A Study of Treatment in Fifty-Six Cases of Rheumatoid Arthritis

Jack, Thomas (1955) A Study of Treatment in Fifty-Six Cases of Rheumatoid Arthritis. PhD thesis, University of Glasgow.

Abstract

1. A series of fifty six cases suffering from active rheumatoid arthritis has been studied. This series contained samples representing all stages of severity of the disease. 2. The results of simple, inexpensive, treatment given in hospital for a short term ( mean duration 6. 6 weeks ) are presented. Treatment consisted, for the most part, of daily administration of large doses of aspirin, and injections of hyperduric adrenalin given three times a day. Aspirin was given to relieve the pain in the affected joints, and the rationale for the administration of adrenalin was based on the alleged action of this drug on the pituitary adrenal mechanism,and its resultant adrenocortical stimulation. 3. The difficulties which exist in assessing the results of any treatment of rheumatoid arthritis, and the errors which may occur in the assessment of improvement, have been discussed in full. A system has been devised by means of which the results of the individual tests used to assess improvement in functional capacity and in activity of the disease are clearly presented in the individual case records. The classification of improvement recommended by the New York Rheumatism Association has been used to translate the results of these tests into terms which permit comparison between individual cases of the series, and between other series. It is thought that these methods overcome,as far as possible, the errors which may arise in assessment of progress. 4. The relationship between improvement in functional capacity and improvement in activity of the disease in the cases of this series has been studied. In this present work it has been shown that, although these two factors are related, improvement in functional capacity can often occur without commensurate improvement in activity of the disease. The serial cinematographic record which was made in fourteen cases of the series illustrates this point, and shows in addition the marked improvement in functional capacity which occurred in many eases. 5. Considerable improvement in the activity of the disease also occurred in this series. Fifty four per cent of all cases showed major improvement in activity of the disease at the end of all treatment. The importance of grouping the cases of any series according to the severity of the disease before treatment, because severe eases of the disease are, as a general rule, less responsive to treatment, has been confirmed. Sixty seven per cent of the cases of this series in the mild or moderate stages of the disease showed major improvement in activity of the disease at the end of all treatment, whereas only thirty five per cent of the cases in the severe and terminal stages of the disease showed similar improvement. 6. An attempt has been made to discover if the admininistration of hyperduric adrenalin,in addition to the giving of large doses of aspirin,secures additional therapeutic benefit. This has not been proved in a statistical sense, although the results in some individual cases, appeared to indicate that adrenalin gave some added benefit. 7. Biochemical and other studies were carried out in an attempt to ascertain if the administration of adrenalin resulted in adrenocortical stimulation. There was no biochemical evidence to support this concept, but the results of serial eosinophil counts in some cases support the possibility. 8. The difficulties which exist in the comparison of the results of one series of cases of rheumatoid arthritis given a certain form of treatment and the results of another series given the same or different treatment, have been explained. As far as possible the results in this series have been compared with the results of some of the other workers on this subject, who used different forms of treatment. 9. A follow-up record of each ease was kept when possible. The number of cases who did not return as outpatients makes any conclusion regarding the long term effects of this treatment impossible. In those cases who did return, it would appear that treatment in hospital by the method used gave no lasting benefit.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Medicine, Immunology
• Date of Award: 1955
• Depositing User: Enlighten Team
• Unique ID: glathesis:1955-79149
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 05 Mar 2020 11:38
• Last Modified: 05 Mar 2020 11:38
• URI: https://theses.gla.ac.uk/id/eprint/79149