724 treatment of reactive arthritis. Scand J Rheurnatol Suppl67:7679, 1988 9. Nissila M, Lehtinen K, Leirisalo-Rep0 M, Luukkainen R, Mutru 0, Yli-Kerttula U: Sulfasalazine in the treatment of ankylosing spondylitis: a twenty-six-week, placebo-controlled clinical trial. Arthritis Rheum 31:1111-1116, 1988 10. Frazer SM, Sturrock RD: Evaluation of sulphasalazine in ankylosing spondylitis: an interventional study. Br J Rheumatol 29~37-39, 1990 11. Farr M, Kitas GD, Waterhouse L, Jubb R, Felix-Davies D, Bacon PA: Sulphasalazine in psoriatic arthritis: a double-blind placebo-controlled study. Br J Rheumatol 29:4649, 1990
Association of anti-topoisomerase I with cancer We have previously reported an association be1ween the presence of anti-topoisomerase I and cancer in patients with scleroderma (1). We are currently providing followup care for 148 patients who meet the American College of Rheumatology (formerly, the American Rheumatism Association) criteria for the classification of scleroderma (2). Thus far, 7 of 36 anti-topoisomerase I-positive scleroderma patients have had cancer, compared with 2 of 112 negative for anti-topoisomerase I (2 = 11.94, P = 0.0005, odds ratio 13.27, at 95% confidence limits 2.33-57.5). The antibody was present in all of these patients prior to the diagnosis of cancer. Of the 7 anti-topoisomerase I-positive scleroderma patients with cancer, 4 had lung cancer, 1 had colon cancer, 1 had lymphocytic lymphoma, and 1 had metastatic brain cancer, with the primary site unknown. Three were men and 4 were women; their ages ranged from 33 to 61 (mean 50). Of the 2 scleroderma patients without anti-topoisomerase I who developed cancer, 1 patient had ovarian carcinoma 1 year prior to the diagnosis of scleroderma and the other tleveloped oral cancer 10 years after a diagnosis of CKEST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias). Both patients were women; their ages were 62 and 57 at the time of the study. Because of this association of anti-topoisomerase I with cancer, we carried out a study of patients with active cancer without scleroderma, assessing the presence of antitopoisomerase I.. The following patients were studied: 52 with breast cancer, 50 with lung cancer, and 50 with colon cancer. Control subjects were 50 consecutive patients with osteoarthritis and 51 spouses of the cancer patients. ‘There were 86 female and 66 male cancer patients, whose ages ranged from 29 to 93 (mean 63). There were 70 female and 31 male controls, whose ages ranged from 42 to 83 (mean 64). An enzyme-linked immunosorbent assay for antitopoisomerase I was carried out using purified, enzymatically active calf thymus topoisomerase I, as previously described (3). All control subjects answered a questionnaire in which a current or previous cancer was ruled out, except for 1 osteoarthritis patient and 5 spouses who, at the time of our study, had had no evidence of cancer for a period of 5-30 years after treatment.
CONCISE COMMUNICATIONS All of the sera from the cancer patients and from the controls were negative for anti-topoisomerase I. Thus, it appears that while anti-topoisomerase I is associated with the development of cancer in scleroderma patients, it is not associated with cancer in patients without scleroderma. Supported by NIH grants AM-AR20621 and AM-AR37986 and by a grant from the Department of Surgery, University of Connecticut School of Medicine.
Naomi Rothfield, MD Scott Kurtzman, MD Dolores Vazques-Abad, MD Carolyn Charron, RN Leslie Daniels, MS Bernard Greenberg, MD University of Connecticut School of Medicine Farmington, CT
I . Weiner ES, Earnshaw WC, Senecal J-L, Bordwell B, Johnson P,
Rothfield NF: Clinical associations of anticentromere antibodies and antibodies to topoisomerase 1: a study of 355 patients. Arthritis Rheum 31:37&385, 1988 2. Subcommittee for Scleroderma Criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee: Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23581-590, 1980 3. Hildebrandt S, Weiner E. SenCcal J-L, Noell S, Daniels L, Earnshaw WC, Rothfield NF: The IgG, IgM, and IgA isotypes of anti-toposomerase 1 and anticentromere autoantibodies. Arthritis Rheum 33:724-727, 1990
Severe anemia associated with active systemic-onset juvenile rheumatoid arthritis successfully treated with recombinant human erythropoietin: a pilot study A microcytic anemia very often accompanies active juvenile rheumatoid arthritis (JRA), and the degree of anemia and microcytosis has been shown to correlate with disease activity ( I ) . Recently, a recombinant DNA-derived human erythropoietin (rHuEPO) has been made available through genetic engineering, and its therapeutic efficacy in the treatment of anemia associated with chronic renal failure has been established (2). Early trials have also shown that this drug can increase the hematocrit level in adult patients with RA (3). We conducted an open prospective study of the efficacy and tolerability of rHuEPO in correcting the severe anemia associated with active systemic-onset JRA. The therapeutic protocol consisted of 2-5 weekly subcutaneous or intravenous (IV) injections of rHuEPO (Eprex 4000; Cilag AG, S c h a a u s e n , Switzerland). The study was originally planned for a 3-month treatment period, as well as a longterm observation period for maintenance in those who responded.