Assessment of stiffness in rheumatology: the use of rating scales.

A study of 100 patients with rheumatoid arthritis has shown good correlation amongst three rating scales when used for measuring severity of morning stiffness and severity of stiffness present at the time of interview. Duration of morning stiffness was found to correlate only moderately well with severity of morning stiffness and poorly with severity of stiffness present at the time of interview. Investigation of the patients' definitions of stiffness, with and without the aid of a list of descriptive words, indicated an inter-relationship of pain and limited movement in the majority. This linking of the two symptoms under the term 'stiffness' may explain why some objective methods of measurement do not appear to reflect the subjective stiffness of which patients complain.

A clinical and biochemical evaluation of Clozic, a novel disease modifying drug in rheumatoid arthritis.

We have compared two dose levels of Clozic, a novel agent with potential anti-rheumatoid activity, to D-penicillamine and aspirin in an observer blind randomised parallel group study of 56 patients with active rheumatoid arthritis. Eight clinical assessments and 26 laboratory assessments were performed on each patient at each visit over a six month period. Results were analysed by conventional methods and also by correlation matrices constructed between clinical and laboratory variables. Patients treated with D-penicillamine (500 mg/day) responded adequately and the control group on aspirin (up to 3.6 g of enteric coated formulation/day) performed well, though the withdrawal rate from this latter group was high, predominantly because of continued disease activity. Patients receiving Clozic (100 mg/day or 300 mg/day) improved more than patients receiving penicillamine, particularly at the higher dose. Comparison of methods of analysis validates the use of correlation matrices both for detecting anti-rheumatoid activity and for determining the optimum dose of a novel compound. This trial illustrates the problems of a study of this nature, with the powerful effect on patients of being enrolled in such a closely monitored investigation. It emphasises the greater value of biochemical changes in following disease changes.

A comparison of clinical assessments of disease activity in rheumatoid arthritis.

Six clinical assessments of disease activity, including a new summated change scale (SCS), have been compared in a group of 30 patients with rheumatoid arthritis seen on 8 separate occasions during their first 6 months of therapy with either D-penicillamine or hydroxychloroquine. Articular index and grip strength correlate best with erythrocyte sedimentation rate and C-reactive protein, pain score and early morning stiffness less well, and summated change score and joint circumference least well. Articular index and grip strength also correlated well with the other clinical parameters and are therefore judged to be the best clinical indices of change in treatment with these drugs.

Rheumajecta in the treatment of rheumatoid arthritis.

A double-blind controlled trial of Rheumajecta in rheumatoid arthritis demonstrated lack of effect of this compound and unacceptable side-effects. It was not felt ethically justifiable to complete the trial.

A comparative study of benoxaprofen and indomethacin in ankylosing spondylitis.

Benoxaprofen (600 mg once daily) has been compared to indomethacin (25 mg 3 times daily) in a double-blind crossover study of 20 patients with active ankylosing spondylitis (AS). The clinical improvement was comparable with both drugs; 6 patients preferred benoxaprofen and 7 patients indomethacin. Although 2 patients discontinued benoxaprofen because of lack of effect, no upper gastrointestinal side effects were reported with this drug. Benoxaprofen is an alternative to indomethacin in the treatment of AS.

Adrenocortical suppression by synthetic corticosteroid drugs: a comparative study of prednisolone and betamethasone.

1 Single-dose studies were conducted to investigate the relative potency of prednisolone and betamethasone in suppressing adrenocortical function. 2 Betamethasone produced more profound suppression of plasma cortisol than an equivalent anti-inflammatory dose of prednisolone.

Gamma glutamyl transpeptidase levels in arthritis: a correlation with clinical and laboratory indices of disease activity.

Gamma glutamyl transpeptidase (GGTP) was measured in 62 patients with rheumatoid arthritis (RA) and 27 with osteoarthrosis (OA). The values for GGTP were significantly higher in the subjects with RA compared with the OA group. The prevalence of elevation of GGTP was higher in the RA subjects (77%) than in the OA patients (33%). Levels of GGTP correlated significantly with a number of objective indices of activity of RA in a separate group of 28 patients. Following treatment with penicillamine, GGTP levels showed a significant drop towards normal levels.

The visual analogue scale in the assessment of grip strength.

The accuracy of information derived from a visual analogue scale has been assessed by comparing the measured grip strength of 100 subjects against their estimate of grip strength scored on a visual analogue scale. There was relatively poor correlation between the measured and assessed values, suggesting that similar inaccuracies may occur when the scales are used to assess subjective phenomena.

Studies with pain rating scales.

Good correlation has been shown between pain scores derived from 4 different rating scales. The correlation was maintained when presentation of the scales was separated by a series of questions and by physical examination. There is good evidence that the 4 scales are measuring the same underlying pain variable as they calibrate well. There is also evidence that an 11-point (0-10) numerical rating scale performs better than both a 4-point simple descriptive scale or a continuous (visual analogue) scale.

A comparative study of floctafenine (Idarac) and ibuprofen in the treatment of osteoarthrosis.

A two-by-two-week crossover trial was conducted in patients with osteoarthrosis, using a double-dummy technique of drug administration. The drugs used were floctafenine (Idarac) and ibuprofen both given in a dose of 200 mg four times daily. Both drugs provided comparable relief of pain. Side-effects were few and generally mild. The results indicate that in the treatment of osteoarthrosis, floctafenine is comparable to ibuprofen (in the dose used in the study) in terms of efficacy and toxicity.

Dose dependent pharmacokinetics of prednisolone.

The pharmacokinetics of prednisolone elimination have been studied in both arthritic patients and normal volunteers using tritiated prednisolone alone, and in conjunction with unlabelled prednisolone in doses of 0.15 mg-kg-1 and 0.3 mg-kg-1 body weight. With increasing dose there is prolongation of the plasma half-life and increase in the volume of distribution and plasma clearance of prednisolone. It is proposed that these changes in pharmacokinetic parameters may be associated with non-linear binding of the steroid to plasma proteins.