[Rehabilitation of non-specific low back pain. Results of a multidisciplinary in-patient program]. / Rehabilitation des chronisch unspezifischen Kreuzschmerzes. Ergebnisse eines multimodalen stationären Behandlungskonzepts.

In this study we documented the effectiveness of a 3-week multidisciplinary rehabilitative intervention in patients with chronic nonspecific low back pain. We compared the therapy group (136 patients: 91 female, 45 male) with a waiting list control group (34 patients: 25 female, 9 male). The patients showed chronic pain grades 1 and 2 (according to the Mainz Pain Staging System) and mild restriction of activity. Pain intensity, activity, participation, and health-related quality of life improved significantly in the intervention group (VAS from 46.34 to 25.91; FFbH-R from 19.79 to 18; PDI from 21.02 to 14.57; NHP from 161.83 to 120.97); the waiting list control group remained unchanged. The improvement was independent of age, gender, duration of disease, work status, or workplace satisfaction.

[Panalgesia and the fibromyalgia concept]. / Panalgesie und das Fibromyalgiekonzept.

Fibromyalgia is a chronic soft tissue pain syndrome characterized by the presence of widespread musculosceletal aching, tender points at characteristic sites, fatigue and poor sleep. Associated disorders are restless leg syndrome, irritable bowel syndrome, irritable bladder syndrome, cognitive dysfunction, cold intolerance, multiple sensitivities and dizziness. Despite the superficial appearance of normality, many fibromyalgia patients have difficulties with remaining competitive in the work force. Impressive resurgence of research had been done about fibromyalgia in a better understanding in the neurobiology of chronic pain. The results demonstrate that sensory disorders processing at a central level are in part involved in fibromyalgia. These findings also influence the management of the disease with the tendency to a multidisciplinary therapeutical concept.

[Hormonal status of the woman and its effect on symptoms and progression of chronic polyarthritis]. / Die hormonelle Situation der Frau und deren Einfluss auf Symptome und Progression der chronischen Polyarthritis.

In a retrospective study 434 female patients suffering from rheumatoid arthritis (mean age at the onset of disease 45.7 +/- 13.3 years) were asked about information concerning number of deliveries, abortions, hormonal contraception or treatment respectively, and any changes of complaints during pregnancy, after deliveries or hormonal treatment. The effect of oral contraceptives on the progression of the disease was of particular interest. The present results show that the progression of RA is not influenced dramatically by the hormonal situation or hormonal treatment respectively. The worldwide opinion of female sex hormones regarding their influence on symptoms and progression of RA and the risk of developing RA are controversial. Positive and negative studies on the influence of hormonal situation or treatment respectively are depending very much on the individual study conditions. In order to find out more on the effects of hormones on RA, a prospective approach and much more data would be required. This is the reason why no study so far has shown unanimously acceptable results.

[Intra-articular injections in arthrosis of the small and medium size joints]. / Intraartikuläre Injektionen bei Arthrosen kleiner und mittlerer Gelenke.

Intraarticular injections into small and medium-size osteoarthritic joints may play an important role in the therapeutic plan. However, they are merely indicated if synovitis (with or without effusion) is present. Apart from irritating factors such as detritus or proteases, calcium pyrophosphate and hydroxyapatite are important pathogenetic factors in arthritis, i.e. activated osteoarthritis (2). The extent of the resulting pain and functional impairment in the mostly elderly patients often demands a rapid and efficient therapeutic action. An adequate indication provided, intraarticular administration of injectable corticosteroid preparations can afford quick relief. Although the progression of osteoarthritis will hardly be stopped, a persisting relief of pain can be achieved (13). Each intraarticular injection has to be considered a minor operation, so all its risks and possible complications have to be taken into account.

[Fibromyalgia]. / Fibromyalgie.

Fibromyalgia, also called (primary) fibromyalgia syndrome or fibrositis (syndrome), is a chronic soft tissue pain syndrome characterized by the presence of widespread musculosceletal aching, tender points at characteristic sites, fatigue, and poor sleep. The etiology of this common and painful condition is incompletely understood, non-restorative sleep, which has been correlated with an electroencephalic abnormality called alpha-delta sleep (intrusion of alpha rhythms in the non-REM sleep EEG), may be important. Several observations suggest that serotonin is likely to mediate both pain and non-REM sleep, and serotonin deficiency in the brain has been suggested to be of pathogenetic significance in fibromyalgia syndrome. A lower than normal threshold for pain can often be observed. The newly proposed criteria for the classification of fibromyalgia syndrome (widespread pain in combination with tender points at 11 or more of 18 specific tender point sites) are important for the differential diagnosis and to compare results in international studies.

Night pain and morning stiffness in osteoarthritis: a crossover study of flurbiprofen and diclofenac sodium.

Forty patients took part in an observer-blind multiple dose crossover study to compare the efficacy and tolerability of 300 mg flurbiprofen (100 mg twice a day orally and 100 mg suppository at night) with 75 mg diclofenac sodium (25 mg twice daily orally and 25 mg suppository at night) in the relief of night pain and morning stiffness in patients with osteoarthritis. Equal numbers of patients were randomized to receive one of the treatments for the first 7-day treatment period and then the other treatment for the second 7-day treatment period. There were significant differences in favour of flurbiprofen for the reduction in night pain, improvement in quality of sleep and patients' assessment of overall improvement on treatment. Two patients withdrew from the study due to side-effects experienced whilst taking diclofenac sodium during the first treatment period. Eight patients in all reported a total of 18 side-effects during this study. Six patients reported 12 side-effects whilst taking diclofenac sodium compared with three patients who reported six side-effects whilst taking flurbiprofen. This study confirms the good efficacy and tolerability of flurbiprofen in the symptomatic relief of osteoarthritis.

[Acemetacin in the treatment of painful arthroses. Results of an open short-term study on the starting point of the analgesic effect and its duration]. / Acemetacin in der Behandlung schmerzhafter Arthrosen.Ergebnisse einer offenen Kurzzeitstudie über den Zeitpunkt des analgetischen Wirkungs- eintrittes und dessen Dauer.

Acemetacin was tested in an open clinical study with regard to occurrence and duration of its analgesic effect to 20 patients suffering from arthrosis of the hip and knee joint. The treatment lasted 3 days. The therapeutic effect was judged by the influence of pain on rest and movement. With Acemetacin the majority of the patients reported a quick onset and long duration of the analgesic effect. The tolerance of Acemetacin was very good.

[Fibronectin and other immunologic parameters in chronic polyarthritis]. / Fibronectin und andere immunologische Parameter bei chronischer Polyarthritis.

In 20 patients with rheumatoid arthritis the plasma fibronectin concentrations were measured and correlated with the levels of C-reactive protein, alpha 1-antitrypsin, alpha 2-macroglobulin, fibrinogen, C3, C4 complement fractions and alpha 2-antiplasmin in serum respectively plasma. Patients with rheumatoid arthritis showed plasma fibronectin concentrations within reference levels. However, the concentrations of C-reactive protein, alpha 1-antitrypsin, alpha 2-antiplasmin, fibrinogen and C3-complement fraction were significantly higher in comparison to the healthy controls. The results indicate that fibronectin does not belong to the group of "acute phase proteins". Measurement of plasma fibronectin give no additional information about the activity of rheumatoid arthritis.

[Auranofin in the treatment of chronic polyarthritis. Results of an open multicenter study]. / Auranofin in der Behandlung der chronischen Polyarthritis. Ergebnisse einer offenen multizentrischen Studie.

Auranofin (Ridaura SK and F 39 162) was tested in an open multicenter study with regard to its anti-inflammatory effect in 166 patients suffering from rheumatoid arthritis. The time for treatment lasted for one or two years. The therapeutic effect of the drug was judged by its influence on pain, joint swelling, morning stiffness, grip strength, blood-sedimentation rate and rheumatoid factor etc. The serum gold concentration was measured regularly. With Auranofin the majority of the patients achieved a lasting improvement of the condition. The therapeutical effect was observed gradually. Side-effects were frequent but removal from the therapy was rare. Most of the side-effects were diarrhea, rash, pruritus and conjunctivitis. Regular laboratory controls revealed in some cases toxic organic reactions.

[Comparison of glycosaminoglycan polysulfate (Arteparon) and physiological saline solution in arthrosis of the large joints. Results of a multicenter double-blind study]. / Vergleich von Glykosaminoglykanpolysulfat (Arteparon) und physiologischer Kochsalzlösung bei Arthrosen grosser Gelenke. Ergebnisse einer multizentrischen Doppelblindstudie.

In a double-blind study, glycosaminoglycan polysulfate (GAGPS, Arteparon) was compared to saline solution: both preparations were applied intramuscularly in two groups of 70 patients, each over a period of 8 weeks. The patients were suffering from pain and impaired function of the knee and hip joints. To assess the therapeutic efficacy, the following parameters were employed: pain, joint mobility, and walking distance. The post trial observation period lasted for 6 months. In the GAGPS group, a statistically significant improvement compared to the results in the saline group was noted during the 2nd and 6th months of observation respectively. The global assessment by investigator and patient at the end of the observation period was superior in the GAGPS group to that in the saline group. While the difference regarding the onset of pain remission between the GAGPS and the saline groups was insignificant, the rate of complete relief from pain was better in the GAGPS group, and pain worsened in fewer incidences in this group, too. Laboratory findings did not reveal any detrimental effect of either treatment with respect to hematology, blood chemistry, or urinalysis. 3 patients of the GAGPS group developed harmless hematomas of short duration at the site of injection.

[Characteristic joint function disorders in inflammatory and degenerative rheumatism]. / Charakteristische Funktionsstörungen der Gelenke bei entzündlichem und degenerativem Rheumatismus.

Inflammatory and degenerative joint diseases show a characteristic local picture. So it is recommended that a joint examination of the joint movement extent alone is not sufficient, all articular and periarticular structures must be included. In this way it is possible to differentiate on a clinical basis inflammatory and degenerative arthropathies and also to determine the stage of inflammation. Including the joint pattern, the findings of the general examination and the case history of arthropathy can be mostly diagnosed as a distinct type of rheumatism. The directed laboratory and X-ray examination confirms the diagnosis which already has been made clinically. Therefore the physical examination of the joints is of greatest importance in rheumatology.

Oral gold therapy with auranofin (SK&F 39162). A multicenter open study in patients with rheumatoid arthritis.

One hundred and fifty patients with rheumatoid arthritis received 6 mg of auranofin daily for 2-24 months. Thirty patients were withdrawn from the study, and 82 patients were observed for 12 months. Statistical evaluation was available for 74 patients at weeks 24, 38, and 48, respectively. The major side effects observed were diarrhea, rash, and alopecia. Significant improvement was noted in the articular index, ESR, pain, and morning stiffness.

[Double-blind comparative trial of lonazolac-Ca versus naproxen in spinal osteoarthrosis, coxarthrosis and gonarthrosis (author's transl)]. / Vergleich von Lonazolac-Ca mit Naproxen bei vertebragenen Syndromen und bei Arthrosen der grossen Gelenke: Ergebnisse einer Doppelblindstudie.

Two groups of patients, each consisting of 20 patients suffering from spinal osteoarthrosis, coxarthrosis or gonarthrosis participated in a double-blind comparative trial. They received either Lonazolac-Ca (200 mg three times daily) or Naproxen (250 mg twice daily plus 1 placebo capsule in between doses) for three weeks. The therapeutic response was assessed by monitoring pain intensity at rest and on exercise, joint tenderness and joint movement, muscular tension, morning stiffness and walking ability. In spinal osteoarthrosis vertebral flexibility was also measured. Nine out of 11 parameters showed significant improvement with Lonazolac-Ca, whereas only 6 out of 11 improved with Naproxen. However, no clinically relevant differences were recorded between both medications. Laboratory tests in both treatment groups revealed no changes in haematological or biochemical parameters nor in urinanalysis results. Drug-related gastro-intestinal side effects were observed in 2 patients of each treatment group. The patients on Lonazolac-Ca tolerated their medication with the aid of concomitant antacids whereas Naproxen had to be discontinued. One case of dermatitis, which was probably not drug-related was observed in each group. One patient suffering from migraine experienced vertigo and headache on taking Lonazolac-Ca; although this was probably not drug-related medication was discontinued.

[Diflunisal in the treatment of hip and knee joint arthroses]. / Diflunisal in der Behandlung von Arthrosen der Hüft- und Kniegelenke.

Diflunisal (Fluniget, MK-647) was tested in an open clinical study with regard to its analgesic effect and its improvement of function in 30 patients suffering from osteoarthrosis of the hip and the knee. The treatment lasted for 4 weeks. The therapeutic effect was judged by the influence on day and night rest pain and on pain from pressure and movement, the change of morning stiffness and the functional improvement. Further judgement included general assessment by the physician and the patients. With Diflunisal the majority of the patients achieved a lasting improvement of their condition. A marked analgesic effect was observed during the first two weeks of therapy. Diflunisal was well tolerated. Laboratory data at the beginning and at the end of the four week treatment period revealed no toxic effects on organs, particularly no hematotoxic effects.

[Calcium-phosphate metabolism in chronic polyarthritis]. / Kalzium-Phosphorstoffwechsel bei chronischer Polyarthritis.

20 patients suffering from rheumatoid arthritis were studied to evaluate both, radiological and scintigraphic osseous changes, as well as possible disturbances in calcium phosphate metabolism. Joint and osseous alterations were assessed in all of them. Serum levels of magnesium, calcium, phosphate and alkaline phosphate were within the normal range, and also concurrent measurements of serum 25-OH-D3 concentrations and plasma levels of parathyroid hormone (PTH). However, in our patients with normal renal function, the plasma concentration of calcitonin (CT) was significantly elevated compared to normals (p less than 0.01). Our data indicate that in patients studied PTH and 25-OH-D3 does not contribute to the development and progression of osseous changes due to rheumatoid arthritis. Possibly the stimulatory effect of various osteolytic factors may cause as counterbalance elevations in plasma CT levels.

[Sulindac in the treatment of soft tissue rheumatism (periarthropathy of the hip and shoulder (author's transl)]. / Sulindac in der Behandlung des Weichteilrheumatismus (Periarthropathia humeri et coxae).

Sulindac (Clinoril) was tested in an open clinical-therapeutical study with regard to its analgesic effect and the improvement of function in 20 patients of both sexes suffering from periarthropathy of the hip or shoulder. The treatment lasted 4 weeks. The therapeutic effect was judged on the basis of the influence on the spontaneous pain and on the pain by pressure, on the functional improvement and on the daily habits of the patients. It was noted, that there was a lasting improvement due to the analgesic effect already in the first week of therapy and an improvement of function in the second week of therapy in the majority of the cases. Sulindac was well tolerated. Laboratory findings in the beginning and at the end of the four weeks treatment period revealed no toxic effects on organs, particularly on hematopoietic system.

[Long-term comparative study: diclofenac (voltaren) and naproxen (proxen) in arthritis]. / Langzeitvergleichsstudie: Diclofenac (Voltaren) und Naproxen (Proxen) bei Arthrosen.

Two non-steroidal antirheumatic drugs, diclofenac (Voltaren) and naproxen (Proxen), were compared with respect to their analgesic effect and the observed improvement in joint mobility in two groups of patients, each consisting of 20 males with either cox-arthrosis or gonarthrosis. The duration of treatment was up to six months. The therapeutic response was assessed by the mean scores of spontaneous and exercise-induced pain, the clinical state of joints and painfree time of walking. Both drugs led to a persistent improvement in the condition of most patients, but the clinical impression would appear to point to a more marked analgesic effect of diclofenac. The daily maintenance dosage from the fourth week of treatment onwards was 75 mg diclofenac and 500 mg naproxen. Both drugs were generally well tolerated. Occasionally gastrointestinal side effects were observed (more frequently in the naproxen group). Laboratory controls were carried out periodically, but no evidence of organ toxicity or hemotoxic effects was found.