Rheumatic manifestations of leprosy: clinical aspects.

Articular manifestations had been identified in leprosy in ancient times. However, for the last 5 decades, the focus has been on inflammatory changes resembling rheumatologic diseases. Better understanding of these manifestations is important both to improve therapy and to clarify the pathogenetic mechanisms involved in leprosy.

Rectal administration of tenoxicam for the treatment of rheumatoid arthritis and arthrosis.

Seventy-nine patients with arthrosis (40) or rheumatoid arthritis (39) were included in an open, non-comparative multicentric study. All the patients were treated by rectal route with a suppository form of tenoxicam (20 mg/day) during 6 weeks (in the first 3 days the dose was increased to 40 mg). The drug was administered once daily at evening. Clinical evaluation was performed before treatment and thereafter every 2 weeks. In the patients with arthrosis the parameters evaluated for efficacy were: pain on movement, pain at rest, tenderness, spontaneous pain, pain after 1 day of normal activity, flexion, functional status, and time to walk 10 metres. For patients with rheumatoid arthritis the parameters were: articular index, duration of morning stiffness, functional status, spontaneous pain and pain when moving. Efficacy was considered excellent or good in 22 patients with rheumatoid arthritis and moderate or poor in 17. In the group of patients with arthrosis the results were excellent or good in 28 and moderate or poor in 12. Side effects occurred in five cases.

DMSO and colchicine therapy in amyloid disease.

There is no specific therapy for primary amyloidosis, and acquired generalised amyloidosis can be treated only if the underlying disease is eliminated. In this study we have investigated the role of colchicine therapy in primary amyloidosis, and dimethylsulphoxide (DMSO) in leprosy associated secondary amyloidosis. No effect on creatinine clearance or 24 h proteinuria could be observed in the patients with primary amyloidosis. In the DMSO group renal function was considerably improved in 3 patients with moderate renal failure but not in those with severe renal impairment (creatinine clearance less than 10 ml/min). Serum SAA determinations were not particularly informative. These findings point to a beneficial effect of DMSO in human secondary amyloidosis when given at an early stage of renal involvement.

Poliarterite nodosa cutanea. / Cutaneous polyarthritis nodosa

Os autores apresentam um caso de PAN cutanea em paciente do sexo masculino de 42 anos, com a seguinte historia clinica: manifestacoes iniciais de febre, artralgias, nodulos subcutaneos dolorosos, livedo reticular e lesoes cutaneas fixas tipicas nos membros superiores e inferiores. A biopsia de pele confirmou o diagnostico de PAN. A biopsia de sinovia mostrou sinovite subaguda fibrinosa e a arteriografia renal foi normal. Varios aspectos clinicos evolutivos e laboratoriais dessa forma de PAN localizada sao revistos e discutidos

[Developmental aspects of the Rubino reaction]. / Aspectos evolutivos de reação de Rubino.

The Rubino reaction was studied in 178 leprosy patients to correlate its positivity, clinical form, E.N.L., and time and activity of the disease. The patients studied were classified according to the criteria established by the 1953 Madrid Congress. The results show that the tuberculoid patients presented negative Rubino reactions regardless of any of the parameters studied. The borderline patients showed 9% positive Rubino reaction not related to any of the observed parameters studied. The lepromatous patients showed a significant difference of positivity to the Rubino reaction when grouped as to the disease's active or non-active presence. Active lepromatous patients showed 55% of positivity to the Rubino reaction whereas patients considered clinically inactive showed only 6% of positivity. The fact that the Rubino reaction is negative in the majority of patients who are clinically cured would indicate that this test could be included as part of the criteria used in determining which clinically cured lepromatous patients can discontinue medication without risking a relapse.

Emprego do naproxen 500 mg em duas doses diarias no tratamento da osteoartrose. / Use of naproxen 500 mg in two daily doses in the treatment of osteoarthrosis

Em estudo nao comparativo aberto, os AA. avaliam a acao terapeutica do naproxen-farmaco antiinflamatorio e analgesico nao hormonal na posologia de l.000 mg diarias - em 40 pacientes adultos com osteoartrose de coluna e dos joelhos, num periodo de 4 a 6 semanas. O medicamento foi administrado por via oral, em comprimidos na posologia de 500 mg pela manha e 500 mg a noite, a intervalos de 12 horas, utilizando-se parametros clinicos de avaliacao baseados no percentual de recuperacao dos sinais e sintomas relacionados com a dor e com o movimento. Os resultados foram considerados excelentes, muito bons e bons em 32 pacientes (80.00%). A tolerancia ao produto foi boa, nao ocorrendo nenhum efeito secundario em 33 pacientes (82,50%). Em apenas 2 casos foi necessario interromper o tratamento apos o decimo e decimo quinto dias por efeitos gaastrintestinais, mas ambos ja apresentavam total remissao do quadro clinico inicial. Nos 5 casos restantes predominaram os efeitos gastrintestinais facilmente controlados por medicacao antiacida. Concluem os AA. ser o naproxen, na posologia de 1.000mg diarios uma terapeutica com alta eficacia, constituindo-se em poderosa arma no tratamento das enfermidades reumaticas degenerativas

Sindrome da urticaria cronica com vasculite necrosante. / Chronic urticaria with necrotizing vasculitis

Os autores apresentam 3 casos da sindrome de urticaria cronica com vasculite necrosante (SUC), que ainda nao foi descrita no Brasil.Essa sindrome se caracteriza por surtos recorrentes de urticaria artralgia e ocasionalmente artrite, dor abdominal e glomerulonefite apresentando particularidades clinicas e laboratoriais que permitem individualiza-la como entidade distinta dentro do grupo das doencas difusas do tecido conjuntivo. Sao apresentados resultados de sinovianalise, bem como 2 nao descritos na SUC: alopecia generalizada e orquite. Tambem e documentado o segundo caso de SUC com biopsia de sinovia e sao discutidos dados de evolucao clinica, diagnostico diferencial e tratamento