Læknablaðið : fylgirit - 01.07.1978, Blaðsíða 96

effect of certain vaccines and to stabilise
tumour remissions. In animals with
certain spontaneous immune deficiency
diseases it appears to have a favourable
effect and in certain animals this appears
to be mediated by a serum factor which
can be detected in only these animals
which respond. This serum factor has
the same effect as the drug when injeeted
into untreated animals.
Levamisole has been used to treat a
variety of clinical disorders in whicli
immunological disturbances are present,
such as: chronic and recurrent infections,
primary and secondary immune deficiency
states, allergic disorders, neurological,
gastrointestinal and rheumatie diseases,
and tumours (Symoens and Rosenthal,
1977). In rheumatoid arthritis the
majority of clinical trials have shown
superiority of levamisole compared to
placebo (Trabert, Rosenthal and Mueller,
1976), and thus has been our own
experience (Dr. A.F. El-Ghobarey,
unpublished observations). In most studies
clinical improvement occured after three
months treatment. Huskisson et al (1976)
compared levamisole with D-penicillamine
in a double blind, controlled trial in
patients with rheumatoid arthritis, and
found both drugs to be equipotent. We
have similar results comparing levamisole
with gold (Dr. A.F. El-Ghobarey,
unpublished observations.). Goebel et al
(1977) have recently reported clinical
benefit in patients with ankylosing
spondylitis.
Levamisole is not without its toxicity
and leucopenia and thrombocytopenia are
the most serious side effects. Clearly
this drug is an important new discovery
for the clinical rheumatologist, but further
evidence will be required before its true
place in the management of patients with
rheumatoid arthritis can be determined.
Surgery
The major advance in medicine has been
the artificial replacement of the human hip.
The replacement of knee joints is probably
as good as will be achieved. We have
only limited experience with replacements
of other joints. Probably thé best results
are obtained with motatarsal head
resection. Results of reconstructive
surgery of the hand are less dramatic.
Health planners are preoccupied with
the costs of delivering all the orthopaedic
surgery now required, but it is salutary
to remember that there are also oconomic
benefits to be derived from medical and
surgical treatment. We have shown that
these benefits outweigh the costs in
treating patients with rheumatoid arthritis
in hospital (Nuki et al, 1973). Perhaps
it is not so surprising that the first cost
benefit analysis was carried out in the
city which published Adam Smith'"s famous
treatise, A Wealth of Nations.
References
1) Alvarez, A.S. and Summerskill,
W. H.J. (1958) Lancet 2, 920
2) Ansell, B.M. (1969) Prescribers'
Journal 8, 120
3) Askari, A. , Moskowitz, R.W. and
Ryan, C. (1974) Arthr. Rheuma.
17, 263
4) Aylward, M., Maddock, J., Wheeldon,
R. and Parker, R.J. (1975) Rheum.
Rehab. 14, 101
5) Baillie, L. , Buchanan, W.W. and
Dick, W.C. (1974) Health Bull.
(Scott. Home Hlth. Dept.) 32, 78
6) Baker, H. (1966) Brit. J.
Dermatol. , 78 , 161
7) Baragar, F.D. and Duthie, J.J.R.
(1960) Brit. Med. J. , 1 , 1106
8) Barber, R. (1973) King Arthur
in Legend and History,
Cardinal, London
9) Bernstein, H.N. and Ginsberg, J (1964)
Archiv. Ophtal. , 71 , 238
10) Boardman, P. L. and Hart, F.D. (1967)
Ann. Rheum. Dis. , 26, 127
11) Brooks, P.M. and Buchanan, W.W.
(1976) Curr. Med. Res. Opin.,
4, 94
12) Brooks, P.M. , Bell, M.A., Sturrock,
R.D., Famey, J.P. and Dick, W.C.
(1974) Brit. J. Clin. Phf.rmac,
1, 287
13) Brooks, P.M., Walker, J.J., Bell,
M.A., Buchanan, W.W. andRhymer,
A.R. (1975) Brit. Med. J., 3,
69
94