Algodystrophy in conjunction with van der Hoeve's syndrome.

Van der Hoeve's syndrome is the all-round variant of Lobstein's disease (late osteogenesis imperfecta) and is characterized by the concurrent presence of osteoporosis, blue sclerae, and deafness. The literature has reported sporadic cases of a combination of algodystrophic syndrome and Lobstein's disease. Our case represents a classic example: a 50-year-old woman with blue sclerae since birth, bilateral deafness, major dental alterations, vitreous osteoporosis and a history of pathological fractures who, two years from the onset of menopause, complained of pain involving the right ankle. After admission to our Department, a diagnosis of algodystrophy combined with van der Hoeve's syndrome was made on the basis of her clinical history, objective signs and x-ray results. Treatment consisted of i.v. clodronate disodium at a dose of 300 mg daily in 250 ml saline solution for 7 consecutive days. At the end of the treatment cycle the patient reported an improvement in her symptoms with nearly total regression of right ankle pain, while swelling disappeared within a few weeks.

Magnetic resonance imaging for the study of cervical myelopathy in rheumatoid arthritis.

Cervical myelopathy is found fairly often with rheumatoid arthritis. It is one of the worst complications of the disease and can lead to tetraplegia or even to sudden death. However, when we consider the high incidence of involvement of the cervical spine in rheumatoid arthritis, the number of cases of cervical myelopathy, even of slight degree, is not very high. We have used magnetic resonance to identify the condition of the cervical structures, especially the nerve structures, in 15 patients with rheumatoid arthritis, with involvement of the cervical articulations but without neurological symptoms. We found anterior compression of the spinal cord caused by the odontoid process of the epistropheus in 13 cases. One case had lateral deviation of the spinal cord and another had compression of a vertebral artery. In another the lumen of the nasopharynx was decreased and one had posterior compression of the spinal cord by the posterior arch of the atlas. Magnetic resonance also makes it possible to detect a rheumatoid pannus on the affected articulations. We conclude that magnetic resonance is at present a useful instrument for evaluation of the presence of cervical myelopathy in rheumatoid arthritis patients, to prevent more serious complications.

Plasma and synovial fluid concentrations of piroxicam during prolonged treatment with piroxicam pivalic ester.

Piroxicam pivalic ester (CHF 10/21) is a prodrug of piroxicam and is characterized by a reduced gastric irritant activity. Plasma and synovial fluid samples were simultaneously taken from 7 patients with mono- or poly-articular arthritis causing knee effusion, during 4 weeks of treatment with CHF 10/21 at the dose of 30 mg/day. The time courses of plasma levels of both the prodrug and the active principle were studied and a correlation of the latter with synovial fluid levels was made. After 14 days of treatment the steady-state was reached in the systemic (plasma) and peripheral (synovial fluid) compartments with therapeutically active drug levels. Clinical results were good and a complete disappearance of local pain occurred in 2 cases. Good gastric tolerance was also achieved.

Computerized axial tomography in investigations of the rheumatoid knee.

It is essential when deciding on the therapeutic approach to the rheumatoid knee--medical or surgical--to make a precise and thorough assessment of the joint situation as a whole. In order to overcome the limitations of traditional X-ray methods, the Authors used computerized axial tomography (C.A.T.) to study the knees of twenty rheumatoid arthritis patients. They analysed three particular sections: the first at the level of the subquadriceps bursa, the second through the femoral condyles, and the third through the proximal tibio-fibular joint. C.A.T. permits an assessment of the conditions of the muscles and any hypertrophy of the synovial membrane; this kind of investigation reveals them clearly. It was possible to make an accurate investigation of the femoro-patellar joint and of lesions involving the femoral condyles and tibial plate. The findings indicate that C.A.T. in the study of the rheumatoid knee provides information on the soft tissues that cannot be obtained by traditional radiological methods. It also shows with greater precision the extent and morphology of bone lesions to the joint heads, an extremely important question in planning the use of prostheses.

Double-blind multicentre study of the activity of S-adenosylmethionine in hip and knee osteoarthritis.

A randomized double-blind multicentre clinical trial was carried out to verify the effectiveness and tolerance of S-adenosylmethionine (SAMe) versus ibuprofen in 150 patients with hip and/or knee osteoarthritis. Both drugs were given orally 400 mg thrice daily for 30 days. SAMe exhibited a slightly more marked activity than the reference drug in the management of the various painful manifestations of the joint disease. Minor side-effects developed in five patients of SAMe group, and in 16 patients of ibuprofen group. No drop-outs occurred. No changes were observed in the routine laboratory tests.

A multicentre comparison of flurbiprofen and naproxen in rheumatoid arthritis: a four-week study in 118 patients.

One-hundred and eighteen patients with rheumatoid arthritis were treated for 4 weeks with flurbiprofen 300 mg/day (sixty patients) or naproxen 750 mg/day (fifty-eight patients) in a six-centre randomized trial. Flurbiprofen proved to be more effective than naproxen in reducing morning stiffness (p less than 0.01), Ritchie articular index (p less than 0.01) and number of swollen joints (p less than 0.05) and in relieving night pain (p less than 0.01). The incidence and severity of side-effects, mainly gastric, were both low and similar with flurbiprofen (17%) and naproxen (19%).

Indoprofen in rheumatic patients with acute episodes: a multicentre trial.

The results are reported of an open multicentre trial in 228 rheumatic patients with flare-ups. Fourteen centres adopting the same investigational protocol collaborated in the study. Indoprofen was administered for 1 week at a daily dosage of 1000 mg according to a treatment schedule used with success in acute gouty arthritis: a 400 mg i.v. bolus was followed by 200 mg (1 tablet) t.i.d. Subjective (pain) and objective variables were used for reliable assessment of activity. Marked reduction of pain intensity was already noticeable on day 1 of treatment and was followed by progressive improvement in subjective and objective variables for all the diagnoses considered. According to the patients' own overall assessments, results were good or very good in more than 50% of cases. The best outcomes were obtained in low back pain, acute gout and psoriatic arthritis. At the end of treatment only 7.4% of patients experienced no change or deterioration of symptoms. Adverse reactions, consisting mostly of mild and reversible gastrointestinal disturbances, were reported by 9.2% of patients, but only in 1.8% was treatment discontinued. Indoprofen administered according to the above schedule is an appropriate treatment for acute episodes of rheumatic diseases.

[Pharmacological and clinical aspects of S-adenosylmethionine (SAMe) in primary degenerative arthropathy (osteoarthrosis)]. / Aspetti farmacologici e clinici della solfo-adenosil-metionina (SAMe) nella artropatia degenerativa primaria (osteoartrosi)

After some preliminary remarks of a biochemical and pharmacological nature, the authors have started a clinical study to test the antiinflammatory activity of the S-adenosyl-methionine (SAMe). An open trial, carried out on 90 patients with severe degenerative arthropathies has shown that 30 mg SAMe intravenously twice a day for 14 days have a marked anti-inflammatory effect a rather term and no side-effects. In a "double-crossover" investigation, SAMe was next compared to indomethacin by i.m. administrations to 15 arthropathic patients. The therapeutic responses of the two drugs proved exactly alike, whereas the side-effects following indomethacin administration were not present after SAMe. In 9 patients affected with rheumatoid arthritis administrations of SAMe have proved less effective, although some clinical parameters showed improvements.

[Importance of enzymes in the synovial fluid. Progress report]. / Importanza degli enzimi nel liquido sinoviale. Nota di aggiornamento

The significance and importance of investigation of the synovial fluid enzymes in the main arthropathies are explanined. Tables are given for the main enzymes studied, the cell compartments of origin, and data for their values in rheumatic diseases (as reported in the literature). Stress is laid on the importance of enzymes belonging to the lysosomial compartment, both in the pathogenesis of the underlying inflammation and in the relation to anatomopathological lesions in the joints. Attention is directed to the most widely accepted hypotheses. These ten to see enzymes increases in breakdown of condrocytes, as inflammatory arthritis attributable to synoviocytes and leukocytes. A personal opinion based on prior research is also presented. Further work in this sector is urged a mean of learning more about the pathology of rheumatic diseases.