The role of a peripheral dopamine-antagonist (Motilium) in improving the tolerance to steroidal and non-steroidal anti-inflammatory agents.

Domperidone protective therapy has been applied in 50 patients suffering from locomotor disease, who responded with dyspeptic complaints to the steroidal and non-steroidal antiphlogistic therapies which meant a risk of the activation of an earlier gastro-intestinal disease. The basic therapy could be applied to 80% of patients due to the Motilium protection because of the favourable changes in gastro-intestinal symptoms. Since domperidone is well tolerated by the patients and it does not yield higher risks, it's use is highly recommended as a protective therapy as well.

[Reactive arthritis following Chlamydia infection]. / Chlamydia fertözést követö reaktív arthritis.

The authors report on the clinical observation of 23 patients (5 women, 18 men) who suffered from seronegative spondylarthritis following chlamydia infection diagnosed clinically and serologically. Nine patients (2 women, 7 men) carried HLA B27 histocompatibility antigen. Sacroileitis confirmed by radiology was found in 16 cases. Genicular synovitis was the most frequent peripheral articular syndrome as well as Achilles tendinitis, "sausage-like" swelling of the finger and toes were observed and the ankle-, wrist-, elbow- and in a few cases the sternoclavicular and temporomandibular joint showed also involvement. Urological inflammation occurred in 9 cases, ophthalmological inflammation in 3 cases and pleuritis, pericarditis was observed in 1 patient. During the observation period 15 patients recovered upon Doxycyclin (Chinoin), Eryc (Biogal) non-steroid and occasional steroid therapy given 3 weeks long.

[Defects in opsonization activity of the serum of patients with chronic arthritis]. / Defekte Opsonisationsaktivität des Serums von Patienten mit chronischer Arthritis.

The opsonizing capacity of sera from 22 patients with rheumatoid arthritis (RA), from 14 with psoriatic arthritis (AP), from seven with ankylosing spondylitis, and from healthy control persons was investigated by luminol-dependent chemiluminescence, induced during yeast phagocytosis of normal polymorphonuclear leukocytes. The chemiluminescence response using opsonizing sera was compared to that induced by no-opsonized yeast and the opsonizing capacity was expressed as a percentage. For the opsonization, fresh native serum, in some experiments Mg2+-EGTA and EDTA-treated serum, was used. In RA and AP sera, a significantly diminished opsonizing capacity (p less than 0.005) was observed. In healthy controls and in SPA patients, the opsonizing capacity of their sera was over 200%, while in seronegative RA patients, it was only 175%, in seropositive RA 125%, and in AP 150% was measured. There was no correlation between opsonizing capacity and complement or immunoglobulin content of the investigated sera. The amount of C3b, IgG and IgM covalently bound to yeast particles was determined, too. Yeast particles bind significantly less (p less than 0.01) IgG when opsonized with RA and AP sera, while a higher relative amount of IgM (p less than 0.01) was bound to yeast incubated in the sera of seropositive RA patients. No significant differences in the C3b binding were observed.

Maintenance therapy of rheumatoid arthritis and of osteoarthrosis with proglumetacin.

Maintenance therapy with proglumetacin was studied in an open investigation in 25 patients with classical or definite rheumatoid arthritis and in 34 patients with osteoarthrosis. Proglumetacin (150 mg) was administered twice daily, at meals, and therapy was continued without interruption for 12 months. Patients with rheumatoid arthritis showed a progressive improvement in objective parameters (erythrocyte sedimentation rate, haemoglobin) and in semi-objective parameters (pain, articular tenderness, number of painful joints, morning stiffness, grip strength, Ritchie articular index). Patients with osteoarthrosis also showed a progressive improvement in objective parameters (movement angles of the affected joints) and in subjective parameters (pain, mobility, response to therapy). During the study, 4 patients reported occasional nausea (3 with vomiting), and 3 reported episodes of slight headache. These symptoms did not require interruption of treatment. Haematology, blood chemistry and urinalysis were not adversely affected by the treatment. Five drop-outs were recorded in the rheumatoid arthritis group: 2 because patients failed to report, 2 because of severe relapses which required a radical change in the therapeutic programme and 1 for incorrect enrollment. Fourteen drop-outs were recorded in the osteoarthrosis group: 6 because the patients failed to report, 4 because of orthopaedic surgery and 4 because it was necessary to change the therapeutic programme. No drop-out was due to an intolerance to proglumetacin. It is concluded that proglumetacin appears to have the effectiveness of tolerability features required for a first-choice medicament for long-term maintenance treatment of patients with rheumatoid arthritis or with osteoarthrosis.

A 3-month, double-blind study of proglumetacin and naproxen in the treatment of rheumatoid arthritis.

A double-blind clinical trial was carried out on 2 parallel groups each of 20 in-and out-patients with classical or definite rheumatoid arthritis, to compare the efficacy and tolerance of proglumetacin, a new non-steroidal anti-inflammatory drug, with naproxen. Each patient received daily either 300 mg proglumetacin or 500 mg naproxen in two divided doses, at meals, over a period of 3 months. The whilst both drugs were effective in the long-term treatment of chronic rheumatoid arthritis, proglumetacin appeared to be somewhat more effective than naproxen in reducing the duration of morning stiffness, the articular inflammation score index, erythrocyte sedimentation rate and the dosage of concomitant basic medication. Few side-effects were reported but 1 of the 2 patients in the naproxen group who developed allergic reactions had to be withdrawn during the first few days of treatment.

Protein-corticosteroid interactions in peripheral plasma and synovial fluid of patients with rheumatoid arthritis and osteoarthrosis.

The individual protein fractions, together with the unbound (biologically active) and specifically globulin-bound 11-hydroxysteroids, were determined in the plasma and synovial fluid of patients with rheumatoid arthritis (RA). The values were compared with those measured in control subjects and in patients with severe osteoarthrosis (OA). Hypoalabuminaemia and hyperglobulinaemia, as well as an increase in the unbound and a decrease in the specifically bound corticosteroids were found in the plasma of the RA patients. The protein and corticosteroid levels were lower, and the level of the protein-bound corticosteroid fraction higher, in the synovial fluid than in the plasma. Significant differences between the RA and OA patients in respect of these parameters were also observed. The findings indicate that the altered hormone pattern is not a nonspecific result of the permanent stress situation to which RA patients are subjected. They point out the existence of a fairly specific but still unknown mechanism that compensates the high level of unbound corticosteroids, thus accounting for the absence of any clinical signs of hypercortisonism.

Study on the inactivation mechanism of androgens in rheumatoid arthritis: excretory rate of free and conjugated 17-ketosteroids.

Unconjugated, sulpho- and glucurono-conjugated androgen hormone metabolites have been determined in the urine of patients with rheumatoid arthritis. An increase in the excretory rate of unconjugated 5 beta-reduced 17-ketosteroids and a decrease in that of 17-ketosteroid conjugates, especially in dehydroepiandrosterone sulphate and in the sum of dehydroepiandrosterone, etiocholanolone and androsterone glucuronoside were observed. In contrast to unconjugated metabolites, there was less significant change in the 5 beta-metabolite conjugates in urine. Corticosteroid treatment resulted in an additional decrease of metabolite excretion by patients. Further study is necessary to determine the causative factors in the altered steroid pattern observed in this severe, non-endocrine disease.