LETTERS 239

Figure 1. Serial measurements of C3. C4, anti-DNA, and amylase levels. The arrows indicate episodes of abdominal pain.

In October 1980. she had a second, prolonged epi- sode of abdominal pain with no evidence of active SLE in other organ systems. Serum amylase was elevated and serum complement levels were greatly depressed. She was treated with intravenous methylprednisolone 50 mg twice daily, which quickly relieved the abdominal pain. Serum amylase levels returned to normal.

In April 1981, while taking 10 mg prednisone per day. she developed diarrhea, rash, fever, myalgias. and severe abdominal pain. Serum amylase was greatly elevated, com- plement levels were diminished, and anti-DNA antibodies were increased (Figure 1). Upper gastrointestinal radiogra- phy revealed mucosal ulceration and thickened folds in the terminal small bowel. Abdominal ultrasonography revealed a liver of normal size and density with minimal subhepatic fluid. The pancreas was of normal size and density with a pancreatic duct diameter of 2.5 mm. She was treated with intravenous methylprednisolone 80 mg every 8 hours. Her abdominal pain subsided over the next 72 hours, and the amylase levels returned to normal. She was discharged and given a maintenance dose of oral methylprednisolone 64 mg per day.

One month later the patient was asymptomatic. the complement levels had improved, and the anti-DNA level had decreased. Endoscopic retrograde cannulation of her pancreatic duct revealed normal pancreatic anatomy and normal duct size.

Many of the early reports attributing pancreatitis to SLE are flawed by the concomitant use of medications such as high-dose corticosteroids or thiazide diuretics, or by other medical problems such as uremia or pregnancy. Reynolds, in a recent retrospective review of patients with SLE and acute abdominal pain. found that 37% had pancreatitis. usually in the setting of acute multisystem disease (Reynolds JC.

Inman KD, Kimberly KP. Chuong JH. Kovacs JE, Walsh MB: Acute pancreatitis in systemic lupus erythematosus: report of twenty cases and review of the literature. Medicine 61:26-32. 1982). Recovery was slow and usually occurred despite continued or increased corticosteroid therapy. Di- Vittorio found pancreatitis in 4% of SLE patients studied, often with symptomatic response to corticosteroids (DiVit- torio G, Wees S. Koopman WJ. Ball GV: Pancreatitis in systemic lupus erythematosus [abstract]. Arthritis Rheum [suppl]25:S6. 1982). In 4 patients, widespread vasculitis was found at autopsy.

Our patient had recurrent episodes of pancreatitis with mucosal small bowel ulcerations suggestive of vasculi- tis. She had no anatomic pancreatic abnormality or biliary tract lesion. The time course of the acute episodes of pancreatitis associated with small bowel vasculitis. the con- comitant decrease in serum complement values and increase in anti-DNA antibodies. and the rapid clinical and serologic response to corticosteroids suggest a diagnosis of SLE- induced vasculitis as the etiology of her pancreatitis.

Steven M. Croft, MD Mark P. Jarrett. MD Robert Craig, MD Susan G. Perlman, MD Northwestern University Medical School Chicogo, IL

Involvement of pharmaceutical companies at the Pan- American Congress of Rheumatology

To the Editor: The following, taken from a news story in the June I5

edition of the New York Times (New York Times. June 15, 1982, p. Bl), is perhaps relevant to the request made at the VIII Pan-American Congress of Rheumatology that mem- bers comment on the involvement of the pharmaceutical companies in that meeting:

An official of the New York City Transit Authority charged with illegally taking benefits from companies doing business with the authority said yesterday he "thought there was nothing wrong with it" because other officials were doing the same.

(The official) is charged with having accepted weekend vacations and trips. tickets to entertainment events and meals from the companies. . .

(The lawyer) . . . told a reporter that the "whole essence of the defense is ' I only did what everyone else did. which was common practice-1 didn't do anything wrong.' "

David Kaplan, MD State Universitv of Nen York Downstate Medical Center