Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study.

The aim of the study was to evaluate the efficacy of methotrexate treatment in patients with ankylosing spondylitis in a 3-year open trial. Seventeen patients, 14 men and three women (mean age 32.7+/-8.9 years), suffering from ankylosing spondylitis and non-responders to treatment with sulphasalazine, were enrolled in our study. Sixteen of them were evaluable at the end of the study. Methotrexate (7.5-10 mg/week) was administered for 3 years. Efficacy was evaluated on the basis of clinical and laboratory variables, radiographic signs of disease progression and daily dosage of indomethacin. We obtained a good and relatively prompt clinical response except for peripheral arthritis and iridocyclitis; in fact, after 3 months of methotrexate treatment a significant amelioration of the following parameters was observed: visual analogue scale for the evaluation of both night pain and general well-being, Shober's test, occiput-wall distance, fingertip to floor, erythrocyte sedimentation rate, C-reactive protein level and daily dose of indomethacin. A further improvement was obtained during the subsequent period. Radiographs of the spine and sacroiliac joints did not show any signs of disease progression. Side-effects were a transitory elevation of transaminases (four cases) and slight hypogammaglobulinaemia (one case). Methotrexate treatment may be useful in ankylosing spondylitis, but a combined treatment might be indicated for patients with peripheral arthritis.

[The articular damage of hemochromatosis. A little known aspect]. / Il danno articolare dell'emocromatosi. Un aspetto poco conosciuto.

Genetic haemochromatosis is a HLA-linked disease characterized by a high and inappropriate gastrointestinal iron absorption; the excess iron is stored in parenchymal cells, provoking the failure of the involved organs. The common target organs of genetic haemochromatosis are liver, heart, pancreas, pituitary, joints and skin. The disease is inherited in an autosomal recessive manner with predilection for male sex and penetration conditioned by age, sex and food habits. The first clinical manifestation of genetic haemochromatosis, whose onset is typically between ages 40 and 60, is represented by arthropathy in 45% of the cases; the articular features are unfortunately often misdiagnosed and it is known that the diagnosis delay heavily compromises the outcome; vice-versa the early identification of the disease, and the consequent suitable treatment give back a normal life expectancy to these patients. The articular features of genetic haemochromatosis are of two types: 1) progressive degenerative arthropathy, characterized by pain without inflammatory signs, morning stiffness and functional impairment involving hands, wrists, shoulders, hips, knees and feet; 2) chondrocalcinosis with its typical proteiform clinical manifestations. The aim of this report is to underline that the patients with premature osteoarthritis or unexplained chondrocalcinosis must be screened for genetic haemochromatosis in order to formulate the correct diagnosis before the development of severe internal organ involvement.

Neutrophil functions and IL-8 in psoriatic arthritis and in cutaneous psoriasis.

The aim of this study is to determine some functions of neutrophil in patients affected by psoriatic arthritis and to compare them to those of patients affected by cutaneous psoriasis and to normal controls. We used a model of experimental cutaneous inflammation allowing to separate a cluster of purified and viable PMN cells. Then we analyzed, within the three groups, the IL-8 concentration in serum and in the supernatant obtained from the inflammatory site to gather data on the possible pathogenic role played by this cytokine in psoriatic arthritis. We studied neutrophil functions in patients with cutaneous psoriasis and psoriatic arthritis, in acute phase, in comparison with healthy control subjects. We investigated in vivo neutrophil migration by Senn's skin window technique and measured adhesion assay and superoxide production in circulating and migrating neutrophils after different stimuli. We also measured IL-8 concentration in serum and in the supernatant obtained from the inflammatory site, artificially created through the skin window scrape. Neutrophil migration in vivo was significantly higher in both groups of patients than in controls. In the presence of fMLP, blood cells showed a burst of superoxide release, which was significantly more pronounced in patients when compared to healthy controls. Neutrophils from skin window scrape showed a much higher response to fMLP as compared to blood cells of all subject groups, but no differences were observed between patients and controls. No correlation was found between the three groups in adhesion ability under basal condition or in response to different stimuli by circulating and migrating neutrophils. Our results also show a great increase of IL-8 in the exudate from patients compared to controls. Our study shows that there is no difference in neutrophil functions between patients with psoriatic arthritis and cutaneous psoriasis; moreover we suggest that the source of high IL-8 levels are neutrophils rather than the keratinocytes.

[Efficacy of topical azelastine in the treatment of allergic rhinitis caused by Parietaria officinalis]. / Efficacia dell'azelastina topica nel trattamento della rinite allergica de Parietaria officinalis.

We have evaluated the efficacy of azelastine, a new long acting antihistamine, in the topic treatment of seasonal allergic rhinitis to Parietaria officinalis. Forty five patients have been considered, 20 males and 25 females, mean age 28.5 years, suffering from seasonal rhinitis to Parietaria officinalis for at least 4 years. Azelastine was administered twice a day for 4 weeks in the pollen season. On a daily diary-card, patients had to record the severity of the symptoms considered: runny nose, sneeze, itching nose, nasal obstruction, following an arbitrary score from 0 to 3. At the end of the study, patients obtained a significant improvement of the symptoms considered without the addition of any other topical or systemic therapy. No side effects have been reported. Therefore azelastine is an effective drug in the treatment of seasonal allergic rhinitis to Parietaria officinalis.

[Topical cyclosporine in the treatment of oral pemphigus]. / Ciclosporina topica nel trattamento del pemfigo orale.

BACKGROUND: Pemphigus vulgaris presents the typical blistering lesions at the level of oral mucosa in nearly all patients. The main drugs used in the treatment of the disease are steroids and immunosuppressive agents. Among the latter, cyclosporine A plays a pivotal role. METHODS: In this study the effects of topical cyclosporine have been evaluated in 12 patients (4 males and 8 females, mean age 65 years) suffering from oral pemphigus for at least 4 years non responsive to the previous treatments. Five ml of oral suspension (500 mg) were divided into three times a day; cyclosporine had to be kept in the oral cavity for 15 mins and no food nor drinks were allowed for 30 mins before and after the oral wash. The treatment lasted for 2 months. RESULTS: At the end of the study a significant beneficial effect on erythema, oral lesions and pain was noticed. No side effects have been reported and the monitoring of full blood count, of renal and hepatic function and of blood pressure has not shown any variation from the baseline. Serum cyclosporine level has always been undetectable. CONCLUSIONS: These encouraging results in the treatment of oral pemphigus need to be confirmed in controlled studies.

[Nedocromil sodium is effective in the treatment of mild and moderate allergic asthma caused by Dermatophagoides pteronyssinus]. / Il nedocromile sodico è efficace nel trattamento dell'asma allergico lieve e moderato da Dermatophagoides pteronyssinus.

We have evaluated the efficacy of nedocromil sodium in 38 patients (18 males and 20 females, mean age 37.2 yrs) suffering from mild or moderate allergic asthma due to Dermatophagoides pteronissinus. Nedocromil sodium was given twice a day at the dosage of 4 mg each time for two months. On a daily diary card patients had to record the severity and the number of asthmatic attacks, the usage of bronchodilators and the values of peak respiratory flow measured in 1/min in the morning and at night. The improvement of the parameters considered was statistically significant, and no side effects have been observed. Nedocromil sodium is therefore an efficacious and safe drug in the treatment of mild and moderate asthma induced by Dermatophagoides pteronyssinus.

[Nedocromil sodium 1% nasal spray in the treatment of allergic rhinitis caused by Dermatophagoides pteronyssinus]. / Trattamento della rinite allergica da Dermatophagoides pteronyssinus con nedocromile sodico 1% spray nasale.

We have evaluated the efficacy of Nedocromil sodium 1% nasal solution in 36 patients (20 females and 16 males, mean age 29.5 years) suffering from perennial allergic rhinitis caused by Dermatophagoides pteronyssinus. Nedocromil sodium was given four times a day for 2 months. On a daily card patients had to report the severity of the considered symptoms (runny, nose, sneezing, itchy nose and stuffy nose) following an arbitrary score from 0 to 3 (0 = no symptom, 1 = mild, 2 = moderate, 3 = severe). Clinical evaluation was performed after 1 month and at the end of the treatment. We observed a statistically significant decrease of the considered symptoms already after a one month therapy. This improvement was higher after two months (p < 0.001). No side effects have been reported and no concomitant symptomatic therapy was needed. Nedocromil sodium is therefore a safe and efficacious drug in the treatment of allergic rhinitis caused by Dermatophagoides pteronyssinus.

[The effect of formoterol on light or moderate bronchial asthma due to allergy to Parietaria officinalis]. / Effetto del formoterolo sull'asma bronchiale lieve o moderato da allergia a Parietaria officinalis.

We have evaluated the effect of formoterol in 28 patients (20 males and 8 females, mean age 25.4 years) affected by mild or moderate bronchial asthma due to Parietaria allergy. Inhaled formoterol was given at the dosage of 24 mg twice a day for 10 weeks during the pollen season. Patients had to record daily the peak respiratory flow, the severity and the number of asthmatic attacks and the severity of cough. Moreover they had to report the use of additional bronchodilators and the possible side effects. The treatment with formoterol obtained in increase of PEF values from 254 +/- 6.1 to 329 +/- 6.1 l/min in the morning and from 237 +/- 7.1 to 365 +/- 7.1 l/min in the evening. A significant improvement on the number of asthmatic attacks and on the cough was also obtained. No side effects have been reported. Our results show the safety and the efficacy of formoterol in the treatment of mild or moderate bronchial asthma.

[Efficacy of levocabastine in perennial rhinitis]. / Efficacia della levocabastina nelle riniti perenni.

We have evaluated the efficacy of topical levocabastine in 42 patients (20 males and 22 females; mean age 37.5 yrs.) affected by perennial allergic rhinoconjunctivitis due to Dermatophagoides pteronyssinus. Diagnosis was performed on the basis of clinical history, Skin Prick test and RAST. The study lasted for 90 days and nasal spray levocabastine was administered at the dose of 2 puff in each nostril twice a day. Patients had to record the severity of the symptoms considered (sneezing, nasal pruritus, nasal obstruction and rhinorrhea) on a diary card according to an arbitrary score from 0 to 3. At the end of the treatment patients experienced a significant improvement of their symptoms and no side effects were recorded. On the basis of our results levocabastine can be considered a useful drug in the treatment of allergic rhinitis due to Dermatophagoides pteronyssinus.

[Nedocromil sodium nasal spray in the treatment of seasonal allergic rhinitis]. / Nedocromil sodico spray nasale nel trattamento della rinite allergica stagionale.

We have evaluated the efficacy of nedocromil sodium 1% nasal spray in 29 patients (14 males and 15 females, mean age 23 years) who had been suffering from seasonal allergic rhinitis due to Parietaria for at least three years. Diagnosis was based on medical history, skin prick test and RAST. Nedocromil sodium was given for 4 weeks in May, at the dosage of 4 mg, 4 times a day in each nostril. On a daily diary card patients had to record both the severity of symptoms following an arbitrary score from 0 to 3 and the possible presence of side effects. After 4 weeks of treatment patients obtained a statistically significant improvement of the symptoms considered (p < 0.001). No side effects have been reported and no other drugs have been necessary to control the symptoms.

[Nedocromil sodium as a topical treatment of allergic conjunctivitis due to grasses]. / Nedocromil sodico come trattamento topico della congiuntivite allergica da graminacee.

Thirty-two patients (20 males and 12 females, mean age 31 ys) with seasonal allergic conjunctivitis to grass pollen, were selected for this study. Nedocromil sodium 2% ophthalmic solution was given at the dosage of 1 drop four times a day for four weeks during the month of June. On a daily diary card each patient had to report the severity of the symptoms: itchy eyes, lacrimation, red eyes and photophobia, following an arbitrary score from 0 to 3 (0 = no symptom, 1 = mild, 2 = medium, 3 = severe). After four weeks of treatment we observed a statistically significant improvement of the symptoms considered. Patients did not take other medications and did not report any side effects. Nedocromil sodium is therefore a valid alternative in the treatment of allergic conjunctivitis to grass pollen.

[Oral immunotherapy in oculorhinitis from Gramineae]. / Immunoterapia orale nelle oculoriniti da graminacee.

We have evaluated the efficacy of oral immunotherapy in 34 patients affected by seasonal allergic rhinoconjunctivitis due to grass pollen. Diagnosis was performed on the basis of medical history, Skin Prick Test and Rast and the mean duration of the disease was 6 years. The treatment started in November and consisted of increasing daily doses of allergen; when the maximum dose was reached, it was continued twice a week till April. After two years of treatment we observed a statistically significant reduction in the severity of the symptoms considered and in the amount of oral antihistamines taken during the pollen season. The treatment was well tolerated and patients did not experienced any adverse effect. We therefore conclude that oral immunotherapy is a valid alternative to traditional subcutaneous immunotherapy in the treatment of seasonal allergic rhinoconjunctivitis due to grass pollen.

[Latex allergy]. / Allergia al lattice.

In 1979 the first case of contact urticaria to rubber gloves was reported in a patient with a positive skin prick test to latex. The use of articles containing rubber is widespread and this can explain the increasing frequency of allergic reactions to natural rubber latex. The symptoms may be localized like contact urticaria or systemic like angioedema, generalized urticaria or anaphylactic shock. In this study we have considered 12 patients who presented clinical manifestations after direct contact with objects containing rubber. Three patients had eczema and pruritus after the use of household gloves, 4 subjects had lips and tongue oedema following the contact with rubber tube during a dental treatment, 5 patients suffered from urticaria and pruritus during the use of surgical gloves. Generalized angioedema was also present in 4 out of 12 patients. All the patients had positive Skin prick test and Rast to latex. Three out of 12 patients were atopic. Our study confirms the increasing frequency of immediate hypersensitivity reactions to latex. This phenomenon must be taken into account especially before surgery, since severe clinical manifestations such as anaphylactic shock may occur.

[Efficacy of salmeterol in patients with allergic bronchial asthma]. / Efficacia del salmeterolo in pazienti affetti da asma bronchiale allergico.

Inhaled beta 2-agonists play a central role in the treatment of acute bronchial asthma. A new long-acting beta 2-receptor agonist has recently become available: salmeterol. It improves FEV 1, has an antiinflammatory effect on bronchial airways, provides a strong protection against histamine-and allergen-triggered bronchoconstriction, thus leading to better control of asthmatic symptoms during day and night. The aim of this study was to evaluate the efficacy of salmeterol in 22 patients with allergic bronchial asthma. Our results show that inhaled salmeterol (50 micrograms twice daily) can successfully control diurnal and nocturnal asthmatic attacks and can induce an important increase of PEFR. During the study no further treatment with bronchodilator drugs was necessary.

[Safety of azithromycin in patients allergic to penicillin and cephalosporin]. / Sicurezza dell'azitromicina in pazienti allergici a penicillina e cefalosporina.

We have evaluated the safety of a new antibiotic, azithromicin, in 48 patients with allergy to penicillin and/or to cephalosporin. Diagnosis of allergy was based on clinical history, skin test and detection of serum specific IgE. The most common symptoms were urticaria, oedema, pruritus, oral aphthosis. Azithromicin was administered at the increasing dosage of 100-200-300 and 400 mg every 2 days. Our patients did not show any reaction to azithromicin. This antibiotic is therefore a valid alternative to penicillin and/or cephalosporin in patients allergic to these two drugs.

[The efficacy of long-term specific immunotherapy for Dermatophagoides pteronyssinus in patients with atopic dermatitis]. / Efficacia dell'immunoterapia specifica a lungo termine per Dermatophagoides pteronyssinus in pazienti affetti da dermatite atopica.

The aim of this study was to evaluate the efficacy of hyposensitization therapy with Dermatophagoides pteronyssinus vaccine in patients with moderate and severe atopic dermatitis and sensitization to house mite dust. We studied 32 patients who showed strongly positive Skin Prick Test and high levels of circulating specific IgE to Dermatophagoides pteronyssinus. All the patients were treated with sodium alginated dialyzed allergenic extract (Bayropharm, Milan), realized by increasing progressively subcutaneous injections for three years. Erythema and lichenification were monitored. The Skin Prick Test positivity and serum level of specific and total IgE were measured before and after the treatment. We divided our subjects in two groups on the basis of presence or absence of respiratory symptoms such as rhinitis and asthma. All the patients showed substantial improvement of the cutaneous lesions and respiratory symptoms. Analysis of specific circulating IgE and Skin Prick Test showed significant tendency to normalization. The total IgE serum level showed no significant difference. Our results showed a definite benefit from a DPT hyposensitization regime in patients with atopic dermatitis and sensibilization to house mite dust.