Efficacy of celecoxib in treating symptoms of viral pharyngitis: a double-blind, randomized study of celecoxib versus diclofenac.

This study compared the efficacy and safety of the cyclooxygenase-2 specific inhibitor celecoxib with the conventional non-steroidal anti-inflammatory drug diclofenac in the symptomatic treatment of viral pharyngitis. Adult patients from 27 study centers in Latin America were treated with oral doses of celecoxib 200 mg once daily or 200 mg twice daily, or diclofenac 75 mg twice daily for 5 days in a double-blind, randomized study. The primary efficacy assessment was 'Throat Pain on Swallowing' on day 3. In addition, secondary quality-of-life assessments were performed on days 3 and 5. All adverse events and treatment-emergent signs and symptoms were recorded. Data from 313 patients were evaluable for efficacy (105 celecoxib 200 mg once daily, 107 celecoxib 200 mg twice daily, 101 diclofenac 75 mg twice daily). The upper 95% confidence limits for the visual analog scale of 'Throat Pain on Swallowing' on day 3 for celecoxib 200 mg once daily relative to diclofenac 75 mg twice daily, and celecoxib 200 mg twice daily relative to diclofenac 75 mg twice daily were 9.26 and 7.83, respectively. All secondary efficacy and quality-of-life measures were clinically similar for the three treatment groups, and no statistically significant differences were detected. The incidences of treatment-emergent adverse events and withdrawals due to adverse events were similar for all groups, but numerically higher among patients taking diclofenac than celecoxib. More patients in the diclofenac group reported gastrointestinal complaints (7.3%) compared with those in the celecoxib groups (4.3% in the celecoxib 200 mg once-daily group and 3.4% in the celecoxib 200 mg twice-daily group). In conclusion, 5 days of treatment with celecoxib 200 mg once daily is as effective as diclofenac 75 mg twice daily in the symptomatic treatment of viral pharyngitis. Celecoxib 200 mg once daily is also as effective as celecoxib 200 mg twice daily in this condition.

Muscle involvement in polyarteritis nodosa: report of a patient presenting clinically as polymyositis and review of the literature.

Muscle symptoms, especially myalgias, appear to be common in patients with polyarteritis nodosa (PAN). We describe a patient who presented with a generalized myopathy and elevated creatine kinase (CK) suggestive of polymyositis. However, subsequent exploratory surgery for an acute abdomen revealed colonic perforation on the basis of PAN. A review of the literature suggests that generalized myopathy and elevated CK are uncommon features of PAN. A muscle biopsy can be a helpful procedure to secure the diagnosis in patients with PAN especially those with myopathies. Strategies for optimizing the choice of biopsy site are discussed.

Can tests for IgA, IgG, or IgM antibodies to cardiolipin or phosphatidylserine substitute for lupus anticoagulant assays in screening for antiphospholipid antibodies?

Antiphospholipid antibodies (APL) are detected by both ELISA and tests for lupus anticoagulants (LA). We evaluated ELISA tests for IgG, IgM, and IgA isotopes of antibodies binding cardiolipin (CL) and phosphatidylserine (PS) in samples from LA patients presenting with recurrent miscarriages. All values were expressed in multiples of the normal median (MOM). In 32% (11/34) of cases, not only were all ELISA values at or below 2.5 MOM, but the distribution of these ELISA MOM values within the normal range was similar to distribution of values from LA negative controls with the same history. Neither the use of PS as the antigen nor the addition of IgA assays improved the correlation of ELISA results with the presence of LA. ELISAs are inadequate as the sole screening test for these separate, but often associated, families of APL.

Abnormal T-cell function in patients with psoriatic arthritis: evidence for decreased interleukin 2 production.

Psoriatic arthritis (PSA) is an inflammatory arthritis associated with psoriasis. Although not considered an autoimmune process, there is evidence for humoral and cellular immune abnormalities similar to autoimmune diseases such as rheumatoid arthritis and systemic lupus (SLE). We investigated mitogen-induced proliferation and interleukin 2 (IL-2) production by peripheral blood mononuclear cells in patients with PSA. Both IL-2 production and proliferation were significantly decreased in PSA patients when compared to controls. Increased arachidonic acid metabolism has been reported in skin and peripheral mononuclear cells of patients with psoriasis and PSA. We therefore also investigated the effect of indomethacin and prostaglandin E2 (PGE2) on IL-2 production. Addition of indomethacin to cultures did not significantly change IL-2 production in patients with PSA, but did so in controls. PGE2 produced a significant reduction in IL-2 production in PSA and in controls.

B cell surface marker analysis of synovial fluid cells in a patient with monoarthritis and chronic lymphocytic leukemia.

We describe a women with clinically quiescent chronic lymphocytic leukemia who developed monoarthritis consistent with her known diagnosis of osteoarthritis. Because of the concurrent chronic leukemia, we were concerned with the possibility of leukemic arthritis. Immunofluorescence of synovial fluid cells demonstrated an increase in B cells that failed to demonstrate monoclonality as determined by light chain class expression. However, biopsy of synovial tissue revealed leukemic infiltration. Local radiation therapy resolved the monoarthritis.

Osteogenic sarcoma in a child.

Osteogenic sarcoma is a malignant bone tumor that occurs more frequently in long bones of the extremities, mainly in the second and third decades of life. It rarely occurs in children younger than 5 years of age. We describe the case of a 3 9/12 years old boy, who is one of the youngest patients described in the literature. This patient had an aggressive disease, with pulmonary metastases at the time of diagnosis. The disease progressed rapidly despite surgery and chemotherapy. Diagnosis was delayed probably because of the unusual presentation of this disease at this age.