Effect of diclofenac alone or in combination with alpha-tocopherol on the oxidative activity of polymorphonuclear leukocytes in healthy and osteoarthritic individuals.

OBJECTIVE: To investigate the effects of diclofenac alone or when combined with alpha-tocopherol on the oxidative activity of polymorphonuclear leukocytes (PMNs) in healthy and osteoarthritic (OA) patients. METHODS: The study was carried out at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, over the period 1999 to 2000. Twelve healthy controls and 12 osteoarthritic patients were recruited to the study. Twelve healthy controls and osteoarthritic patients were given diclofenac 50 mg thrice daily orally, initially for 5 days then alpha-tocopherol at 200 mg thrice daily orally, was added for another 5 days. Blood samples were drawn before the start of the study (pre-treatment) and at 5 days following treatment with diclofenac alone and 10 days following treatment with diclofenac and alpha-tocopherol. Chemiluminescence (CL) response was measured for whole blood and isolated polymorphonuclear leukocytes (PMNs) on all samples. RESULTS: Diclofenac enhanced CL response of whole blood and of PMNs of healthy controls when stimulated with phorbol myristate acetate (PMA) and opsonized zymosan (OPZ). Co-treatment with alpha-tocopherol resulted in no appreciable change in the CL response of whole blood when stimulated with PMA or OPZ but a further significant enhancement of CL response of isolated PMNs when these cells were stimulated by either PMA or OPZ. In osteoarthritic patients, diclofenac alone and when combined with alpha-tocopherol showed no significant change in CL response of whole blood. The CL response of PMNs from OA patients was decreased by diclofenac alone. However, this inhibitory effect was not observed when alpha-tocopherol was used together with diclofenac. CONCLUSION: The effect of diclofenac alone or in combination with alpha-tocopherol did not produce a consistent effect on the CL response of whole blood or isolated PMNs of healthy or osteoarthritic patients.

Interaction of allopurinol and non-steroidal anti-inflammatory drugs on the carrageenan-induced rat paw edema.

OBJECTIVE: To find out the effect of combining allopurinol with non-steroidal anti-inflammatory drugs on carrageenan-induced rat paw edema. METHODS: The study was carried out at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, over the period 1999 to 2000. Male wistar rats were randomly divided into 12-16 rats in each group. Edema was induced by subplantar injection of 0.1 ml of carrageenan (10 mg/ml) and the resulting edema volume was measured by plethysmograph, 3 hours after the injections. Saline of 0.9% (0.1 ml/100 g) was administered to the first group serving as control. The second and third groups received variable concentration of allopurinol (12.5, 25, 50 mg/kg) and tenoxicam (0.0625, 0.125, 0.25 mg/kg) 30 minutes before carrageenan injection. The fourth group received a combination of tenoxicam and allopurinol. Similar procedures were carried out with respect to diclofenac at 1.25, 2.5, 5.0 mg/kg and indomethacin at 0.25, 0.5, 1.0 mg/kg. The activities of the drugs were expressed as percentage inhibition of edema. RESULTS: Pre-treatment of the rats with the 4 drugs individually resulted in dose-dependent reduction of volume of paw edema. The combination of allopurinol and diclofenac acted synergistically to reduce edema. A similar synergistic action was obtained when allopurinol was combined with indomethacin. By contrast, tenoxicam-allopurinol combination resulted in antagonistic action and produced an effect on edema, which was less than their individual inhibitory action. CONCLUSION: Combining allopurinol with either diclofenac or indomethacin produced synergistic inhibitory action on rat's paw edema. However, tenoxicam, when combined with allopurinol, produced antagonism.

Musculoskeletal pain in the community.

OBJECTIVE: To estimate the prevalence of musculoskeletal (MSK) pain in Al-Qaseem province in central Saudi Arabia. METHODS: Over a period of 18 months extending from September 1993 through to the end of February 1995, a house-to-house survey was conducted in Al-Qaseem province and included 5,894 adults asking regarding musculoskeletal pain. RESULTS: We obtained a response from 5,823 (98.8%), 2,667 (45.8%) men, and 3,156 (54.2%) women. The mean age was 34.14 +/- 15.16 years. Musculoskeletal pain was reported by 1,477 (25.4%), 762 (13.1%) men and 715 (12.3%) women. Musculoskeletal pain was significantly correlated with age (r =0.454), married status (r=0.238), unemployment (r=0.122), lower educational attainment (r=0.347), frequent attendance at local doctor (r=0.703), consumption of medications for pain (r =0.551), and change in ability to work (r=0.492). We found no association with sex or body mass index. CONCLUSION: Musculoskeletal pain, although common in the community, is less prevalent than reported from Western countries, but has similar socio-medical consequences.

How common is back pain in Al-Qaseem region.

OBJECTIVE: The aim of this study was to estimate the prevalence of back pain in the adult population of Al-Qaseem Central Province, Kingdom of Saudi Arabia and to find associated features and factors. METHODS: A house-to-house survey covering 1,000 household in the towns and villages of Al-Qaseem province was carried out over a period of 18 months extending from September 1993 until the end of February 1995. A total of 5,894 adults, aged 16 years and above, were questioned by trained staff regarding back pain, and the demographic data in addition to general, medical and social history. RESULTS: A response was obtained in 5,743 (97.4%). Their mean age was 34.14 15.16 (range 16-99). Back pain was reported by 1,081 (18.8%), wherein 499 (8.8%) were men, and 574 (10%) were women. Back pain was more prevalent in married (23.3%) individuals than unmarried (6.4%). Adjusted odds ratio (OR) for back pain in married individuals was 1.88 (95% confidence intervals [CI] 1.49-2.37). Back pain was strongly correlated with age (correlation coefficient = 0.378 P < 0.01). It also showed significant correlation with weight and height, depression, family history of back pain, change in work ability, frequency of attendance at local doctor, use of medication and lower education level. The association with body mass index became evident only after comparing the heaviest 20th percentile to the lightest (OR 1.335 [95% CI, 1.279-1.402]). Certain occupational status (unemployed, farmers, professional workers and housewives) were associated with back pain. CONCLUSION: Back pain was relatively common in this largely unindustrialized community although its prevalence is lower than reported from some western countries.

Knee osteoarthritis in Al-Qaseem, Saudi Arabia.

OBJECTIVE: The aim of this study was to estimate the prevalence of clinical osteoarthritis (OA) of the knee in Al-Qaseem, a central province in the Kingdom of Saudi Arabia (KSA). METHODS: A house to house survey of randomly selected inhabitants of Al-Qaseem, KSA was conducted. A total of 10,406 persons were interviewed of whom 5,894 were above the age of 16 years. The study was carried out at King Khalid University Hospital and College of Medicine, Riyadh, KSA, from September 1993 to February 1995. They were questioned regarding musculoskeletal complaints, and those positively identified were interviewed further by a team of trained medical staff and later examined by trained doctors including rheumatologists. RESULTS: We found 766 (13%) cases of clinical OA of the knee in the 5,894 adult population (13%). The prevalence of OA increased with increasing age reaching 30.8% in those aged 46-55 years and 60.6% in the age group 66-75 years. The odds ratio (OR) for the association between clinical OA of the knee and age adjusted for sex and body mass index (BMI) was 1.0894 (95% CI, 1.08-1.09). The association of clinical OA of the knee with female sex was also significant [OR (adjused for age and BMI) was 1.261 (95% CI, 1.0456-1.5208)]. CONCLUSION: Clinical OA of the knee is common in this community, particularly in the older age groups.

Mouth and genital ulcerations in the community.

OBJECTIVE: To estimate the prevalence of mouth and genital ulceration in the community and its relationship to rheumatic diseases. METHODS: A house to house survey was carried out over a period of 18 months extending from September 1993 to February 1995, on 5,894 individuals utilizing detailed questionnaires on symptoms of musculoskeletal diseases and associated symptoms including history of mouth, genital ulcers, eye symptoms, and skin changes. After the initial phase, a 2nd phase was completed by trained nurses and paramedical staff, the purpose of which was to explore in detail, the history of those responding positively to any of the questions in phase one. The 3rd stage was conducted by general practitioners and rheumatologist to interview and examine those identified in phase 2 at King Fahad Hospital, Buraidah, Kingdom of Saudi Arabia. RESULTS: We identified 7 (0.1%) cases of genital ulceration, 43 (0.7%) cases of mouth ulceration, 263 (4.5%) cases of reddish eye or blurred vision, and 124 (2.1%) cases of skin rashes. Only 2 cases had both mouth and genital ulceration in addition to eye disease, skin rash and musculoskeletal pain. There was significant correlation between mouth ulcers and skin rash, eye symptoms, genital ulcerations, male sex, single status, weight loss and backpain. CONCLUSION: The vast majority of mouth and genital ulcers are not associated with a known rheumatic disease.