Evaluación gastrointestinal en los pacientes con fiebre mediterránea familiar con dolor abdominal crónico y tratados con colchicina: serie de casos / Gastrointestinal evaluation in colchicine-treated familial Mediterranean fever patients with chronic abdominal pain: Cases series

El objetivo de este estudio fue evaluar a los pacientes con fiebre mediterránea familiar (familial Mediterranean fever, FMF) y dolor abdominal crónico resistentes al tratamiento con colchicina. Se incluyó a 48 pacientes diagnosticados en nuestro consultorio de reumatología pediátrica que tenían dolor abdominal a pesar del tratamiento con colchicina. A todos los pacientes se los derivó a un gastroenterólogo pediátrico. Se registraron las características del dolor, tales como aparición, duración y frecuencia; se planificó una endoscopía digestiva para obtener un diagnóstico diferencial. Se determinó la presencia de una mutación del gen MEFV en 46 pacientes. La mediana de la duración del tratamiento fue de 2,8 años. Aproximadamente el 60% de los pacientes tenían dolor abdominal todos los días o de dos a tres veces a la semana; en el 73% de los casos, duró menos de tres horas. A 41 pacientes se les realizó una endoscopía digestiva alta. La gastroduodenitis es un hallazgo frecuente en los pacientes con FMF y dolor abdominal persistente a pesar del tratamiento. Los pacientes con los puntajes más altos de severidad de la enfermedad tenían inflamación digestiva grave.

The aim of the study to evaluate familial mediterranean fever (FMF) patients with chronic abdominal pain unresponsive to colchicine treatment. Forty-eight patients who diagnosed in our Pediatric Rheumatology clinics and suffering from abdominal pain despite colchicine treatment were include. All patients were referred to a pediatric gastroenterologist. The pain characteristics such as onset, duration and frequency were recorded; gastrointestinal (GI) endoscopy was planned for differential diagnosis. MEFV mutation was determined in 46 patients. The median duration of treatment was 2.8 years. Approximately 60% of the patients suffered from abdominal pain every day or 2-3 times a week, in 73% of the cases it lasted less than three hours. Forty-one patients underwent upper GI endoscopy. Gastroduodenitis is a common finding in persisting abdominal pain despite therapy of FMF patients. The patients with the highest disease severity scores had severe inflammation within the entire GI system.

A prospective, randomized, single - blind study comparing intraplaque injection of thiocolchicine and verapamil in Peyronie's Disease: a pilot study

ABSTRACT Objectives: To compare the response to tiocolchicine and verapamil injection in the plaque of patients with Peyronie's disease. Materials and Methods: Prospective, single-blind, randomized study, selecting patients who have presented Peyronie's disease for less than 18 months. Thiocolchicine 4mg or verapamil 5mg were given in 7 injections (once a week). Patients who had received any treatment for Peyronie's disease in the past three months were excluded. The parameters used were the International Index of Erectile Function (IIEF-5) score, analysis of the curvature on pharmaco-induced erections and size of the plaque by ultrasonography. Results: Twenty-five patients were randomized, 13 received thiocolchicine and 12 were treated with verapamil. Both groups were statistically similar. The mean curvature was 46.7° and 36.2° before and after thiocolchicine, respectively (p=0.019) and 50.4° and 42.08° before and after verapamil, respectively (p=0.012). The curvature improved in 69% of patients treated with thiocolchicine and in 66% of those who received verapamil. Regarding sexual function, there was an increase in the IIEF-5 from 16.69 to 20.85 (p=0.23) in the thiocolchicine group. In the verapamil group the IIEF-5 score dropped from 17.50 to 16.25 (p=0.58). In the thiocolchicine group, the plaque was reduced in 61% of patients. In the verapamil group, 8% presented decreased plaque size. No adverse event was associated to thiocolchicine. Conclusion: The use of thiocolchicine in Peyronie's disease demonstrated improvement on penile curvature and reduction in plaque size. Thiocolchicine presented similar results to verapamil in curvature assessment. No significant side effects were observed with the use of tiocolchicine.

Frosted branch angiitis, neuroretinitis as initial ocular manifestation in Behçet disease.

Behçet disease is an idiopathic, multisystem disorder characterized by recurrent episodes of orogenital ulceration and vasculitis of the veins and arteries of all calibers. Ocular involvement may affect the conjunctiva, sclera, uveal tract, vitreous, blood vessels, and retina. Many theories have pointed toward an autoimmune response behind its pathogenesis, which may be triggered by exposure to an infectious agent. Frosted branch angiitis is characterized by vascular inflammation, sheathing, retinal edema, and retinal hemorrhages. The disease may be idiopathic in a majority of the cases or may be associated with ocular and systemic pathology. Association between Behηet disease, Frosted branch angiitis, and neuroretinitis is not reported in literature. This uncommon combination reflects the varied systemic and ocular manifestations in Behηet disease, especially in patients who are not diagnosed and treated in time. We hereby report a case of bilateral frosted branch angiitis and neuroretinitis in a young male from Middle-east, suffering from Behçet disease.

Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial

PURPOSE: This study aimed to evaluate the efficacy of the systemic drugs thalidomide, dapsone, colchicine, and pentoxifylline in the treatment of severe manifestations of RAS. METHODS: An open, 4-year clinical trial was carried out for 21 consecutive patients with severe RAS. Initially, patients were given a 2-week course of prednisone to bring them to a baseline status. Simultaneously, one of the four test drugs was assigned to each patient to be taken for a period of 6 months. During the course of the trial, patients were switched to one of the other three drugs whenever side effects or a lack of satisfactory results occurred, and the 6-month limit of the treatment was then reset. RESULTS: The most efficient and best-tolerated drug was thalidomide, which was administered to a total of eight patients and resulted in complete remission in seven (87.5 percent). Dapsone was prescribed for a total of nine patients, of whom eight (89 percent) showed improvement in their symptoms, while five showed complete remission. Colchicine was administered to a total of ten patients, with benefits observed in nine (90 percent), of whom four showed complete remission. Pentoxyfilline was administered to a total of five patients, with benefits observed in three (60 percent), of whom one patient showed complete remission. CONCLUSION: The therapeutic methods used in this trial provided significant symptom relief. Patients experienced relapses of the lesions; however, this occurred after withdrawal of their medication during the follow-up period.

Efficacy of thiocolchicoside in Indian patients suffering from low back pain associated with muscle spasm.

Low back pain (LBP), a high prevalent condition among middle aged population, is usually associated with 'muscle spasm' that is responsible for giving rise to pain as well as its persistence. Muscle spasm is an involuntary, painful contraction of muscles that interferes with the function and cause of muscular disorder. Therefore centrally acting skeletal muscle relaxants, also called lissive drugs, are commonly used for its treatment. Sometimes these are combined with NSAIDs. The use of centrally acting skeletal muscle relaxants, though efficacious, is associated with frequent development of dose-related adverse drug reactions like sedation, impairment of voluntary motor functions and ataxia. So there is an urgent need for newer better drugs for treatment of conditions associated with muscle spasm. The objective of this study was to assess the efficacy and safety of oral thiocolchicoside (TC), a natural glycoside as compared to an adrenergic alpha 2 agonist tizanidine (TZ) in the Indian patients with LBP accompanied by muscle spasm. In this randomised, non-cross over clinical study, 60 adult Indians aged between 18 and 65 years with clinical diagnosis of muscle spasm associated with low back pain were enrolled. Patients satisfying the inclusion and exclusion criteria were either treated with TC and TZ for one week duration. Visual analogue scale (VAS) for pain at rest and VAS for tiredness, drowsiness, dizziness and alertness was used as the self-rated primary efficacy and safety variable. Pain was also assessed by mobility assessment; muscle spasm assessment and analgesic consumption. Data obtained from 58 patients (those who completed the study) indicated that in this one week study both TC and TZ provided sustained symptoms relief compared with the baseline. There was statistically significant reduction in severity of symptoms from day 0 to day 7 in both the groups. Patients were followed up on 3rd and 7th day and severity score of various parameters was recorded. There was significant difference among the treatment groups in favour of TC than TZ in efficacy parameters thus showing TC is at slightly better effective than TZ and in case of safety, TC scores significantly better over TZ in the patients with accompanying muscle spasm. These findings confirm that TC is a preferred option for the LBP with muscle spasms.

Different duration of colchicine for preventing recurrence of gouty arthritis

Gout is a Common recurrent clinical syndrome characterized by increased serum uric acid and recurrent attacks of acute arthritis. Colchicine is used for Prophylaxis against recurrence of arthritis, but the duration of its administration has mentioned variable. In this study, optimal duration of prophylactic colchicine for prevention of gouty arthritis was assessed. In a clinical trial 190 patients with gouty arthritis divided randomly to group 1,2and 3 and received colchicine for 3 to 6, 7 to 9 and 10 to 12 months then colchicine discontinued and the patients followed one year for recurrence of arthritis. Result assessed by survival analysis with Kaplan 'Meier method. The probability of recurrence of arthritis [in order of duration of colchicine prophylaxis] was 54%, 27.5% and 23%, respectively. The difference between group one and others was statistically significant, but between group 2 and 3 was not statistically significant. The most suitable duration of colchicine prophylaxis that accompanied with lower recurrence rate was 7-9 months, which seems more cost -effective than 10-12 months regimen

Familial Mediterranean Fever

Familial Mediterranean Fever is a genetic disorder frequently diagnosed among the Arabs. It is also prevalent among Jews, Armenians and Turks. The clinical picture consists of febrile and painful attacks that differ in quality across patients and even within the same patient. There may be accompanying joint pain, chest pain, skin manifestations and other findings, and amyloidosis may occur in some patients as a complication. The primary treatment is Colchicine, which decreases the frequency of the attacks and prevents the occurrence of amyloidosis. The gene responsible for Familial Mediterranean Fever, MEFV, has been mapped and cloned and mutations were identified within its coding sequence. It encodes a protein that is expected to be a down regulator of inflammation. The spectrum of mutations in the Arabic population is partially studied. There are still several issues to be solved before we fully understand the disorder, and to enable us to confront it and decrease the morbidity and mortality inflicted by it

Tratamiento de la fibrosis pulmonar idiopática con colchicina / Treatment of idiopathic pulmonary fibrosis with colchicine

Background: Experimental and clinical evidences suggest that colchicine can be effective in the treatment of patients with idiopathic pulmonary fibrosis. Aim: To assess the effect of colchicine in the treatment of idiopathic pulmonary fibrosis. Patients and methods: Patients with clinically diagnosed idiopathic pulmonary fibrosis were treated with colchicine in doses of 0.5 to 1 mg/day, according to tolerance and followed for periods ranging from 7 to 40 months. The clinical and radiological score reported by Watters et al was used for the longitudinal assessment of patients. Maintenance or improvement in forced vital capacity and maintenance or decrease in alveolar arterial O2 gradient during follow up, were considered as positive therapeutic responses. Results: Seventeen patients (10 male, aged 61 to 81 years old) were studied. Their basal score for dyspnea was 5.8 (over 20), for the chest X ray examination was 2.4 (over 3) and for CT scan was 2.8 (over 3). Basal FVC was 77 percent of predicted value (range 51-108 percent), basal FEV, was 82 percent (range 59-117 percent) and FEV1/FVC was 0.82 (range 0.68-0.95). PaO2 at rest was 78 mm Hg (ranges 63-97). Alveolar-arterial PO2 gradient was 16 mm Hg (range 5-31.6) at rest and 31 mm Hg (range 5.7-51.4) after exercise. Six patients (35 percent) had a positive response to therapy. Conclusions: The response rates of these patients to colchicine are at least similar to those obtained with steroids, but with less side effects

Recurrent episodic fever. A presenting feature of familial mediterranean fever

Objectives to study the natural course and outcome of recurrent episodic fever without serositis as a presenting feature of familial Mediterranean fever [FMF]. Patients: of 309 children with FMF seen over a period of 5 years, 8 presented with recurrent episodes of fever without serositis, imposing a difficult diagnostic problem. Results the age at onset of fever ranged between 5 months and 8 years with a mean of 2.5years. five patients eventually developed serositis. The duration between onset of fever and onset of serositis ranged between 1.5-3 years with a mean of 2 years. Of the 3 patients who did not develop serositis, 2 had a family history of FMF. Therapeutic response to colchicines was dramatic in 7 children [one refused colchicines prophylaxis]. Conclusion episodic fever alone without serositis is a presenting feature of FMF. In patients from Mediterranean ancestors and / or the presence of family history of FMF, a therapeutic diagnostic test with colchicines could be rewarding

Experiencia con la plastia de injerto de Dacron en la enfermedad de Peyronie / Experience with Dacron graft plasty in La Peyronie disease

Se presenta la experiencia quirúrgica de los autores con la enfermedad de Peyronie durante cuatro años. Se utilizó un injerto de Dacron para substituir el defecto, lo cual resultó de utilidad. La tasa de buenos resultados de 60 por ciento, es similar a la informada en la literatura. Se revisan algunos aspectos importantes de la entidad

Enfermedad de Peyronie: informe de cinco casos tratados con interferón alfa dos B y colchicina / Peyronie's disease: report of five cases treated with alpha 2 B interferon and colchicine

La enfermedad de Peyronie es una induración en superficie dorsal o lateral del cuerpo cavernoso que desvía al pene hacia el lado afectado. Los interferones (alfa 2 B y beta) ejercen actividad antifibrótica mediante inhibición del fibroblasto y bloqueo de la producción de colágena. La colchicina produce colapso del retículo endoplásmico rugoso, y reducción de los miofilamentos y la colágena. Se realizó un estudio prospectivo, comparativo y no al azar, con la finalidad de comparar el tratamiento de pacientes con enfermedad de Peyronie con la inyección intralesional de interferón alfa 2 B en dos casos, la utilización de interferón por la misma vía, más colchicina por vía oral en otros dos casos y colchicina solo en uno. La mejoría (subjetiva y objetiva) con el tratamiento de interferón es satisfactoria, pero más lenta que en los pacientes tratados con interferón y colchicina. En el enfermo tratado con colchicina sola, hubo mejoría de los síntomas, sin disminución de la placa. Se concluye que el interferón alfa 2 B es útil para disolver las placas de fibrosis y aumenta su efecto con la utilización simultanea de colchicina por vía oral, lo que se logra más rápidamente y con menores dosis de interferón

Efectos de la colchicina e indometacina en la pulpitis producida experimentalmente en el cobayo / Effects of colchicine and indomethacin in experimentally produced pulpitis in guinea pigs

Este estudio se realizó en cobayos machos, a los cuales se les provocó pulpitis mediante la realización de cavidades clase V en los dientes incisivos. Se les aplicó indometacina y colchicina a razón de 7 mg/kg de peso respectivamente, por vía intraperitoneal. Previa anestesia se sacrificó a los animales infiltrando formol al 10 por ciento en el ventrículo izquierdo para la fijación de las células inflamatorias. Por medio de la disección del maxilar y la mandíbula se obtuvieron los dientes incisivos y se realizaron los cortes histopatológicos correspondientes para la cuantificación de las células inflamatorias con un objetivo de 400 X. Encontramos que la pulpitis tratada con indometacina se elevó contra lo esperado cuando se utiliza la colchicina, pese a mostrar pulpitis en menor grado que con indometacina, aumentó (a nivel polimorfonucleares). La colchicina, por otra parte, actuó sobre histiocitos y linfocitos. Por lo tanto, es posible afirmar que ambos medicamentos sí bloquean el desarrollo de la pulpitis puesto que la indometacina actuó sobre linfocitos

Histopathological changes of the optic nerve after intravitreal injection of colchicine

Colchicine is a drug commonly used in the prophylaxis and treatment of gout. Also, it is of good role in the therapy of Behcet's disease. The optic nerve effects after eight weeks durations of 10 and 100 micro .g of intravitreal injection of colchicine were studied on pigmented rabbits. The present histopathological electron microscopic studies on the optic nerve showed all forms of optic neuritis. These forms included decreased content of neurotubules in the axoplasm of myelinated fibers and oligodendrocytes. In addition, thinned out myelin sheath, reaching up to disrupted myelin in high doses were observed, indicating the myelinolyic effect of colchicine. Contracted axolemma, was also seen. Clumping of nuclear chromatin and intended nucleus of oligodendrocytes were prominent observations

Colchicine in diabetes mellitus.

As anti-inflammatory drugs such as acetylsalicylic acid are known to partially restore insulin response to glucose, the possible beneficial effect of colchicine, an anti-gout and anti-inflammatory drug, in non-insulin dependent diabetes mellitus (NIDDM) was studied. Colchicine could significantly reduce blood glucose levels, both fasting and post-prandial when given at a dose of 0.5 mg thrice a day in NIDDM patients. There were no side-effects due to the therapy. This study suggests that colchicine has anti-diabetic properties.

Amiloidosis primaria con compromiso oseo a nivel de columna vertebral, hepatomegalia y polineuropatía

Describimos el caso de una paciente con amiloidosis sistémica adquirida, quien presentó compromiso de la columna lumbar con lesiones líticas y fracturas de cuerpos vertebrales por invasión amiloide, polineuropatía documentada por electromiografía y hepatomegalia evidenciada por gamagrafía y examen físico. El compromiso directo de hueso se corroboró por biopsia de L4. La paciente se ha manejado con colchicina fundamentalmente y en la actualidad tiene supervivencia de 12 años y se encuentra en buen estado general. Es el primer caso en la literatura médica confirmado de affeción de columna lumbar por amiloidosis.

Colchicina em dermatologia / Colchicine in dermatology

Os autores agrupam no presente trabalho as principais indicaçöes terapêuticas da colchicina em dermatologia, discorrendo também sobre aspectos históricos e farmacológicos. Foi efetuada revisäo dos últimos cinco anos da literatura mundial