Clinical measurement of the anti-inflammatory effects of salicylates in rheumatoid arthritis.

Abstract

Salicylates in relatively low dosage modify certain components of the inflammatory reaction in animal experiments (Adams and Cobb, 1963).Theoretically they may be used in rheumatoid arthritis to promote the relief of pain or for their anti- inflammatory effect.It is important to determine whether there is a different dose-response relationship for each of these characteristics.The cardinal signs of inflammation-pain, heat, redness, and swelling-are the indices available for the direct clinical assess- ment of inflammatory activity in rheumatoid arthritis.Pain is subjective and difficult to quantitate.Joint heat was studied by Smyth and Clark (1957) and by Vaughn, Howell, and Kiem (1959); it was found to be of little value.The latter authors also found redness an unsatisfactory index for assessment.Hart and Clark (1951) introduced the method of standard jewellers' rings for the measurement of joint size, by which accurate serial recordings could be made.Fremont-Smith and Bayles (1965) investigated the effect of high dosage of salicylate in 11 patients in hospital with rheumatoid arthritis.Aspirin was given orally in increasing quantity over a five-day period until the largest tolerated dose was reached-on average, 5.2 g./24 hours.In most cases dosage increase was stopped because of tinnitus or deafness.Potent analgesics without anti-inflammatory action were then abruptly substituted.An increase in joint size, measured by standard jewellers' rings, and deterioration of grip strength, symptoms, and other indices followed rapidly the withdrawal of aspirin.They concluded that all patients with active rheumatoid arthritis, whether it was mild or severe, should receive salicylates regularly in the largest tolerated dosage in the absence of obvious contraindications.Because of side- effects "blind" techniques and quantitation of the changes were not attempted.* Westminster, Hospital London S.W.1.