[Expression of pain in rheumatic disease. Exploratory study]. / L'expression de la douleur en rhumatologie. Etude exploratoire.

An investigation done in 34 rheumatology departments on 259 patients in order to analyse their perception of pain and its repercussions on daily living. The main three diseases justifying hospitalization are: rheumatoid arthritis, lumbosciatica and bone neoplasia. In these patients, pain occurs daily in 75 p. cent of them and continuous in 32 p. cent; the intensity of the pain varies according to the time. There are repercussions on work (63 p. cent), walking (81 p. cent), but also on leisure (74 p. cent), friendly interelations (42 p. cent) and disposition which is disturbed in 62 p. cent of patients. Behavioral analysis in the presence of pain brings up differences depending on the patients: the elder the patient, the least they are able to respond to the handicap caused by pain. Analysis of the pain vocabulary suggest that if the terms expressing the experience of the patient are different according to the diseases, the usual description of painful phenomena are common to patients and the diseases in question.

Total and free ketoprofen in serum and synovial fluid after intramuscular injection.

Free and total ketoprofen levels in serum and synovial fluid were determined in 37 patients after a single intramuscular injection of ketoprofen, 100 mg. Free drug was separated by equilibrium dialysis. Ketoprofen was assayed by HPLC. Ketoprofen penetrated into the joints rapidly and significant concentrations were found at 15 minutes. The equilibrium time was about 3 1/2 hours. The AUC for total ketoprofen was greater in serum than in synovial fluid. On the other hand, the free fraction AUC in the serum and synovial fluid were quite similar. The mean residence time in the joint was about three times that in the systemic circulation. Ketoprofen was strongly bound to proteins and the percentage of free ketoprofen was not significantly different between serum and synovial fluid. These results provide a possible explanation for duration of the therapeutic effect of ketoprofen despite the short elimination half-life from the serum.

Ketoprofen-induced reduction of polymorphonuclear cell activation in rheumatoid arthritis.

Ten early rheumatoid arthritis (RA) patients and 10 healthy volunteers were given 200 mg of ketoprofen daily for 8 days. Polymorphonuclear cell functional studies were performed just before and immediately after this treatment. In RA patients, increased chemotactic index and adherence returned to normal after this short-term treatment whilst reduced phagocytosis and bacterial function were not significantly modified by the drug. In healthy volunteers, no significant effect was shown. In addition, ketoprofen diminished the chemotactic activity induced by zymosan in RA patients and also in healthy volunteer plasma.

[Central inhibitory effect of intravenous ketoprofen on the nociceptive flexion reflex in man]. / Effet inhibiteur central du kétoprofène intraveineux sur le réflexe nociceptif de flexion chez l'homme.

In a double-blind, cross-over study, the nociceptive flexion reflex threshold of the biceps femoris was investigated in 10 healthy volunteers before and after intravenous administration of ketoprofen (100 mg in 5 ml) or placebo (5 ml). A significant difference was observed between the increase of reflex threshold produced by ketoprofen (+ 68%) and that produced by the placebo (+ 17%). These results show that ketoprofen has intrinsic inhibitory properties of the nociceptive flexion reflex, which could be explained by a central depressive effect on the transmission of nociceptive messages.

[Comparative study of ketoprofen and pethidine in severe postoperative pain]. / Etude comparative du kétoprofène et de la péthidine dans les douleurs postopératoires sévères.

A double-blind study was conducted to compare the efficacies of a non steroid antiinflammatory drug (ketoprofen) and a central analgesic drug (pethidine). The series included 59 patients who had undergone especially painful joint surgery (knee arthrolysis and ligamentoplasty, carpal or foot surgery). Main pain relief as assessed by the patients was the same in both groups (67% with ketoprofen or 63% with pethidine). It lasted the same length of time in both groups: 9.2 h with ketoprofen and 8 h with pethidine. An identical efficacy was observed in the most painful surgery, i.e. arthrolysis (efficacy 57% for a period of 8 h in both groups), as well as in the better tolerated procedure, i.e. carpal surgery; in this case, however, the pain relief seemed to last longer with the ketoprofen (10 h) than with the pethidine (8 h). Ketoprofen probably acts more through its central analgesic effect than its antiinflammatory effect. It has few side-effects. It does not have the risks of respiratory depression or tolerance unlike the opiate drugs. This drug could therefore be interesting in elderly patients and in surgical procedures where the active participation of patients is required for early rehabilitation, e.g. joint mobilization.

[Double-blind comparative study of slow-release ketoprofen and a placebo in chronic inflammatory rheumatism]. / Etude comparative á double insu du kétoprofène à libération prolongée et d'un placebo dans les rhumatismes inflammatoires chroniques.

Twenty-five inpatients with chronic inflammatory rheumatic disease were entered into a double blind crossover trial. Consecutive treatment regimens consisted of a single daily dose of Bi-Profenid 150 mg at 8 pm for 3 days and a single placebo tablet at 8 pm for 3 days. Order of treatment regimens was randomly assigned. Bi-Profenid proved highly superior to placebo with a very significant (p less than 0.01) difference in effectiveness on nocturnal pain, morning stiffness and pain evaluated on the pain scale. During the short treatment period no significant clinical side-effects were recorded. The authors conclude that Bi-Profenid is effective at a daily dosage of 150 mg, thus enabling to adjust prescriptions to actual needs when pain is not continuous throughout the 24 hours.

[Bi-Profenid in rheumatologic practice]. / Etude du Bi-Profénid en pratique rhumatologique.

Sixty-six patients managed in an outpatient clinic for various inflammatory or degenerative conditions were given 300 mg per day of Bi-Profenid in two daily doses of one 150 mg tablet each, for 20 days. At completion of the trial, patients with degenerative disease showed a statistically significant improvement in pain upon mobilization, nocturnal pain and pain index as evaluated by the pain scale. Similarly, in patients with inflammatory conditions, significant effectiveness was recorded upon nocturnal pain, overall pain as assessed by the pain scale and articular index. Tolerance was considered satisfactory in more than 65% of cases. The most common undesirable side-effect was gastric pain (22.7%). Bi-Profenid thus confirms its effectiveness in pain due to arthrosis as well as in inflammatory conditions.

[Long-term study of 150 mg. Bi-Profenid in patients followed at the Department of Rheumatology of Cochin Hospital]. / Etude à long terme du Bi-Profénid 150 mg chez les patients suivis dans le Service de Rhumatologie de l'Hôpital Cochin.

The effectiveness and tolerance of Bi-Profenid 150 mg (two tablets a day) was evaluated in 37 patients under long-term treatment by retrospective analysis of case records. Mean duration of therapy was 15.5 months. Over this period improvement in the usual surveillance criteria was recorded. In 6 patients the "therapeutic follow-up test" allowed to decrease dosage to one tablet a day. Conversely, attempts at discontinuing the drug were followed by recurrence of pain. Tolerance was evaluated as excellent in 89% of cases and the only recorded side-effects were gastrointestinal.

[Synovial folds of the knee (plica synoviales). Treatment under arthroscopy]. / Les brides synoviales du genou (plica synoviales). Traitement sous arthroscopie.

The authors report on synovial folds of the knee examined by arthroscopy. 60 arthroscopies in 59 patients showed a plica synoviale. The authors recount the different anatomical types. A suprapatellar plica is found in all the cases and a lateropatellar plica is found in 7 out of 60 cases. The suprapatellar plica forms a fibrous fold which is sometimes completely folded off (6.6%) but more often it is an incomplete fold: internal (66.6%), external (21.6%) or annular (15%). In some cases arthroscopy reveals cartilaginous lesions associated with the plica. 18 patients out of 37 showed lesions of secondary chondromalacia. Endoscopic resection offers a possibility of treatment for this condition. The results of this operation were good or excellent in 64.7% of the patients without cartilaginous complications and in 40% of the patients who had a lesion of their cartilages. In the discussion the authors present the possible physiopathology of this syndrome and the presenting symptoms.