Combination therapy with hydroxychloroquine and methotrexate in rheumatoid arthritis.

The aim of the study was to compare the efficacy of hydroxychloroquine (HCQ) alone and in combination with methotrexate (MTX) in a randomized placebo-controlled study lasting 6 months. Forty patients with rheumatoid arthritis participated in the study and were randomly assigned to two groups--20 patients were treated with HCQ (200 mg daily) and placebo, 20 patients with HCQ and MTX (7.5 mg) once a week. Patients were assessed at regular intervals of 1 month up to 6 months using six clinical and five laboratory tests and one radiological measure. All six clinical variables and two laboratory variables were favorably influenced by combination therapy during the 6-month period. HCQ alone significantly influenced only three clinical variables and none of the laboratory parameters. There was a greater number of patients without radiological progression in the combination group. There was one drop-out in combination group due to general allergic reaction; otherwise the treatment was well tolerated. The results suggest that a combination of HCQ and MTX is more potent than HCQ alone.

Articular needle biopsy and pigmented villonodular synovitis.

The authors discuss the significance of needle biopsy of joints for the diagnosis of pigmented villonodular synovitis (PVS). Their own 4 cases of this disease were diagnosed with the help of articular needle biopsy. The representative sample of the synovial membrane obtained with the biopsy and its histology, together with the clinical picture and other paraclinical investigations are fully adequate for establishing the diagnosis of pigmented villonodular synovitis.

Needle biopsy of joints--its contribution to the diagnosis of ochronotic arthropathy (alcaptonuria).

The authors present the case history of a 48-year-old man with ochronosis. They discuss the possibilities of articular needle biopsy in the diagnosis of this disease. The histology of the synovial membrane may help establish the diagnosis of ochronotic arthropathy.

[Synergic joint diagnostics]. / Synergická kloubní diagnostika.

The author emphasizes the necessity to use all clinical and paraclinical examination methods in rheumatology to assess an early and correct diagnosis of rheumatic diseases. She emphasizes the importance of examination of the articular punctate and importance of the synoviogram in differential diagnostic considerations. The author reflects also on the importance of the frequently omitted unpretentious examination method--needle biopsy of the joints.

[Osteoarthritis--a major rheumatologic problem in internal medicine]. / Osteoartróza--prvoradý revmatologický problém ve vnitrním lékarství.

Degenerative affection of the locomotor apparatus is one of the major problems of rheumatology concerning above all internal medicine. The locomotor apparatus in particular its functionally important components, joints and the spine, undergo in the course of aging and due to endogenous and exogenous factors degenerative changes of a varying extent. From the pathogenetic aspect the condition is multifactorial. Attention is devoted in particular to the articular milieu and its constituents which are responsible for the development of degenerative changes. The problem of osteoarthritis is urgent because of the ever rising incidence and its economic and social sequelae. The authors discuss therapeutic difficulties and emphasize comprehensive care of patients suffering from osteoarthritis. The problem of osteoarthritis is of world-wide importance.

[Perispondylitis psoriatica]. / Perispondylitis psoriatica.

In their brief paper the authors draw attention to the rapid development of morphological changes on the axial skeleton in a patient with psoriasis vulgaris. They give a brief account of the classification of spinal and paraspinal ossifications in seronegative spondarthritis, spondyloses and other spondylopathies. The described case-history pertains to a paraspinal ossification and the authors try to explain why they assume that the term "Perispondylitis psoriatica" is quite justified.

[The importance of benziodarone in the treatment of gout and hyperuricemic syndrome]. / Význam benziodaronu v lécbe dny a hyperurikemického syndromu.

The authors pay attention to benziodarone, a representative of the category of benzofurans. They test its effect on the uric acid serum level in normouraemic subjects as well as in hyperuricaemic syndrome and gouty arthritis. The hypouricaemic action of benziodarone (Amplivex-Labaz) is prompt. The maximum drop of uricaemia after Amplivex administration (2 tablets/day) occurs during the first three days. The uric acid level declines by as much as 80% of the baseline value. For long-term treatment 1 tablet per day is sufficient, in some instances even 1 tablet twice a week. The tolerance of the preparation is satisfactory. The authors deal also with the mechanism of action of benziodarone. Amplivex is not only a uricostatic but also a uricosuric agent.

[Puncture biopsy of the joint--contribution to research on the joint milieu]. / Punkcní biopsie kloubní--príspevek k výzkumu kloubního prostredí.

The authors deal with articular needle biopsy with regard to the extension of knowledge and research of the articular environment. Articular biopsy is indicated in diseases associated with an articular exudate. It is made most frequently on the knee joint. In some diseases the histological picture of the articular lining is typical for the diagnosis, in some it is at least characteristic. In some instances an unequivocal interpretation of the histological finding is rather dubious from the diagnostic aspect. Needle biopsy of the joint is confronted with other findings and the clinical picture. Articular needle biopsy can be used for detection of therapeutic preparations administered systemically and in particular by the intraarticular route. Articular needle biopsy extends moreover the criteria used to evaluate the therapeutic effect.

Injury to gastric mucosa due to cortisonoid therapy.

Drawing on their own experience and reports in literature the present authors analyze the problem of the incidence and origin of alterations on the gastric mucosa (steroid ulcer) in the course of cortisonoid therapy. Over the period of 5 years, 576 patients were studied, 29 (5.03%) of which were found to have developed a lesion of the gastric mucosa. Patients with rheumatoid arthritis and collagenoses were the most frequent of these. This is followed by an analysis of the mechanism of origin and the peculiarities of this lesion as compared with the picture of the classical ulcer. Apart from medicamentous therapeutic procedures in the treatment of steroid ulcers, local application of a HeNe laser radiation has come to be used recently in the healing of a chronic gastroduodenal ulcer. Despite all the vast experience and more accurate knowledge of the drawbacks cortisonoid therapy brings along, the steroid ulcer still represents a feared and not quite rare complication of glucocorticoid therapy.

Principles of managing chronic rheumatic diseases.

The principles of treating chronic rheumatic diseases are to be conceived as a complex care of the patient. Medication is just one part of the treatment, be it a very important one. Its possibilities are, however, restricted. In spite of the explosive appearance of new antirheumatic drugs we are sticking to the classical forms of treatment (salicylates, gold, antimalaric drugs). Pyrazolone derivatives and corticoids are still holding their place in the therapeutic design. They should be administered, however, wisely and one must be aware of what is to be expected of their effect. A special therapeutic problem appears to be osteoarthrosis, which has recently become more actual among the other rheumatic diseases. The therapeutic effort must be completed by social care of the patient suffering from a chronic rheumatic disease, at least in cases when the patient depends on the help of another person.