Amiprilose hydrochloride for rheumatoid arthritis.

STUDY OBJECTIVE: To assess the safety and efficacy of amiprilose hydrochloride (HCl), a novel synthetic carbohydrate with anti-inflammatory and immunomodulatory properties, in patients with rheumatoid arthritis. DESIGN: Prospective, multicenter, randomized, parallel group, double-blind placebo-controlled 12-week trial. PATIENTS: Two hundred and one functional class I and II patients with definite or classic rheumatoid arthritis, previously untreated with disease modifying antirheumatic drugs. INTERVENTIONS: Patients were withdrawn from nonsteroidal anti-inflammatory drug therapy. Those who flared were randomly assigned to amiprilose HCl, 6 g/d, or placebo for 12 weeks. No concomitant anti-inflammatory or antirheumatic drug therapy was permitted during the study. Combination acetaminophen and propoxyphene napsylate was the only supplemental analgesic medication allowed. MEASUREMENTS AND MAIN RESULTS: The number of painful joints and swollen joints, joint pain and joint swelling indices, left and right grip strength, investigator global assessment, and patient global assessment returned to baseline for the amiprilose group and showed statistically significant (P less than 0.05) differences from the placebo group within 4 to 6 weeks. The protocol criteria for overall therapeutic response were satisfied by 41% of the amiprilose patients, compared with 21% of the placebo group (P = 0.003). Approximately 0.5 tablet per day less analgesic medication was taken by the amiprilose group (P less than 0.05 at weeks 6 and 12). There were no statistically significant differences in morning stiffness, walking time, erythrocyte sedimentation rate, C-reactive protein, or rheumatoid factor between the groups. A similar number of adverse experiences were reported by the patients on amiprilose (67%) and on placebo (63%). One patient on amiprilose developed thrombocytopenia of unknown cause; no other reported adverse effects were serious. CONCLUSIONS: Amiprilose HCl has significant anti-inflammatory activity and a favorable safety profile when used as the sole antirheumatic therapy in patients with active rheumatoid arthritis. Synthetic carbohydrates may represent an important new class of drugs for the treatment of inflammatory, autoimmune diseases.

Biomechanical and biochemical properties of dog cartilage in experimentally induced osteoarthritis.

The finding of other investigators that increased water content is often associated with signs of a torn collagen network in human osteoarthritic (OA) cartilage led to this study. In the Pond-Nuki model of post-traumatic OA experimental but not control femoral condylar cartilage showed evidence of breakdown and stiffening of collagen network as assessed by measurement of swelling properties and indentation behaviour respectively. These changes in the unstable knees occurred despite lack of erosion of that surface cartilage ascertained from carbon black mapping and history. The stiffening rather than softening change was therefore attributed to cartilage oedema of the middle and deep certilagenous zones, wherein breakdown of collagen network has been postulated to occur. Because of insignificant reduction of total hexuronate in these cartilages, a proteoglycan (PG) profile of sedimentation coefficients for aggregate (PGA) and subunit species (PGS) was analysed to see if collagen network changes in the dog preceded PG alteration. Despite minimal histological changes our results confirmed previous findings in the tibial plateau cartilage in this model, that PGA was reduced in size and PGS increased in amount. Slight enzymatic breakdown of PGs, or altered synthesis due to cellular responses to either the injury directly or to synovial inflammation, seems necessary to explain such changes in the absence of cartilage erosion.

Complications of local corticosteroid injections.

Unusual complications associated with local microcrystalline corticosteroid injections were observed in four patients with diverse rheumatic disorders. Adverse reactions included (1) bilateral digital flexor tendon rupture following carpal tunnel injection for idiopathic median nerve compression syndrome; (2) bowstring deformity of a finger after local corticosteroid treatment of psoriatic digital flexor tendonitis; (3) carpal tunnel infection following dorsal arthrocentesis of a wrist in a patient with rheumatoid arthritis; and (4) pronounced flushing of the face, neck, and chest after intrasynovial corticosteroid injection in a patient with psoriasis and arthritis. This article considers some physiologic actions of corticosteroids possibly responsible for development of these untoward effects.

Pulmonary dirofilariasis: another coin lesion.

A 67-year-old woman with a long history of debilitating rheumatoid arthritis developed a peripheral coin lesion in the lower lobe of the left lung. A wedge resection was done and pathologic study revealed noncaseating granuloma secondary to rheumatoid infection with Dirofilaria immitis, a nematode. Although rare, canine dirofilariasis should be considered in the differential diagnosis of coin lesions.

Algorithm-directed triage in an emergency department.

At Brooke Army Medical Center the Emergency Services Section has developed an algorith,-directed triage system to be used by "screeners" who may be basic medical corpsmen but sometimes have had no previous medical experience. After 25 hours of classroom and 120 hours of on-the-job training, the screeners use the algorithms to triage patients into one of three treatment areas in the emergency section or to clinics outside the emergency section during the day and evening. The screeners may consult with a triage physician if the algorithm-directed disposition appears inappropriate, Triage dispositions of 78,822 patient visits during the calendar year 1975 are presented.