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The value of spa treatment of rheumatic disease is an established feature of medical management based on experiences for many centuries. The author has been practising the balneotherapy of rheumatic diseases at Misasa Spa for several years, and has found this therapy efficacious in many cases in relieving the anemia that accompanies rheumatoid arthritis. For this reason, the author is investigating the metabolism of iron in rheumatic anemia, which is expected to occur in the course of the spa treatment. In this report, the results of clinical examinations of 24 patients with rheumatoid arthritis, of the type (2. 2. 2.) Polyarthritis systemica chronica (in Prof. Kodama's classification of arthritis), are described. I. Some observations of anemia in rheumatoid arthritis 1. The peripheral blood The number of erythrocytes is 266×10(4)～455×10(4)/c. mm. (average: (381±32)×10(4)/c. mm.), Hb-content : 55～90% (average : 76±5.8%), and the color index is about 1.0. The anemia of rheumatic disease treated is mostly normochromic. The white blood count is between 3240 and 13300/c. mm. (average: 6421±955/c. mm. ), and the number of the leucocytes in 80% of the cases ranges within the normal limits. Eosinophilia is observed in 15% of the cases. 2. Anemia-producing substance in the serum of rheumatoid arthritis When serum from rheumatoid arthritis patients was injected into rabbits, the number of erythrocytes and the hemoglobin -content of the rabbits was found to decrease markedly for 2～6hours after the injection. But no such effect was observed when the serum of healthy subjects was injected. From this, the author presumes the presence of an anemia-producing substance in the serum of rheumatoid arthritis. The nature of this substance in now under investigation. II. Clinical-biochemical studies 3. Gastric acidity of rheumatic patients Of 7 cases examined, anacidity of gastric juice was observed in 2 cases, subacidity in other 2 cases and normacidity in the remaining 3 cases. Thus, a decrease in the gastric acidity was found to occur in 57% of the cases. 4. Takata-serum-test and sedimentation rate It is said that the sedimentation rate and the Weltmann-reaction are very sensitive indicators of the extent of the activity of rheumatic disease. The Takata-serum-test was applied in 18 cases and was found to give positive results in 10 cases (55%). The sedimentation rate was found to increase in 17 of 20 cases (85%). 5. Blood uric acid As is well known, the concentration of uric acid is abnormally high in the blood of patients with gout; while, according to the literature, the blood uric acid levels of patients with rheumatoid arthritis range within the normal limits. The author, using the method of Benedict, obtained the following results for blood uric acid in 14 normal subjects in fasting state: Range - 2.30～3.47mg./dl. , 5% rejection limit -- 1.97～3.68mg./dl. In 5 of 7 cases of rheumatoid arthritis, the blood uric acid levels were shown to be above the upper limit of the normal range, but the concentrations of blood uric acid of non-rheumatic joint diseases and neuralgias were mostly within the normal range. 6. Blood sugar The fasting blood sugar levels of rheumatoid patients ranged from 82 to 1l0mg./dl. (average : 100mg./dl.), higher than the levels of healthy subjects (78～108mg./dl., average : 90mg./dl.). The intravenously injected glucose load test was applied to 8 rheumatoid patients. A solution of 40 ml. of 20% glucose was injected into a fasting subject for 2 minutes. Blood samples were taken before the injection, 3 minutes after the injection, and at each subsequent 10 minute-interval for 70 minutes. The glucose tolerance curves in 5 of these cases were found to be out of the normal range. It is to be noticed that the average blood sugar for rheumatoid arthritis is similar to the curve for liver disease. 7. Serum alkaline phosphatase activity and serum phosphorus The method of Taussky-Shorr was used for the determination of the level of alkaline phosphatase activity and inorganic phosphate in the serum. The alkaline phosphatase activity of 11 normal individuals ranged from 1.4 to 6.4 Shinowara-Jones-Rheinhart units/dl. (5% rejection limit), while in 4 of 8 cases of rheumatoid arthritis, it was of abnormally high levels. The concentration of inorganic phosphate in the serum of 12 normal subjects ranged from 2.9 to 5.0mg. /dl. (5% rejection limit), while in 3 cases of rheumatoid patients, it showed higher levels than normal. 8. Total cholesterol in serum The total cholesterol in the serum of fasting normal individuals was measured by Bloor's method, and the concentration was found to range from 124 to 188mg./dl. (rejection limit of 5% level of significance), and the total cholesterol in the serum of rheumatoid arthritis to be abnormally high in concentration in 6 of 7 cases. The liver function was evaluated by the Takata-serum-test, the test of fasting blood sugar levels, the glucose load test, and the test of serum alkaline phosphatase activity; and from this the hepatic dysfunction was found to occur in rheumatoid arthritis patients in about 50% of the cases examined. Disturbances in the protein, fat, and carbohydrate metabolism were also found to occur. The above-mentioned findings indicate that rheumatoid arthritis is not only a disease of the joints, but also a general and systemic illness. Attention must accordingly be given to the general condition of the patient in the treatment of rheumatic disease.
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