Clinical experience with tolmetin sodium.

Two studies are reported with tolmetin sodium. The first compared tolmetin sodium, phenylbutazone and placebo in rheumatoid arthritis. The second compared tolmetin sodium and aloxiprin in osteoarthritis and soft tissue rheumatism. In the first study, a double-blind crossover trial involving 12 patients, tolmetin sodium (1600 mg daily) was shown to be superior to placebo and comparable to phenylbutazone (400 mg daily). The reductions in morning stiffness and pain were statistically significant when compared to placebo. Tolmetin sodium and aloxiprin were compared in the treatment of osteoarthritis in a single-blind study which investigated efficacy and safety over a 3-month period. Initial dosages were 1600 mg tolmetin sodium and 6 g aloxiprin (equivalent to 5 g aspirin) daily. Thirty-four patients were enrolled in the study. Both drugs produced an improvement over the 3-months treatment period. The reduction in pain was statistically significant. The dosage of tolmetin sodium remained at 1600 mg daily for the 3-month duration of the study but side-effects necessitated the reduction of the dosage of aloxiprin in many patients and after 3-months' treatment the mean dosage was 4 g daily. Five patients withdrew from the tolmetin sodium group and 11 from the aloxiprin group. Adverse reactions including limiting side-effects, were about twice as common with aloxiprin compared to tolmetin sodium.

Four new anti-inflammatory drugs: responses and variations.

Ninety patients with rheumatoid arthritis completed a double-blind crossover trial comparing fenoprofen, ibuprofen, ketoprofen, and naproxen. Fenoprofen and naproxen were slightly more effective than the other two drugs but there were striking individual variations in response. Groups of patients could be identified who preferred each of the four drugs. The commonest side effects were those related to the upper gastrointestinal tract; these showed individual variation and seldom occurred with more than one or two of the drugs. Side effects were least common with ibuprofen and naproxen. Since naproxen combined greater effectiveness with a lower incidence of side effects it must be regarded as the first choice among these drugs. It may be necessary to try several drugs before finding the right one for a particular patient.

Immunostimulant therapy with levamisole for rheumatoid arthritis.

In a controlled study involving thirty-four patients levamisole was shown to be as effective as D-penicillamine and more effective than placebo in the treatment of rheumatoid arthritis. Its action was slow and was accompanied by a reduction in erythrocyte sedimentation-rate, rheumatoid factor, and technetium index. These properties indicate that it has a specific action like that of D-penicillamine. Stimulation of cell-mediated immunity was evident in patients treated with levamisole, and there was a correlation between such changes and pain relief. Animal models confirmed the absence of anti-inflammatory effect and provided some evidence of enhancement of cell-mediated immunity and macrophage stimulation.

Objective measurement of rheumatoid arthritis using technetium index.

The technetium index was measured in 22 patients with rheumatoid arthritis, before and after 6 months' treatment either with penicillamine or with anti-inflammatory drugs. The index was calculated by dividing the sum of the count rates over both knees and both wrists by the dose of technetium given. In the penicillamine group there was a significant reduction in the technetium index and the changes correlated well with some clinical measurements of improvement. It is suggested that the technetium index is a useful objective measure of the effects of drugs with a specific activity in rheumatoid arthritis.

Four new anti-inflammatory drugs responses and variations.

No abstract available.

Treatment of rheumatoid arthritis with fenoprofen: comparison with aspirin.

Fenoprofen, a compound with analgesic, anti-inflammatory, and antipyretic properties in animals, has been compared with placebo in a double-blind cross-over trial in 60 patients with rheumatoid arthritis. There was a statistically highly significant reduction in pain, duration of morning stiffness, analgesic requirements, and articular index, with increase in grip strength. There was no significant reduction in joint size or temperature. In a subsequent double-blind group-comparative study fenoprofen proved to be as effective as aspirin in relieving the symptoms of rheumatoid arthritis, with strikingly fewer side effects. Almost half of the patients taking aspirin were unable to tolerate the drug in adequate dosage for six months. The remainder were able to take on average only 4 g daily, and at this dose almost half still complained of tinnitus and deafness.Fenoprofen is likely to be useful for patients who cannot tolerate aspirin and other more toxic anti-inflammatory drugs or whose disease is not of sufficient severity to justify their use.

Obesity and diabetes

Diabetics have, on the average, higher blood pressures than the general population. This is not due to any specific effect of the diabetes but is related to the obesity to which they are subject. The reduction of obesity by diet in such patients not only relieves them of the harmful effects which obesity always causes but also improves carbohydrate tolerance and reduces hypertension. This provides yet another reason why obesity should be corrected in diabetics wherever possible. (AU)