Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis.

A multicentre, double-blind, randomised, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (123 patients, 100 mg twice daily) in comparison to piroxicam (117 patients, 20 mg once daily and placebo once daily) in patients with osteoarthritis of the knee. The treatment period of two months was preceded by a washout period of one week duration. On completion of the study, patients in both aceclofenac and piroxicam-treated groups exhibited significant improvement in pain intensity and functional capacity of the affected knee, as represented by the Osteoarthritis Severity Index (OSI) (p < 0.0001 and p < 0.001 respectively). This was further substantiated following the patient's assessment of pain intensity using the Visual Analogue Scale (VAS), in which significant improvements were demonstrated at all time points for each treatment group (p < 0.001). Although both treatment groups showed a significant improvement in all investigator's clinical assessments (functional exploration of the knee, knee flexion and extension (EXT)), there were no significant differences between the groups. There was, however, a more rapid improvement in knee flexion in the aceclofenac group after 15 days of treatment. Both aceclofenac and piroxicam were well tolerated by patients, the most commonly reported adverse events being gastrointestinal, although their incidence was low. Only 24 patients on aceclofenac, as opposed to 33 on piroxicam complained of dyspepsia, epigastralgia and pyrosis. While 7 patients in each group were withdrawn because of adverse events, only one patient with piroxicam was withdrawn because of severe upper gastrointestinal bleeding. Twice as many reports of fecal blood loss were made in the piroxicam group in comparison to the aceclofenac group. In summary, this study confirms the therapeutic efficacy of aceclofenac and suggests that it is a well-tolerated alternative NSAID to piroxicam in the treatment of osteoarthritis.

[Radiographic study of the hand in 50 cases of primary articular chondrocalcinosis. Comparison with a control series of 100 subjects]. / Etude radiographique de la main dans 50 cas de chondrocalcinose articulaire primitive. Comparaison avec une série de 100 témoins

The authors analysed radiograms of the hands of 50 patients suffering from primary articular chondrocalcinosis (ACC) and compared them with those of 100 control subjects of similar sex and age. There were 40 women and 10 men, with an average age of 69.6 years (plus or minus 9.82). A chalky incrustation of the semilunar pyramidal interspace was observed in 40 percent of cases. The frequency of this incrustation was next in order of importance to incrustation of the triangular ligament which occurred in 52 percent of cases. The difference from the controls was highly significant (p less than 0.001). Voluminous geodes affecting one or more of the bone of the wrist were present in 20 percent of the patients with ACC and in 5 percent of the controls. The difference was significant (p less than 0.01). Chalky deposits were found in the soft tissues immediately next to a metacarpo-phalangeal articulation in 22 percent of the ACC patients but not in any of the controls. The difference was highly significant (p less than 0.001). These chalky deposits next to metacarpo-phalangeal articulations were always associated with chalky incrustation of the radio-carpal joint. As regards the radiological lesions, considered as being typical images of arthrosis and affecting the trapezo-metacarpal, metacarpo-phalangeal, and interphalangeal articulations, the chondrocalcinosis patients appeared to be more frequently affected than the controls, but the difference was not significant. On the other hand, a type of arthropathy occurs in ACC patients which also resembles an arthrosis radiologically but which was 5 times more frequent in them than in the controls and which in this series occurred without nearby trapezo-metacarpal arthropathy only in ACC patients (16 percent as against 0 percent in the controls: p less than 0.001); this was scapho-trapezial arthropathy. The finding of this kind of radiological lesion, particularly when it is not associated with lesions in the trapezo-metacarpal articulations should indicate the possibility of a diagnosis of ACC and should lead to radiological investigation of other sites.