Plasma zinc and its relationship to clinical symptoms and drug treatment in rheumatoid arthritis.

Total plasma zinc levels in patients with rheumatoid arthritis on different therapeutic treatments were determined in conjunction with total serum proteins, serum albumin and globulin, and articular index of joint tenderness, erythrocyte sedimentation rate, rheumatoid factor, serum copper, and serum iron. There were significantly lower zinc levels in patients with rheumatoid arthritis on nonsteroidal anti-inflammatory drugs than in patients on levamisole and penicillamine. Zinc levels correlated positively with serum albumin, and there was an inverse correlation between zinc levels and both ESR and globulin concentration in all rheumatoid patients. However, the correlation coefficient varied in the different treatment groups. The results of this study support the hypothesis that low plasma zinc level in rheumatoid arthritis is one of the nonspecific features of inflammation.

[Number of basophils and triglyceride levels in patients with gout]. / Basophilenzahl und Triglyzeridspiegel bei Gichtkranken.

Comparing a group of gouty patients with age and sex matched group of patients in a general medical ward without history of arthritis, we failed to confirm and increase in the absolute or relative basophil count. Total white cell count and packed cell volume were similar in both groups of patients. However, fasting serum triglyceride and serum uric acid were increased, as expected, in the gouty group.

Serum copper and its relationship to clinical symptoms in rheumatoid arthritis.

Total serum copper and ultrafilterable copper levels in patients with rheumatoid arthritis were determined and related to articular index, erythrocyte sedimentation rate (ESR), and serum iron concentration. Relationships were found between serum copper and ESR, and between ultrafilterable copper and articular index. The relationship between serum copper and serum iron was found to be a drug-dependent.

A double-blind, crossover trial of mefenamic acid, sulindac and flurbiprofen in rheumatoid arthritis.

A double-blind crossover trial was carried out in 24 patients to compare the effects of mefenamic acid, flurbiprofen, sulindac and placebo. Each drug was given for 2 weeks, the treatment sequence being randomized. Daily doses were 1500 mg mefenamic acid, 150 mg flurbiprofen or 150 mg sulindac. All of the active drugs were significantly superior to placebo in terms of pain score, patients' assessment, articular index of joint tenderness, and duration and severity of morning stiffness. There was improvement in grip strength compared with placebo, but the differences were not statistically significant with sulindac. There was slight reduction in joint circumference but this was only statistically significant in the right hand with flurbiprofen and sulindac. No significant differences were found in technetium uptake in knee joints. The three drugs appeared to be equally effective and tolerated, and no significant differences were noted.

Clinical and laboratory studies of levamisole in patients with rheumatoid arthritis.

Two studies with levamisole in rheumatoid arthritis are reported. In the first study of 30 patients levamisole was superior to placebo in terms of pain relief, reduction in articular tenderness, duration of morning stiffness, erythrocyte sedimentation rate (ESR), and radioisotope uptake in knee and wrist joints. There were no consistent differences in lymphocyte function, immunoglobin or complement concentration, or polymorphonuclear granulocytic function. In the second study forty patients were commenced on treatment with either gold or levamisole. At the end of one year there were significant improvements with both regimens in pain score, joint tenderness and ESR. The patients on levamisole showed significant improvement of duration of morning stiffness, while the patients on gold showed significant improvement of rheumatoid factor titre and left hand grip, but there were no significant differences between the two regimens.

Repeated corticosteroid injections into knee joints.

The effect of intra-articular injections of corticosteroids repeated over a period extending from four to 15 years on the radiological appearances of knee joints affected by rheumatoid arthritis and osteoarthritis has been studied. In 65 cases, the X-ray films of 15 showed no deterioration, 38 showed minimal or moderate deterioration, 10 showed marked deterioration and only 2 showed gross deterioration. The results do not support the contention that repeated intra-articular injections of corticosteroids will inevitably lead to rapid joint destruction. The authors are of the opinion that intraarticular injections of corticosteroids, if used judiciously, have an important part to play in the management of chronic arthritis.

Comparison of sodium meclofenamate and indomethacin in rheumatoid arthritis.

A double-blind crossover study was conducted in 15 patients with classical definite rheumatoid arthritis to compare the effect of sodium meclofenamate (300 mg daily) with placebo and indomethacin (100 mg daily). Each treatment was administered for 1 week to patients assigned at random to treatment sequences. The active drugs were shown to be significantly superior to placebo. Sodium meclofenamate alone reduced the articular index. Patient preference, however, was in favour of indomethacin.

A comparative trial of large doses of ketoprofen and indomethacin in the treatment of rheumatoid arthritis.

A 4-weeks' double-blind, crossover study in 30 patients with definite or classical rheumatoid arthritis is reported using 300 mg ketoprofen per day and 150 mg indomethacin per day. Both drugs had similar effects upon the patients' subjective improvement of pain. Objectively, the results also suggest that ketoprofen may be more effective in reducing the articular index, i.e. a superior analgesic effect. Further studies are underway to assess the value of ketoprofen administered in high dosage for longer duration.