828 7.2 mmol/1 and triglycerides to 2.3 mmol/1, and H.D.L.-cholesterol concentration had returned to normal (1.2 mmol/1). On cholestyramine cholesterol had fallen to 4-6 mmol/1 at last testing. This experience would suggest that patients receiving androgens should be monitored with respect to their H.D.L. levels. to

TABLE II-DISTRIBUTION OF CASES WHICH SHOWED MYOCARDIAL INFARCTION OR ST-T CHANGES ON E.C.G.

University Department of Clinical Biochemistry and Department of Biochemistry, Royal Perth Hospital, Perth, Western Australia

J. R. L. MASAREI

W. J. LYNCH

E.C.G. ABNORMALITIES IN STEROID-TREATED RHEUMATOID PATIENTS SIR,-Glucocorticoid treatment for systemic lupus erythematosus may be accompanied by coronary atherosclerosis and myocardial infarction,I.2 and patients with rheumatoid arthritis who were put on glucocorticoid therapy had arteriosclerosis of the legs three times as frequently as did controls not so treated.3 We have studied, in retrospect, electrocardiograms (E.C.G.) on 39 rheumatoid patients treated with glucocorticoids and on 33 patients not on glucocorticoids in the rheumatic clinic of Keio University Hospital. The mean maintenance dose was 5-4 mg prednisolone equivalent per day (range 2-15 mg), and the average maximum daily dose was 12.0 mg. Steroids had been given for 3 years on average (range 2 months to 10 years)

I

TABLE I-NUMBER OF CASES WITH E.C.G. ABNORMALITIES

No. of cases with E.C.G. abnormalities/no. of cases examined. t Subgroups o, I, and II had 4none, one, and two or more articular features, respectively. *

of

extra-

of the E.c.G. abnormalities we observed in the steroid group were related to coronary arteriosclerosis. Abnormal E.C.G. findings, probably due to coronary arteriosclerosis, may be an important side-effect of low-dose glucocorticoid therapy for older patients with rheumatoid arthritis. most

Y. ICHIKAWA T. TOGUCHI M. KAWAGOE E. SAITO T.ABE M. HOMMA

Department of Internal Medicine, School of Medicine,

Keio University, Tokyo 160, Japan

DISOPYRAMIDE-INDUCED INTRAHEPATIC CHOLESTASIS

before the E.c.G.s. E.C.G. abnormalities noted are summarised in table i (where ST-T changes include E.c.G. patterns of myocardial ischsemia and of non-specific ST-T changes) and broken down by age and by extra-articular features4 in table n. The frequency of ST-T changes or myocardial infarction was 31% in the steroid and 6% in the non-steroid group. To exclude the effects of heterogeneity, the data were analysed by the method of Mantel and Haenszel/ taking age and extra-articular features into account. This analysis revealed that the difference between the steroid and non-steroid groups was significant (P