Effect of stilboestrol on levels of uric acid in plasma and urine.
Authors: A Nicholls, M L Snaith, H Yablonsky, J T Scott
Journal: Annals of the Rheumatic Diseases (1973)

DR. F. DUDLEY HART (London) This interesting com- pound definitely does produce therapeutic benefit.The side-effects are the problem.Would Dr. Golding say that these side-effects all recover and, if you re-start reappear to disappear again on stopping?How long do you go on doing this?How often do you think it is safe to re-start?DR.GOLDING This is a question ofcardinal importance.Our conclusions are as follows: if a patient develops albuminuria, thrombocytopenia, or rash we withdraw the drug and wait until the side-effect has completely gone.We then very cautiously re-introduce penicillamine, but if the same side-effect returns we regard that as a final warning and do not give the patient the drug under any circumstance in the future.All patients recovered.PROF.V. WRIGHT (Leeds) I am very much interested in the functional index that Dr. Golding referred to, because if we don't have a cure, in the final analysis it is the function that is all important.What intrigued me was how one obtained standardization between five units doing occupational therapy assessment?DR.GOLD I NG The functional index worked out as follows.Patients were asked to perform 64 simple tasks, either at home or outside, and they were scored according to whether they could do it easily, with difficulty, or not at all.We did not find that standardization between the five groups was a problem.It needs improving but we are reasonably well satisfied.DR.J. T. SCOTT (London) There was an overall fall in titre of rheumatoid factor.Was there a correlation be- tween this and clinical improvement in individual patients ?D R. G O LD I N G Not particularly.DR.B. MC CO N KEY (Birmingham) Do these results mean that quite a lot of patients did fairly well or that a small number of patients did very well?Can you give me some idea of the proportions?D R. GOLD ING There was a very wide spectrum between those who did extremely well and those who did moderate- ly well.All grades of improvement are shown.DR.H. L. F. CURREY (London) If this drug is effective in rheumatoid arthritis a lot of interest obviously attaches to its mode ofaction.We have looked at this in the laboratory and I should like to report very briefly if I may some work of Dr. Liyanage.We gave rats D-penicillamine by mouth in courses lasting up to 21 days and in doses up to over ten times the human dose (doses which exceeded the rat LD50) and we were able to show absolutely no suppres- sion whatsoever of adjuvant arthritis or indeed of con- ventional minimum response or of nonspecific inflam- matory responses in these rodents.This is in striking contrast to results obtained in the same model using drugs such as azathioprine and cyclophosphamide where one can quite easily suppress the disease by doses comparable to those used clinically in treating rheumatoid arthritis.So this would suggest that, if this drug is effective in rheumatoid arthritis and if the rodent model has any relevance to this, penicillamine works in a different manner from the so-called immunosuppressive drugs.DR.I. A. JAFFE (U.S.A.) In response to your question about the titres, that is exactly what we reported initially.That is to say there is a latent period after treatment has begun, before the titre drops.We agree completely with