion indicated no significant alterations in serum chemistries, formed elements, and circulating lymphocyte subsets. Compilations of the results of patient interviews and self‐assessment questionnaires revealed that seven patients felt that the dietary supplement had improved their fibromyalgia symptoms, while six thought they had experienced no change, and five believed the symptoms had worsened over the time of the trial. The results of this pilot study suggest that dietary Chlorellasupplementation may help relieve the symptoms of fibromyalgia in some patients and that a larger, more comprehensive double‐blind, placebo‐controlled clinical trial in these patients is warranted. Copyright © 2000 John Wiley & Sons, Ltd.

Immune-mediated cochleovestibular disorders continue to present a management challenge to the otolaryngologist. The traditional treatment of these disorders, corticosteroids and/or cyclophosphamide (Cytoxan), has been associated with serious and occasionally life-threatening complications. In this study we report our experience in treating 25 patients with immune-mediated cochleovestibular disorders with methotrexate, a less toxic immunosuppressive agent that has been used extensively in patients with rheumatoid arthritis. Mean duration of treatment was 12.9 months, and adverse reactions were acceptable and reversible. Hearing improved in 69.6% of patients, and vestibular symptoms subsided or improved in 80% of patients. The results of this study suggest that methotrexate treatment is effective in a substantial number of patients with immune-mediated cochleovestibular disorders and has acceptable adverse reactions. A prospective, randomized study is needed to compare the efficacy of methotrexate with that of other immunosuppressive agents. (Otolaryngol Head Neck Surg 1997;116:146-52.)

We sought to assess the impact of recent observations and recommendations on the treatment of rheumatoid arthritis in a university-based rheumatology practice over a recent 6-year period. Data was collected from information recorded in a database by physicians treating patients in outpatient rheumatology clinics. The treatment regimens of all patients with rheumatoid arthritis seen during the first half of 1987 and 1993 were compared. The populations were similar in age, race, and sex distribution, disease duration, and seropositivity. Nonsteroidal anti-inflammatory drug use decreased from 85 to 74, while corticosteroid use increased from 31 to 44 of patients. Second-line agent use increased from 46 to 65 of patients, all of which could be accounted for by the increase in methotrexate use from 11 to 32. The use of other second-line agents remained stable (hydroxychloroquine, auranofin, azathioprine), declined (intramuscular gold, penicillamine), or increased slightly (sulfasalazine). An increase in combination second-line drug therapy from 2 to 6 was noted. This study shows that between 1987 and 1993, our drug therapy for rheumatoid arthritis has become more aggressive: we have increased steroid use, decreased nonsteroidal use, and more frequently used second-line agents, particularly methotrexate.

Immune‐mediated cochleovestibular disorders continue to present a management challenge to the otolaryngologist. The traditional treatment of these disorders, corticosteroids and/or cyclophosphamide (Cytoxan), has been associated with serious and occasionally life‐threatening complications. In this study we report our experience in treating 25 patients with immune‐mediated cochleovestibular disorders with methotrexate, a less toxic immunosuppressive agent that has been used extensively in patients with rheumatoid arthritis. Mean duration of treatment was 12.9 months, and adverse reactions were acceptable and reversible. Hearing improved in 69.6% of patients, and vestibular symptoms subsided or improved in 80% of patients. The results of this study suggest that methotrexate treatment is effective in a substantial number of patients with immune‐mediated cochleovestibular disorders and has acceptable adverse reactions. A prospective, randomized study is needed to compare the efficacy of methotrexate with that of other immunosuppressive agents.