[Treatment of osteoarthritis of the knee joint. Efficacy and tolerance to acemetacin slow release in comparison to celecoxib]. / Behandlung der Gonarthrose. Wirksamkeit und Verträglichkeit von retardiertem Acemetacin im Vergleich zu Celecoxib.

OBJECTIVE: The aim of this trial was to compare acemetacin (ACE) with celecoxib (CEL) in terms of tolerability and efficacy in the treatment of osteoarthritis of the knee joint. METHODS: A total of 105 patients (26-64 years old) suffering from primary osteoarthritis (OA) of the knee were enrolled in this international, multicenter, randomized, double blind controlled trial. Fifty three patients were given ACE and 52 CEL. They were treated with either 90 mg bid of slow release ACE or 200 mg bid of CEL for 6 weeks. Additional gastroprotective therapy was not provided. Tolerability was assessed by physical examination, laboratory tests, vital signs and reports of side effects, as well as by patient and physician global assessments. Efficacy parameters comprised pain assessment by visual analogue scale (VAS) and ordinal scale, WOMAC, SF-36 and patient and physician global impressions of efficacy. In addition, acetaminophen consumption was recorded. RESULTS: In 21 ACE (39.6%) and 19 CEL patients (36.5%), the number of side effects totaled 56 (ACE n=29; CEL n=27) (ns). Mean pain reduction at week 6 was highly significant ( P<0.0001) in both groups and amounted to 38.7 mm (+/-20.3) in the ACE group and to 35.1 mm (+/-18.7) in the CEL group (ns). Very similar results were seen with respect to the other efficacy parameters. CONCLUSION: ACE is not inferior to CEL for the short-term treatment of knee OA in terms of tolerability and efficacy.

Molecular and microscopical evidence of Ehrlichia spp. and Borrelia burgdorferi sensu lato in patients, animals and ticks in the Czech Republic.

We report moderately severe cases of human ehrlichiosis and a lethal one caused by human granulocytic Ehrlichia, the HGE agent, closely related to Ehrlichia phagocytophila and Ehrlichia equi. Their vector is the Ixodes ricinus tick, which also transmits Borrelia burgorferi sensu lato in central, west and east regions of the Czech Republic. The diagnosis was established by PCR with sequence analysis of the genes encoding 16S rRNA of Ehrlichia and with reverse hybridization by using enzyme linked immunosorbent assay with different covalently coupled probes to the activated plate. Ten out of 47 patients and 10 huntsmen were PCR positive and 7 of them seroconverted to the HGE. Coinfection of Ehrlichia phagocytophila with Borrelia burgdorferi sensu lato was detected in 3 patients. Ehrlichia spp., the HGE agent, was isolated and propagated only from one patient in the HL-60 promyelocytic cell line. The maintenance of Ehrlichia in culture and in patients was assayed also by immunocytological staining and electron microscopy. Sequence or hybridization analysis of PCR results in different wild mammals and birds showed significant sources of Ehrlichia fagocytophila in nature. Three variants of E. phagocytophila in wild roe deer and boars, as well as for the first time in birds, have been described. Cultures from the blood of horses, and from the spleen and kidney specimens of roes and boars, PCR positive for Ehrlichia spp., displayed a disappearing level of the pathogen or contamination with other bacteria.

Persistence of Borrelia garinii and Borrelia afzelii in patients with Lyme arthritis.

We repeatedly detected DNA of Borrelia garinii or B. afzelii and Borrelia-like structures in the blood, joint fluid or in the synovium of 10 patients with Lyme arthritis by means of the polymerase chain reaction and immunoelectron microscopy at 2-4-month intervals in the course of two years. All samples were analyzed using primers which amplified the 16S rRNA gene sequence of Borrelia burgdorferi sensu lato and nucleotide sequences for the OspA gene. No cross hybridization occurred with DNA from human cells and with DNA from other bacteria. Capture and labelling with monoclonal antibodies of aggregated antigens, membranes and flagellae were evident in the blood of 7 patients, in 4 synovial membranes and 2 synovial fluids. Borreliae were found in blood capillaries, in collagen and in clusters surrounding inflammatory cells in the synovium of patients with recurrent infections who carried IgM and IgG antibodies to OspA and to 83 kDa core protein. After significant improvement for several weeks after treatment, arthritis recurred in six patients. Synoviocyte hyperplasia, inflammatory infiltration and concentric adventitial fibroplasia were seen in the synovium of the patients with persisting borreliae. Only two patients were infected with B. afzelii, the others with B. garinii.

Joint manifestations of Lyme borreliosis in Czechoslovakian patients.

Involvement of the musculoskeletal system in 50 Lyme borreliosis patients seen in Czechoslovakia is described. Thirty-three patients reported tick bites or that they had removed a tick, four patients had been bitten by some other insect. Skin reaction following tick bite were found in 29 patients. Neurologic involvements have been described in 40 subjects. In one patient complete heart block developed after ECM, so that a permanent pacemaker was necessary for two weeks. Mainly three types of involvement of the musculoskeletal system were observed, mostly as intermittent episodes of arthralgia or migratory musculoskeletal pain. In 37 patients brief attacks of monoarthritis or asymmetrical oligoarthritis were seen, chiefly of intermittent subacute course. Chronic arthritis was diagnosed in seven cases, sacroiliitis in four patients. The authors discuss differential diagnosis, especially in patients with chronic joint involvement.

Detection of Borrelia in the synovial tissue from a patient with Lyme borreliosis by electron microscopy.

We describe a woman who suffered for several years from joint pain with subsequent development of arthritis of her left knee. Because of these symptoms she was subjected to repeated studies including arthroscopy and menisectomy. IgG antibodies to Borrelia determined by ELISA were reported to be present and showed an increase of IgG titer to 1:1024. Histology from the last synovial biopsy disclosed only evidence of a nonspecific synovitis and marked inflammatory infiltration with lymphocytes and plasma cells. Borrelia-like structures were detected electron microscopically on semithin Epon sections from the lumen of the strongly infiltrated blood capillary. In our case the detection of Borrelia indicated the basis for increase of antibodies against Borreliae. It established the correct diagnosis and led to specific therapy of the disease after several years of unsuccessful attempts to control it.

[Empyema--a rare type of pulmonary disease in rheumatoid arthritis]. / Empyém--vzácná forma plicního postizení u revmatoidní artritídy.

In 52-year old patient with rheumatoid arthritis a massive empyema without development of pyopneumothorax was found. The authors discuss the mechanism of development of the empyema, its type and treatment.

[Knee joint replacement with the Motorlet endoprosthesis in patients with rheumatoid arthritis and osteoarthritis]. / Náhrada kolenního kloubu endoprotézou Motorlet u nemocných revmatoidní artritidou a osteoartrózou.

60 type MOTORLET knee joint endoprostheses are evaluated in this paper. Endoprostheses were implanted in the years 1984-1986 to 51 patients with rheumatoid arthritis and osteoarthrosis of the knee joint. EULAR knee project questionnaire was used to evaluate the results. In 72% of patients the pain completely disappeared both at rest and in movement. The average range of movement, ability to walk and knee joint stability were significantly improved, with highly favourable evaluation in 90% of operated patients. All parameters were compared with the results of 1569 knee joint operations evaluated within the range of EULAR knee project. At the same follow-up period the endoprosthesis type MOTORLET has been comparable to other widely used knee joint replacements.

Ultrastructure of Borrelia burgdorferi in tissues of patients with Lyme disease.

Spirochetal organisms were sought in 18 skin and 4 synovial membrane specimens obtained by biopsy from 22 Lyme disease patients. The presence of spirochetes in body tissues was histologically demonstrated in one patient with lymphadenosis benigna cutis, one patient with acrodermatitis chronica atrophicans and in one patient with active arthritis. The organisms were 5-30 microns long and 0.12-0.25 microns thick, had 8 or 11 flagella arising from both ends of the body, and their ultrastructure was analogous to that of cultured Borrelia burgdorferi strains. They were located intra- or perivascularly, or in the collagenous connective tissue of the skin and synovium. This implies that Lyme spirochetes may have a potential to survive in body tissues and cause injury to blood vessels.

Acute cricopharyngeal obstruction in dermatomyositis.

We report a case of a 44-year-old woman with dermatomyositis complicated by acute total cricopharyngeal obstruction resistant to corticosteroid therapy. This condition was successfully resolved by cricopharyngeal myotomy.