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Praise to our deficiencies.

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1532
LETTERS
Table 2. Correlations between markers of inflammation and cytokine levels measured at the time of peak inflammatory activity, in
patients with juvenile rheumatoid arthritis*
95% CI
P
0.507
0.729
(0.232, 0.707)
(0.537. 0.849)
0.007
<0.001
0.407
0.397
0.591
(0.109, 0.638)
(0.098, 0.631)
(0.339, 0.764)
0.026
0.042
0.001
(-0.609, -0.063)
(-0.734, -0.268)
(-0.794, -0.412)
0.050
0.004
<0.001
r-F
CRP versus
sIL-~R
IL-6
ESR versus
sTNFR
sIL-~R
IL-6
Hem0 lobin versus
~~
ST&R
sIL-2R
IL-6
Platelet count versus
sIL-2R
IL-6
-0.367
-0.541
-0.641
0.406
0.421
(0.099, 0.642)
(0.126, 0.648)
~~
0.041
0.023
~
* Only the significant correlations (P5 0.05) are shown. See Table
1 for definitions.
Pearson’s correlation coefficient.
t
were actually compared using the nonparametric U test, as
stated in the Patients and Methods section. Unfortunately, in
the Results section these data were erroneously reported as
having been derived from a Student’s t-test. We apologize
for this error.
Detailed clinical scoring was performed only with the
patients who were followed up, and studies are under way to
further document the relationships between serum cytokine
levels and the clinical course of JRA. Nevertheless, a
sequential analysis of data on all JRA patients revealed that
changes in C-reactive protein values, erythrocyte sedimentation rate, and serum iron levels were paralleled by corresponding changes in levels of soluble tumor necrosis factor
receptor, interleukin-1 , and interleukin-6 in individual patients (data not shown).
Harald Mangge, MD
Konrad Schauenstein, MD
University of Graz School of Medicine
Graz, Austria
Praise to our deficiencies
To the Editor:
In reference to Atkinson’s beautiful treatise “Some
Thoughts on Autoimmunity” (Atkinson JP: Some thoughts
on autoimmunity. Arthritis Rheum 38:301-305, 1995), I offer
a thought on immune deficiencies:
Praise to our deficiencies
Immune and all the rest.
Without them would we e’er evolve
To be our very best?
for
Aren’t we but our virions,
Collective and refined,
With metamorphosed cytosol
That calls itself mankind?
Robert G. Hylland, MD, FACR
Muskegon, MI
BOOK REVIEW
Nonsteroidal Anti-inflammatory Drugs: Mechanisms and
Clinical Uses. Second edition. Edited by Alan J . Lewis and
Daniel E. Furst. New York, Marcel Dekker, 1993. 488 p p .
Illustrated. Indexed. $195.00.
This text describes clinical applications of nonsteroidal antiinflammatory drugs (NSAIDs) in rheumatoid arthritis
and osteoarthritis, and provides an update on mechanisms
of action. Newer uses, such as for treatment of migraine,
adult respiratory distress syndrome, and strokes, as well as
topical application and over-the-counter application of these
important agents, are discussed. There are 4 sections with a
total of 24 chapters, each written by different contributing
authors.
The first section on clinical application discusses the
effects of NSAIDs and corticosteroids on cartilage metabolism,
rheumatoid arthritis, and osteoarthritis. It is an excellent review of the different pathways thought to be involved in the
synthesis and degradation of articular cartilage extracellular
matrix and the effects that these drugs have on the pathways.
It also contains an excellent discussion of the effectiveness of
NSAIDs in the treatment of osteoarthritis and rheumatoid
arthritis. There are comprehensive, well-written chapters on
NSAID use in migraine, adult respiratory distress syndrome,
strokes, and topical application, as well as a discussion of
enantiomers. Lacking in this section is a detailed discussion of
NSAID dosage. The chapter on over-the-counter use presents
an excellent historical review of the evolution of salicylates and
acetanilid. The authors give their personal viewpoint regarding
over-the-counter analgesics and do not adequately present a
balance of other available data.
The second section of the text, concerning the toxicity of NSAIDs, is comprehensive and well written. There
are chapters on small intestines and colon toxicity, hepatic
injury, and renal toxicity. In the chapter, “Rare Side Effects,” there is some duplication of the discussion of hepatic
toxicity, renal, and gastrointestinal toxicity.
The third section of the book is entitled, “New
Anti-inflammatory Drugs and Analgesics.” The discussion
of drugs in development is extensive and is meaningful to
pharmacologists and clinical investigators. However, the
chapter on ketorolac does not present a balanced discussion
of the drug. The fourth section reviews future therapy for
arthritis. It is well presented and informative. These therapies include leflunomide, pravadoline, romazarit, tilomisole,
zileuton, 1x2074387, and E5090.
This text should be of importance to clinical investigators and physicians interested in rheumatology, and
should serve as an excellent reference for those who are
looking for newer information on NSAIDs.
Abraham Sunshine, MD
New York, N
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