Musculo-skeletal pathology in patients with angina pectoris and normal coronary angiograms.

PURPOSE: To evaluate the role of the musculo-skeletal apparatus in patients with angina pectoris despite normal coronary angiograms. DESIGN: A survey of patients and controls investigated by blinded observers. SETTING: A tertiary cardiologic referral centre. SUBJECTS: Thirty women and 18 men (mean age 52.9 years) with chest pain of an average duration of 3 years and 11 months were investigated. All had normal resting electrocardiograms. No patients showed evidence of left ventricular hypertrophy or valvular heart disease on echocardiography and all had a normal coronary angiogram. All had left ventricular ejection fraction > 50%, and none had signs of coronary vasospasm. Eighteen healthy persons (10 women and eight men, mean age 51.2 years) served as controls. MAIN OUTCOME MEASURES: The group frequency of chest wall complaints, spinal radiograph and physical examination findings; pressure pain thresholds. RESULTS: The patients had significantly more complaints of pain from the neck, chest, and thoracic spine, and sensations and pain radiating to the arms than the controls. The patients had more degenerative findings on radiograph than the controls, mainly at levels C4-C7. Physical examination showed that abnormal findings were significantly more frequent in patients than in the control group in the anterior and posterior chest wall, in the spine at levels Th1-Th6 and in the muscles of the neck and shoulder girdle. There were no statistically significant differences in pain thresholds or in neurological examination. CONCLUSION: The musculo-skeletal abnormalities observed in the patients could include reflex mechanisms. Whether the abnormal findings are mainly responsible for the angina pectoris symptoms or merely epiphenomena warrants further study.

Back pain and spinal pathology in patients with functional upper abdominal pain.

Thirty-nine hospital outpatients with upper abdominal pain without demonstrable organic abdominal abnormalities and 28 healthy controls were compared blindly with regard to back pain and back abnormalities when subjected to a standardized physical examination of the spine. Seventy-two per cent of the patients versus 17% of the controls were troubled with back pain (P less than 0.001). Seventy-five per cent of the patients with back pain actually had abnormalities revealed at the physical examination, indicating that some organic mechanisms are involved in back pain. Most of the findings were localized to the lower thoracic and thoracolumbar segments, the same segments that innervate the upper gastrointestinal tract. This suggests the existence of a connection between abdominal pain and back pain. Viscerosomatic or somatovisceral reflexes with trigger zones either in the viscera or in the skin, muscles, tendons, or ligaments could be part of the pathophysiology in this syndrome. Fifty-one per cent of the patients had symptoms of irritable bowel syndrome, and 41% had heartburn, which was significantly related to the experience of back pain.

A long-term randomised trial on tenoxicam and piroxicam in osteoarthritis of the hip or knee: a 24-month interim report focusing on the 12-24 month interval.

The long-acting antiphlogistics tenoxicam (Ro 12-0068, Tilcotil) and piroxicam in single daily oral doses of 20 mg are compared in a double-blind, group-comparative, randomised trial planned to last for five years. Results of 12 months' treatment of 108 patients with osteoarthritis of the hip or knee have been reported. This interim analysis focuses mainly on the 12 to 24 month interval. The clinical improvements obtained within the first 12 months persisted during the second year in the 55 patients remaining on treatment. After 24 months, 53 patients had been withdrawn prematurely, three-quarters because of inefficacy or intolerance. Only six patients were withdrawn between 12 and 24 months, three for lack of efficacy, two for side-effects and one for reasons unrelated to therapy. There was no difference between the treatment groups with regard to incidence, time or reason for withdrawal, and only small, insignificant differences in efficacy and tolerability. This trial shows that long-term treatment of osteoarthritis with tenoxicam and with piroxicam is beneficial. Once efficacy and tolerability have been established, maintenance of therapy is feasible.

Bone scanning in lumbar disc herniation.

99m technetium methylene diphosphate was used for whole body scanning and linear multiplane tomoscanning in 10 patients with typical clinical symptoms of prolapsed disc, in order to investigate whether there would be an increased focal accumulation corresponding to the bone structures adjacent to the affected disc. The diagnosis of a prolapsed disc was confined by amipaque myelography, carried out in 9 patients, and finally verified at operation. In none of the 10 cases could accumulation of radioactivity in the bony structures of the affected lumar segment be demonstrated. Consequently this method has not been adopted for the diagnosis of prolapsed lumbar discs. However it was demonstrated that 99m technetium methylene diphosphate scintillography is useful in the differential diagnosis of anchylosing spondylitis and discitis.

Clinical evaluation of ketoprofen (19.583 R.P.) in rheumatoid arthritis. Double-blind cross-over comparison with indomethacin.

In a double-blind cross-over trial the clinical efficacy of ketoprofen (19.583 R.P., Orudis, Profenid N.D.), in comparison with that of indomethacin was investigated in 30 patients with rheumatoid arthritis. The two drugs were each given in a dosage of 150 mg daily for a period of 14 days. The clinical effects of ketoprofen and indomethacin were equal (p less than 0.90), but several side-effects appeared less often and to a milder degree during ketoprofen treatment. The study indicates that ketoprofen may prove to be a valuable drug in the treatment of rheumatoid arthritis.

Clinical evaluation of ketoprofen (Orudis) in rheumatoid arthritis: a double-blind cross-over comparison with indomethacin.

In a double-blind cross-over trial, ketoprofen was found to be as effective as indomethacin in the treatment of rheumatoid arthritis. Side-effects, particularly headache and vertigo, were less common in patients receiving ketoprofen.