In a multicenter, placebo-controlled and randomized double-blind trial 119 patients with rheumatoid arthritis were treated with thymopentin, an immunoregulating drug. The data of 107 patients were complete enough to be evaluated: 51 were given intravenous injections over ten minutes of 50 mg thymopentin three times weekly, 56 were similarly treated with a placebo solution. Significant improvement of five among nine clinical criteria were obtained with thymopentin after the third week of treatment. The response rate (improvement of a clinical parameter by at least 40%) was significantly greater for all clinical parameters in the thymopentin group. Regression to a functionally more favourable class (Steinbrocker's classification) occurred in seven thymopentin-treated, but in none of the placebo-treated patients. The improvement gradually subsided over four weeks after the end of treatment. There were no changes during the trial with respect to immunological, biochemical or haematological findings. Except for one systemic allergic reaction there were no side effects.

The outpatient treatment of rheumatoid patients in Germany depends on certain conditions. Rheumatologists in Germany need to cooperate much more with hospitals specialized in this field than other subspecialties of Internal Medicine. Because of historical reasons many other physicians such as orthopedics, internists, general practitioners participate in this field in contrast to our neighbours in the western hemisphere, where rheumatology is solely covered by rheumatologists. It is therefore conceivable to calculate a rheumatologists/population relation of appr. 1:200,000 and not less than this figure. Starting a business as rheumatologist needs certain conditions, which are specified. One major challenge will be the new law directing out-patient treatment in Germany (Gesundheitskontrollgesetz). It forces the doctor to relate his work to a more financial background with various restrictions and regulations. In this context our goal(s) must be the institution of a specified position in the "Gebührenordnung", to pay for our intense and time consuming efforts to treat our patients.

The outpatient treatment of rheumatoid patients in Germany depends on certain conditions. Rheumatologists in Germany need to cooperate much more with hospitals specialized in this field than other subspecialties of Internal Medicine. Because of historical reasons many other physicians such as orthopedics, internists, general practitioners participate in this field in contrast to our neighbours in the western hemisphere, where rheumatology is solely covered by rheumatologists. It is therefore conceivable to calculate a rheumatologists/population relation of appr. 1:200000 and not less than this figure. Starting a business as rheumatologist needs certain conditions, which are specified. One major challenge will be the new law directing out-patient treatment in Germany (Gesundheitskontrollgesetz). It forces the doctor to relate his work to a more financial background with various restrictions and regulations. In this context our goal(s) must be the institution of a specified position in the ''Gebuhrenordnung'', to pay for our intense and time consuming efforts to treat our patients.

Corticosteroids exert an acute analgetic and antiphlogistic effect in rheumatoid arthritis. These effects have favoured the use of dosage regimens in the past which must be designated as an overtreatment. There are clues that low dose corticosteroids given over a longer period of time may be effective with a justifiable risk of side effects; besides, they may possibly have a disease-modifying effect. The NSAIDs as a therapeutic alternative to suppress the inflammatory activity while awaiting the delayed effect of SAARDs is burdened with a high risk of side effects. A multicentre double-blind placebo-controlled clinical trial is under way, in order to test the hypothesis that low-dose prednisolone exerts disease-modifying effects. Furthermore, the question is discussed whether low-dose prednisolone results in a reduced NSAID consumption and hence, fewer gastrointestinal side effects, and which groups of patients have the highest benefit.

Although randomised controlled comparative trials concerning the efficacy of the drug tested can produce reliable results in a limited number of selected patient groups, drug monitoring studies involving 10,000 patients or more are the methods of choice to detect rare adverse events. The aim of this drug monitoring study was to evaluate the efficacy and safety of dispersible nabumetone tablets. 8865 patients (46.2% male, 53.5% female, mean age 55 years, range 14.95) were involved in the investigation carried out by 1172 general practitioners. The disease indications comprised osteoarthritis (69.8%), soft-tissue rheumatism (11.3%), rheumatoid arthritis (9.9%) and soft tissue injuries (7.7%). Most of the patients (67.3%) received a daily dose of nabumetone 1 g for up to 6 weeks. Efficacy was evaluated at baseline, and after 1 week, 3 weeks and 6 weeks of treatment. With regard to global efficacy, overall improvement (symptoms resolved or markedly improved) was assessed in 82% of the patients. Elimination or at least significant improvement of pain on movement occurred in 95%, pain on pressure in 90% and pain at rest in 89% of the patients with symptoms. In relation to swelling, morning stiffness and joint mobility, elimination or at least significant improvement occurred in 79%, 80% and 82% of patients, respectively. 1846 patients (20.8%) had frequent periods of NSAID-related symptoms before treatment with nabumetone. A total of 1174 adverse events occurred in 850 patients (9.6%), most comprising minor gastrointestinal complaints. Considering that at least 25,000 patients have been documented in 2 German drug monitoring studies, it is therefore unlikely that any unexpected side effects will occur in the future. Consequently, nabumetone can be classified as an effective and safe NSAID.

A variety of clinical syndromes, including AIDS and neurological disorders, may follow as a consequence of infection with the human immunodeficiency virus type 1 (HIV-1). It is not yet clear, however, to what extent the destruction of lymphocytes and neural cells associated with these conditions is caused by adverse immune responses to HIV-1 or how much is due to cytopathic effects of the virus itself. Here we document the existence of HLA-restricted, HIV-1-specific cytotoxic T lymphocytes in the cerebrospinal fluid of two AIDS patients manifesting neurologic disorders. These cytotoxic T lymphocytes showed dual specificity, recognizing target cells coated with purified HIV-1 envelope glycoprotein (gp 120) or inactivated HIV-1 in the context of HLA antigens. Cytotoxic T-cell clones derived from one of the AIDS patients revealed restriction specificities representing both HLA class I and HLA class II antigens. Considerable phenotypic heterogeneity was observed amongst these clones, some expressing conventional combinations of cytotoxic T-cell surface markers, and others displaying unusual phenotypes. The presence of HIV-specific cytotoxic T lymphocytes in AIDS patients, and in particular in their cerebrospinal fluid, suggests that these cytotoxic effectors may participate in the lymphoid cell and/or neurologic damage observed in such patients.

In an open, controlled study we treated 55 patients suffering of psoriatic arthritis (PsA), 29 patients suffering of Bechterew's disease (MB) and 16 patients with Reiter's syndrome with Salazopyrin at a daily dosage of 2000 mg. We monitored the following criteria of activity: duration of morning stiffness, joint index, global well being scored by the patient and erythrocyte sedimentation rate. All these criteria improved during the treatment; there was a profound improvement in the RS group, whereas the MB group showed only a slight improvement; the PsA group ended between this two extremes. The effect of the drug appeared between week 5 and 15 of treatment. 21% of all patients had to discontinue the treatment because of severe side effects; this figure correlates with the percentages given in the literature. Most of these side effects appeared from week 3 to week 7 of treatment; after week 15 none of the patients had to discontinue the medication of because of severe side effects.

17 patients with progressive systemic sclerosis were examined for cardiac involvement using standard ECG, chest X-ray, 24-h Holter ECG, and echocardiography. The control groups consisted of 7 patients with mixed connective tissue disease, 10 patients with systemic lupus erythematosus, and 10 patients with rheumatoid arthritis. The results disclosed a cardiac involvement of 70% using all 4 methods, which is more than is reported in the literature. The data also show that all 4 methods are necessary to diagnose the cardiac involvement. Conduction and rhythm disorders especially are more frequent than in other collagen vascular diseases. The use of calcium channel blockers is discussed as a new therapeutic possibility.