Efficacy and tolerance of naproxen versus pirprofen in the treatment of patients with osteoarthritis.

A double-blind, double-dummy study design was used to compare the efficacy and tolerance of naproxen with that of pirprofen in the treatment of osteoarthritis. Sixty patients were assigned randomly to receive either 500 mg naproxen twice daily or 400 mg pirprofen twice daily for 4 weeks. Both groups were similar in all respects except age, which was significantly greater in the naproxen-treated patients than in the pirprofen-treated patients. Both treatments yielded statistically significant improvement in duration of stiffness after inactivity, global pain, pain on full passive movement, pain during a selected activity, and physicians' and patients' assessments of overall arthritic condition. There were no significant differences between the two groups in either the incidence or the severity of adverse effects of the drugs, most of which involved gastro-intestinal disturbances. Both medications were shown to be well tolerated, acceptable, and effective for treating osteoarthritis.

Algodystrophy of the knee. Anatomo-radiological study of a case.

Presentation of a case of algodystrophy (i.e., Sudeck's dystrophy) of the left knee, affecting the femur, tibia and patella. It was brought on by a simple movement made while playing tennis and it recurred subsequently accompanied by algodystrophy of the corresponding foot. Histological study of the biopsy material showed the classical image of cortical and cancellous bone atrophy with non-specific remodelling which explained the increased uptake on the scintigraph as well as the repairing of the bone tissue observed on the X-rays. Reasons are given for the choice of the term algodystrophy to describe the condition.

Double-blind multicenter study comparing meclofenamate sodium with indomethacin and placebo in the treatment of extra-articular rheumatic disease.

161 patients with extra-articular or non-articular disorders as acute shoulder syndrome, periarthritis humero scapularis, syndrome of the angular of the scapula, acute olecranon bursitis, acute epicondylitis and/or epitrochleitis or periarthritis of the hip were treated in this double-blind multicenter study. 53 patients received 300 mg N-(2,6-dichloro-m-tolyl)anthranilic acid, sodium salt (meclofenamate sodium, Meclomen) per day for a maximum of 3 weeks, 54 received 150 mg indomethacin per day and 54 received placebo. Meclofenamate sodium was significantly superior to placebo in the treatment of such symptoms as spontaneous pain, pain on motion, tenderness on pressure associated with acute episodes of extra- or non-articular rheumatism as demonstrated by earlier and superior improvement. Indomethacin showed comparable efficacy. Adverse reactions, mostly gastrointestinal symptoms, were reported by 15 patients receiving meclofenamate sodium (28.3%), 26 patients taking indomethacin (48.2%) and 5 patients in the placebo group (9.3%). The tolerance of meclofenamate sodium was good with the distinct clinical impression that meclofenamate sodium was better tolerated than indomethacin.

Meclofenamate sodium in the treatment of ankylosing spondylitis. Report of a European double-blind controlled multicenter study.

98 patients with reversible, definite, active ankylosing spondylitis were selected for this study. 49 patients were treated with N-(2,6-dichloro-m-tolyl)anthranilic acid, sodium salt (meclofenamate sodium, Meclomen) and 49 patients with indometacin. Following a single-blind baseline period on placebo, patients received either 200 mg meclofenamate sodium per day or 100 mg indometacin per day for one week, in the second week the doses were increased to 250 mg meclofenamate sodium and 125 mg indometacin and from the third through the eight week 300 mg meclofenamate sodium and 150 mg indometacin were given. The results of this double-blind study showed that similar improvement in mobility of the vertebral column and spondylitic pain could be achieved with meclofenamate sodium and indometacin in patients with ankylosing spondylitis. Although both treatments were well tolerated fewer meclofenamate sodium patients reported adverse reactions than did those who had received indometacin. It is concluded that meclofenamate sodium offers an effective and safe alternative to indometacin in the treatment of patients with ankylosing spondylitis.

A double-blind study of erbium169 synoviorthesis in rheumatoid digital joints. Results after one year.

A double-blind study was made on the effectivenss of erbium169 synoviorthesis in the digital joints of 7 patients with erosive, seropositive rheumatoid arthritis. The study involved 70 joints observed over a 12-month period: 20 pairs of metacarpophalangeal joints (MCP) and 15 pairs of proximal interphalangeal joints (PIP) were injected with erbium169 in one joint and saline in the other one. All joints had radiological lesions corresponding to State I and II of the Steinbroker classification. Six months after synoviorthesis, good and excellent results were observed in 71% of the articulations treated with erbium169 and in only 40% of those injected with saline (placebo) (p less than 0.01). Good and excellent results were noted in 79% of the joints treated with the isotope after one year, compared with only 50% injected with the placebo (p less than 0.05). The beneficial effect of erbium169 synoviorthesis on the pain and inflammatory phenomena of rheumatoid digital joints is therefore proven. Occasionally the isotope causes a slight decrease in the range of movement of the treated joint.

[Synoviorthesis of finger joints using erbium-169. Parameters influencing the clinical results at middle-term]. / La synoviothése des articulations digitales de la main à l'erbium 169. Paramètres influençant les résultats cliniques à moyen terme.

Synoviorthesis of the finger joint with erbium-169 is a beneficial therapeutic procedure which produces reduction of articular pain and swelling in 2/3 of cases. The effect is lasting and shows only slight regression during the first 24 months. However, if the rheumatoid disease is very active, or if the articular lesions are primarily erosive, the results are poorer. No correlation was found between therapeutic results and the radiological findings prior to 169E treatment. Erbium-169 reduces inflammation and leads to progressive articular fibrosis. Any chronic synovitis of interdigital joints resistant to appropriate conventional anti-inflammatory treatment may benefit from radio-synoviorthesis with erbium-169. Erbium-169 synoviorthesis is is technically easy to perform and free of side effects. It is a palliative measure which the authors consider a valuable complement to the classical treatment of rheumatoid arthritis.

[Synoviorthesis of the knee with osmic acid (OsO4). Results at mid-term]. / La synoviorthèse du genou à l'acide osmique (OsO4). Résultats à moyen terme.

Synoviorthesis of the knee joint with OsO4 is a simple procedure with few short or long term side effects. The substance used is inexpensive and easy to handle. All studies published so far have confirmed its suitability in the treatment of synovitis of the knee and various other joints. The initial good results deteriorate steadily, primarily in the first year following injection. However, intra-articular administration of OsO4 may be repeated without risk, and achieves as good results as the first synoviorthesis. The less advanced the lesions and the less active clinically and biologically the systemic manifestations, the better the results. Osmic acid does not appear to damage the joint either radiologically or functionally. The effect of OsO4, although probably shorter in duration, is comparable to that of yttrium-90, with the additional advantage that it can be used in young patients. 100 mg (5 ml of 2% solution) can be considered the optimal dose. Synoviorthesis with osmic acid can be performed before going on to surgical synovectomy. Synoviorthesis with osmic acid is ineffective in the treatment of gonarthrosis.

Tendon calcifications in chondrocalcinosis. A clinical, radiologic, histologic, and crystallographic study.

Fine linear extraarticular calcium deposits were found in X-rays of 7 of 52 patients with articular chondrocalcinosis (ACC). Seven Achilles tendons, seven quadriceps tendons, and one plantar fascia were affected. In a control group of comparable age and sex, without ACC but with generalized osteoarthritis, no calcifications were found in the tendons. On a biopsy specimen of Achilles tendon with such calcium deposits, X-ray diffraction showed that they had the characteristics of calcium pyrophosphate dilhydrate. Isolated small foci of crystals were observed on some segments of tendon bundles. The presence of fine linear calcifications on X-rays of the Achilles or quadriceps tendons may be a useful aid in the radiologic diagnosis of so-called articular chondrocalcinosis.

Coexistence of rheumatoid arthritis and ankylosing spondylitis--report of 10 cases.

The distinction between rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has hitherto relied on supporting evidence of characteristic radiological changes in the sacroiliac joints, together with the Rose-Waaler and Latex tests for rheumatoid factor (RF). This distinction has remained incomplete since some 30 per cent of patients with RA may have sacroiliitis, a similar proportion having negative routine tests for RF. The identification of the HLA B27 antigen, present in 90 per cent of cases of AS and six per cent of the normal population, has enabled a number of cases to be recognized in which both diseases appear to co-exist. Ten cases are described in which either RA appears to have developed in patients with AS, or AS in patients with RA. They all fulfil the ARA diagnostic criteria for classical RA, and the criteria for classical AS. The likelihood of these two diseases occurring by chance in an individual might be of the order of 1:50,000 to 1:200,000.

Synovial deposit of osmic acid after intra-articular injection. Anatomical and radiologic study of a case.

An anatomical and radiologic study of a synovial autopsy specimen 32 months after an intra-articular injection of osmic acid for the local treatment of a rheumatoid synovitis. Osmium deposits are seen within peripheral cells of a fat lobule and also in a few histiocytes of the scar tissue which replaced the rheumatoid synovitis. These osmium deposits in the fat cells are present in a sufficient quantity to give a radiologic opacity.

Rheumatoid arthritis and ankylosing spondylitis occurring together.

Rheumatoid arthritis and ankylosing spondylitis are often difficult to differentiate, though it is important to do so as the natural history and treatment of the two conditions differ. Nine patients have recently been seen, each of whom fulfilled the criteria for both rheumatoid arthritis and ankylosing spondylitis. In eight of the nine patients the histocompatibility antigen HLA-27 was present. A possible explanation of these cases is that one of the diseases occurred by chance in patients already suffering from the other, but this is extremely unlikely. If a chance association is not the correct explanation the basic concepts defining rheumatoid arthritis and ankylosing spondylitis must be reconsidered.

The immediate effects of intra-articular injections of osmic acid.

One hundred mg of osmic acid (with corticosteroid and lidocaine) was injected for therapeutic purposes into the knee in 10 patients suffering from various types of recalcitrant synovitis (mostly rheumatoid arthritis). The effects of this injection were followed by examination of synovial fluid, blood, and urine of these patients, collected at various intervals after intra-articular injection. As a control, a group of 3 patients (5 knees) received corticosteroid and lidocaine intra-articularly, and another group (6 patients, 7 knees) was injected with lidocaine only, both with the same total volume as the first group. Blood and urine examinations revealed essentially no effects of osmic acid, whereas in synovial fluid a strong inflammatory reaction was observed up to the second day after the injection, though the effusion soon disappeared. In a group treated with lidocaine + corticosteroid, a mild, early inflammatory reaction was noted, while lidocaine alone produced only a dilution effect, and the exudate remained relatively longer. Thus, the early local inflammatory reaction due to osmic acid is an expression of the necessary drastic effect of this beneficial therapeutic agent.

Radiological opacities of the knee after intra-articular injections of osmic acid.

Unusual radiological opacities have been observed in 29 cases after intraarticular injection of osmic acid in 113 knees of 72 patients under treatment for a chronic exudative synovitis in different types of rheumatic diseases. They are statistically more frequent after the injection of 200 mg than after 100 mg (33.9 and 15.7% respectively). Most of the time, they are located in the suprapatellar pouch. The opacities appear soon after the injection and can last for several years. They do not seem to have an unfavorable influence on the clinical course. They appear to be caused by a deposition of osmium in synovial fat tissue. From here the osmium might stimulate fibrosis. The radiological image has to be differentiated from intra-articular calcifications, synovial ossifications and various periosteal osteogenic processes.

[Destructive arthropathies associated with articular chondrocalcinosis. Clinical and metabolic study of 16 cases]. / Arthropathies destructrices liées à la chondrocalcinose articulaire

Sixteen cases of severe destructive arthropathy in elderly persons (13 females and 3 males) suffering from articular chondrocalcinosis are described. The knee is the most commonly affected joint, followed by the hips, shoulders, wrists, elbows and feet. One joint is destroyed in seven patients, 2 joints in five, 3 joints in one and 4 joints in three patients. In 13 subjects the onset of the arthropathy was insidious, whereas 2 had only a history of previous recurrent pseudogouty attacks. Associated endocrine, neurological or metabolic diseases were ruled out by clinical examination and laboratory tests. Repeated determinations of serum calcium and phosphorus, as well as of plasma immunoreactive parathyroid hormone, were within normal limits. The possibility of hyperparathyroidism was thus an unlikely explanation for this destructive arthropathy. Its etiopathogenesis remains unclear.

A study of the incidence of articular chondrocalcinosis in Paget's disease of bone.

Amongst 66 pagetic patients, whose average age (median) was 76 years, 9 cases of ACC were found. This represents an incidence of 13.6% of the whole group. Of 72 control subjects, whose average age (median) was 73 years, 7 were found to have ACC. This represents an overall incidence of 9.7% of the control group, but the difference is not statistically significant. From this study we conclude that ACC does not occur more frequently in Paget's disease than in a group of control subjects with the same age distribution.

Osmium deposits detected by x-ray after synoviorthesis of the knee.

A study of 113 knees of 72 patients treated with intra-articular injection of osmic acid for chronic exudative synovitis caused by various rheumatic diseases is reported. Certain cases presented abnormal radiological opacities, statistically more frequent after the injection of 200 mg than after 100 mg of osmic acid (33.9% and 15.7%). These images appear early after the injection and can remain for years. They should not be confused with intra-articular calcium deposits, or with synovial ossifications or various periosteal osteogenic processes. Their appearance does not seem to be related to the rheumatic disease treated or the therapeutic result obtained. They reflect the fixation of osmium in the synovial fatty tissue, which causes a fibrous reaction at this level. Their longterm action in the cicatrization of the synovia, or their part in a relapse of an inflammatory episode should be clarified.