[Radiologic findings in gout]. / Radiologische Befunde bei der Gicht.

Radiological gout manifestations are detectable in the early stage, but also especially in the chronic stage of gout. Whereas in the early stage only soft tissue mutations (bursitis inflammation) and light calcium deposits are usually discernible, chronic gout leads to asymmetrical, diverse forms of osseous destruction, favouring smaller joints, but also affecting larger ones, which are caused by the intra-articular and extra-articular deposit of tophus material, corresponding to the progression and degree of severity of the illness. Radiologically-detectable changes in other organs, such as the kidneys, will be addressed. The high number of, and to some extent very characteristic, osseous mutations are compared with those mutations which are very similar to the diagnoses of other syndromes affecting the joints. Specifically, problems in differentiating diagnosis of rheumatoid arthritis, arthritis psoriatica, chondrocalcinosis, and other diseases of the joints will receive special mention. Reference is also made to the extreme diagnostic difficulties resulting from the rare but nevertheless conceivable influence of gout on the spine or sacroiliac joints. The method of magnetic resonance imaging for gout shows a characteristic signal behaviour of the tophus material. It has been determined that, through magnetic resonance tomography, interosseous tophi can be detected earlier and in a more widespread manner than with the aid of native X-ray images, such that an increase in the use of this method is to be expected.

Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee.

Glucosamine sulfate is able to stimulate proteoglycan synthesis by chondrocytes and has mild anti-inflammatory properties. In clinical trials, glucosamine sulfate was more effective than placebo in controlling the symptoms of osteoarthritis (OA). In order to better characterize this therapeutic activity, we conducted a randomized, double-blind, parallel-group study of glucosamine sulfate 500 mg t.i.d. vs ibuprofen 400 mg t.i.d., orally for 4 weeks. The study included 200 hospitalized patients with active OA of the knee, symptoms for at least 3 months and a Lequesne's index of at least 7 points. Patients were evaluated weekly. Response was defined as a reduction in the Lequesne's index by at least 2 points if the enrollment value was higher than 12 points, or by at least 1 point if the enrollment value was 12 or less points, together with a positive overall assessment by the investigator. The improvement tended to be sooner under ibuprofen (48% responders vs 28% after the 1st treatment week; P = 0.06, Fisher's Exact test), but there was no difference from the 2nd week onward, with a success rate of 52% in the ibuprofen group and of 48% in the glucosamine group (P = 0.67) at the end of treatment. The average Lequesne's index at enrollment was around 16 points and decreased by over 6 points in both groups, again with the above described trend. On the other hand, 35% of patients on ibuprofen reported adverse events, mainly of gastrointestinal origin, vs 6% adverse events with glucosamine (P < 0.001, Fisher's Exact test). The number of adverse event related drop-outs was different between the two groups (7% vs 1%, respectively; P = 0.035). Glucosamine sulfate was therefore as effective as ibuprofen on symptoms of knee OA. These data confirm glucosamine sulfate as a safe symptomatic Slow Acting Drug for OA.

A 6-month randomized dose range study of OM-8980 in rheumatoid arthritis.

Sixty patients with active RA were evaluated over 6 months in a double-blind randomized dose range multicentre study comparing the efficacy and tolerance of three different doses of the slow-acting anti-rheumatic bacterial extract OM-8980 (6, 24 and 48 mg of active principle). No patients were withdrawn during the study. At the end of the 6-month trial, significant improvements were observed for the different RA signs and symptoms (Ritchie index, morning stiffness, swollen joints, grip strength, ESR, pain scale and categories) as well as for the concomitant intake of symptomatic drugs in the 24-mg dose group with respect to the 6-mg group and without significant differences between the 24- and 48-mg groups. Tolerance was very good with nine minor and transient side effects (five itching and four diarrhoea) reported altogether by seven patients, without establishment of a dose-effect correlation. In conclusion, the two higher doses of OM-8980, 24 and 48 mg, were significantly more efficient than 6 mg, with the effect of the 24-mg dose being even slightly superior to the 48-mg dose, confirming the former as the optimal and well-tolerated dose for the treatment of RA.

[Bacterial sacroiliitis]. / Bakterielle Sakroiliitis.

We saw two cases of infectious sacroiliitis in young patients. The multi-various clinical symptoms, the predispositions, as well as the alteration of laboratory analyses are described. Further, we discuss problems of early diagnosis, diagnostic measures like x-ray, sonography, bone-scan, computerized tomography scan, magnetic resonance imaging, and their particular significance. Computerized tomography scan of iliosacral joints determined the further therapeutic procedure. In both cases, we prescribed cephalosporin-antibiotic cefotaxime-sodium.

A three year comparative study of auranofin and gold sodium thiomalate in rheumatoid arthritis.

UNLABELLED: One hundred twenty-one patients with active RA were randomly assigned to receive 6 mg auranofin (AF)/day (60 patients) or 50 mg gold sodium thiomalate (GST)/week (62 patients) in a double-blind fashion. There were no intergroup differences with respect to sex, age, duration (median 2 years), stage and activity of the disease. In the case of "striking improvement" after 24 weeks a dose reduction to 50 mg GST/month or 4 mg AF/day was allowed and carried out in all GST patients and no AF patient. The serum gold levels were 5 times higher with weekly GST, they approached those of the AF group with monthly GST injections. The clinical parameters--number of swollen joints, activity index, articular index, grip strength, ESR--improved significantly in both groups, but grip strength, articular index and ESR improved more pronounced in the GST group. The X-ray progression (hands and forefeet) was significantly greater in the AF group. Forty-eight AF patients (80%) and 39 GST patients (36%) completed the first year. Thereafter the study was continued as an open study but the patients were allowed to switch from GST to AF. After the first and second year 14/7 GST patients switched to AF. The second/third year was completed by 37/22 AF pat. (62%/37%) and by 15/8 GST pat. (24%/13%). Skin reactions were more common with GST (41.9%/26.7%), diarrhoea was more common with AF (36.7%/19.4%), proteinuria occurred in 10% in both groups, leucopenia and thrombocytopenia were rare in both groups (1.7%). The withdrawal rate due to adverse events was 10%/26% in the AF/GST group during the first year (p less than 0.05) and 25%/32% over the three year period (n.s.). CONCLUSION: Both AF and GST are effective in the long-term treatment of RA, but GST is more so in radiological progression and ESR.

Auranofin and gold sodium thiomalate in the treatment of rheumatoid arthritis: a one-year, double-blind, comparative multicenter study.

In a 48-week, double-blind trial, 122 patients were randomly assigned to treatment with auranofin (60) and gold sodium thiomalate (GST) (62) at five centers. Both groups showed significant improvement (P less than 0.05) from baseline in parameters of disease activity. Results of the covariance analysis for all patients who completed the trial showed no significant differences (P less than 0.05) in efficacy between the two groups. The proportions of patients showing 50% or greater improvement in tender joints, swollen joints, activity index, severity of pain, general health rating, and erythrocyte sedimentation rate (ESR) were similar for both auranofin-treated and GST-treated patients who completed the 48-week trial. When all patients who entered the trial were evaluated, a slightly greater proportion of patients on auranofin had improved. Diarrhea occurred more frequently with auranofin (32%) compared to GST (19%), whereas rash and pruritus were twice as common in those patients treated with GST compared to those treated with auranofin. The withdrawal rate due to adverse reactions was 10% for auranofin vs 26% for GST. It was concluded that the efficacy of auranofin was comparable to that of injectable gold and was better tolerated, as evidenced by the lower withdrawal rate from adverse events for the auranofin patients.

Double-blind clinical trial of S-adenosylmethionine versus ibuprofen in the treatment of osteoarthritis.

Thirty-six subjects with osteoarthritis of the knee, the hip, and/or the spine were enrolled in a randomized double-blind study. Patients received a daily oral dose of 1,200 mg of S-adenosylmethionine (SAMe) or 1,200 mg of ibuprofen for four weeks. Morning stiffness, pain at rest, pain on motion, crepitus, swelling, and limitation of motion of the affected joints were assessed before and after treatment. The total score obtained by the evaluation of all the individual clinical parameters improved to the same extent in patients treated with SAMe or ibuprofen. Both treatments were well tolerated and no patient from either group withdrew from the study.

Comparative study of piroxicam and indomethacin retard in osteoarthritis.

Indomethacin retard and piroxicam were compared in an open, randomized, parallel study in the treatment of osteoarthritis. Improvement of the symptoms of the disease was highly significant for both drugs. There was no statistical difference between the two drugs in terms of efficacy. Number and duration of side effects were significantly lower with piroxicam than with indomethacin retard. Piroxicam was administered once a day. Indomethacin retard was always (43% of the cases) or sometimes (14%) given twice daily.

Auranofin and sodium aurothiomalate in the treatment of rheumatoid arthritis. A double-blind, comparative multicenter study.

Auranofin (AF), a new gold compound, has been suggested as an alternative to parenteral gold in the treatment of rheumatoid arthritis (RA). This hypothesis has been tested within a double-blind comparative study and to date 103 patients have been enrolled. Forty-one RA patients have been treated for longer than 6 months. The patients were randomly allocated to treatment with either AF or sodium aurothiomalate (GSTM) and serial comparison of changes within the articular index, grip strength, pain, morning stiffness, and global assessment during treatment were measured. Improvement was noted within both treatment groups. Diarrhea as a side effect was most commonly seen during treatment with AF while rash often combined with pruritus was most commonly reported with GSTM; withdrawal from treatment as the result of this was nevertheless uncommon.

[Comparative study of piroxicam and indomethacin retard in arthroses]. / Vergleichende Untersuchung von Piroxicam und Indometacin retard bei Arthrosen.

Indomethacin retard and piroxicam (Felden) were compared in an open, randomized parallel study in the treatment of osteoarthritis. Improvement of the symptoms of the disease was highly significant for both drugs. A statistical difference in the efficacy was not proved. Number and duration of the side effects were significantly lower with piroxicam than with indomethacin retard. Piroxicam was only applied once a day. Indomethacin retard was always (43% of the cases) or sometimes (14%) applied twice daily.

[Flurbiprofen and indomethacin in chronic polyarthritis and gonarthrosis - a comparative multicentric double-blind cross-over study]. / Flurbiprofen und Indometacin bei chronischer Polyarthritis und Gonarthrose --eine vergleichende multizentrische Doppelblind-cross-over-Studie.

In two multicenter double-blind cross-over studies efficacy and safety of flurbiprofen and indomethacin were compared. Nineteen patients with rheumatoid arthritis and twenty with osteoarthrosis of the knee were treated. Both drugs were effective and almost equal. Also safety was good, however three patients on indomethacin and one on flurbiprofen had to be withdrawn from the trial because of side-effects.

Tizanidine (DS 103-282) in the treatment of acute paravertebral muscle spasm: a controlled trial comparing tizanidine and diazepam.

In a double-blind trial tizanidine (DS 103-282: 5-Chloro-4-(2-imidazolin-2-yl-amino)-2,1,3-benzothiadiazole), a new muscle relaxant, was compared with diazepam in twenty in-patients suffering from acute paravertebral muscle spasm. All the patients had suffered from degenerative spinal disease for some years. Ten patients received tizanidine and the other ten received diazepam. Both drugs were administered t.i.d. for a period of 7 days. Significant improvements were reported in eight of the sixteen variables. Tizanidine was significantly superior to diazepam for two of these variables (lateral flexion of the lumbar spine, right and left). A centrally mediated blood-pressure-lowering effect was observed with both drugs. Tizanidine was generally better tolerated, only two patients reporting transient side-effects compared with five patients in the diazepam group. Like diazepam, tizanidine is a suitable drug for the treatment of acute paravertebral muscle spasm.