Three month treatment of reactive arthritis with azithromycin: a EULAR double blind, placebo controlled study.

OBJECTIVE: To determine the efficacy of weekly treatment with oral azithromycin for 13 weeks on the severity and resolution of reactive arthritis (ReA). METHODS: 186 patients from 12 countries were enrolled in a randomised, double blind, placebo controlled trial. Inclusion criteria were inflammatory arthritis of < or =6 swollen joints, and disease duration of < or =2 months. All patients received a single azithromycin dose (1 g) as conventional treatment for possible Chlamydia infection, and were then randomly allocated to receive weekly azithromycin or placebo. Clinical assessments were made at 4 week intervals for 24 weeks. RESULTS: 152 patients were analysable (34 failed entry criteria), with a mean (SD) age of 33.8 (9.4) and duration of symptoms 30.7 (17.5) days. Mean C reactive protein (CRP) was 48 mg/l, and approximately 50% of those typed were HLA-B27+, suggesting that the inclusion criteria successfully recruited patients with acute ReA. Treatment and placebo groups were well matched for baseline characteristics. There were no statistical differences for changes in any end point (swollen and tender joint count, joint pain, back pain, heel pain, physician and patient global assessments, and CRP) between the active treatment and placebo groups, analysed on an intention to treat basis or according to protocol completion. The time to resolution of arthritis and other symptoms or signs by life table analyses was also not significantly different. Adverse events were generally mild, but were more commonly reported in the azithromycin group. CONCLUSIONS: This large trial has demonstrated that prolonged treatment with azithromycin is ineffective in ReA.

Relevance between arthroscopic pathology and clinical characteristics in knee osteoarthritis.

UNLABELLED: Arthroscopy can be used to identify accurately cartilage and synovial changes in knee osteoarthritis (OA). The objective of this study was to find the correlation between arthroscopically established knee chondropathy and synovitis and the corresponding algofunctional characteristics in OA. METHODS: 41 patients with OA in only one knee joint were investigated. The diagnosis of knee OA fulfilled the clinical, laboratory and radiological ARA criteria. Low pressure arthroscopy of the affected knee was performed under local anaesthesia. Chondropathy was evaluated according to the method of R E Outerbridge. Synovial inflammation was assessed by the scoring system of S. Lindblad and E. Hedfors. RESULTS: We found statistically significant correlation (Spearman's rho test) between chondropathy of the knee and the following clinical indices: pain at night, pain after standing 30 minutes, pain on walking, pain on getting up from a chair without help of arms, maximum walking distance. We failed to demonstrate statistical significant correlation between chondropathy and morning stiffness and activities of daily living. There was also no statistical correlation between knee synovitis and any of the Lequesne's clinical indices. CONCLUSION: The arthroscopically established scores of the cartilage pathology were consistent with most of the clinical algofunctional symptoms. The degree of synovitis in our study was not correlated with clinical activity symptoms of OA, according to Leguesne. Five positive algofunctional Lequesne's scores corresponded to heavy breakdown of knee cartilage in OA.

Differential diagnosis of Kikuchi's disease and systemic lupus erythematosus lymphadenopathy: clinicopathologic algorithm.

The authors have described the first case of Kikuchi's disease in Bulgaria. The present study gives the clinicopathologic algorithm compiled by them to make the correct diagnosis and differentiate Kikuchi's disease from systemic lupus erythematosus lymphadenopathy.

Wrist tuberculosis in cladribine--induced remission of hairy cell leukosis.

A 45-year-old man with "hand-shoulder" syndrome developing eight-months after Cladribine-induced remission of an 11-year-old hairy cell leukosis is presented. Wrist bone biopsy was performed because of failure of the algodystrophy treatment and radiographic findings of progressive osteoporosis. Caseating epiteloid granulomas abundant in Langhans cells were found histologically and later Mycobacterium tuberculosis species was isolated in culture specimen. Fistulas were formed that healed after a prolonged anti-tuberculosis therapy. The role of cellular immunity deficiency in Cladribine-treated hairy cell leukosis that predisposes to mycobacterial infection is discussed.

[Reiter's syndrome: the clinico-histomorphological correlations]. / Sindrom Reitera: kliniko-gistomorfologicheskie korreliatsii.

A total of 11 patients with Reiter's syndrome underwent puncture biopsy of the synovial membrane of the knee joint. At the early stage of the disease the patients showed hyperemia, edema, infiltration with neutrophilic leukocytes, lymphocytes and plasmacytes. At the later stage diffuse and focal infiltrates of lymphocytes and plasmacytes and a rise of the fibrocyte count were predominant. A correlation was established between the degree of edema and pain and histomorphologically ascertained hyperemia and edema of the synovial membrane. As the disease progresses, clinically dominant is the induration of the articular bursa, which correlates with the grade of infiltrative and fibrous alterations established on histomorphology.

[Blood serum and synovial fluid proteins in Reiter's syndrome]. / Belki syvorotki krovi i sinovial'noi zhidkosti pri sindrome Reitera.

Individual proteins (transferrin, ceruloplasmin, alpha 2-macroglobulin, IgG, IgA and IgM) were examined in blood and synovial fluid of 11 patients with Reiter's syndrome. ARA-1981 was used as a diagnostic criteria. The control group included 40 patients with rheumatoid arthritis and 31 with osteoarthrosis of the knee joint. Statistically significant differences between the concentrations of individual proteins in patients with Reiter's syndrome, rheumatoid arthritis and osteoarthritis were only established in synovial fluid for IgM and for IgM index Csf/CS.

[The sensitivity and specificity of the ARA diagnostic criteria for osteoarthrosis of the knee joint (1986). American Rheumatism Association]. / Chuvstvitelnost i spetsifichnost na ARA-diagnostichnite kriterii za osteoartroza na koliannata stava (1986).

The sensitivity and specificity of the ARA criteria for osteoarthrosis of the knee joint (1986) were studied in 61 clinically ill patients. It was established that the diagnostic sensitivity and specificity for the group of clinical and laboratory criteria is 89.2% and 75% respectively, for the clinical and roentgenologic--91.9% and 83.3% and for the classical criteria--94.6% and 70.8%.

[Intravenous pulsed therapy with prednisolone hemisuccinate in severe forms of systemic lupus erythematosus]. / Intravenozna pulsova terapiia s prednizolon khemisuktsinat pri tezhki formi na sistemen lupus erythematosus.

The intravenous pulsed treatment with prednisone hemisuccinate of severe forms of systemic lupus erythematosus influences favorably the basic clinical manifestations of the disease--polyarthritis, fever, vasculitis, myocarditis, sialoadenitis. Prednisolone is as efficient as methylprednisolone in the pulsed treatment of patients with systemic lupus erythematosus.

[Circadian rhythm of uric acid levels of the serum in gout]. / Sutochnyi ritm kontentratsii mochevoi kisloty v syvorotke pri podagre.

Uric acid concentration in the serum was investigated 3 times a day using the uricase method in 15 gout inpatients on a hypopurine diet with age- and sex-adjusted caloric content. The highest uric acid concentration was noted at 7 a. m., the lowest concentration value at 11 p. m. The highest renal clearance values were noted from 7 a. m. till 3 p. m., the lowest ones from 11 p. m. till 7 a. m. Similar regularities were noted in 15 rheumatoid arthritic patients, however uric acid concentration in the serum was lower and its renal excretion was 1.7 times more effective.

[Hamman-Rich syndrome]. / Vurkhu sindroma na Hamman-Rich.

The clinical picture and pathologoanatomical changes of one case with Hamman--Rich syndrome are described, with the diagnosis made while still living of a middle aged woman, textile worker with a subchronic course of the disease. The role of the organic textile dust is admitted to be the triggering factor for the development of the disease according to the mechanism of autoallergization.

[Rheumatoid arthritis among the rural population of southern Bulgaria (transitory morbidity established using the Rome and New York diagnostic criteria)]. / Revmatoidniiat artrit sred selskoto naselenie na Iuzhna Bulgariia (momentna bolestnost, ustanovena s pomoshtta na rimskite i niuiorkskite diagnostichni kriterii).

Examinations of 5021 subjects (2779 females and 2242 males) were carried out with a view to rheumatoid arthritis. En masse examinations of the population over the age of 20 were carried out in eight villages of South Bulgaria. Making use of the Roman diagnostic criteria, rheumatoid arthritis--probable form, was found in 1.47 per cent of the males and 1.40 per cent of the females (mean for both sexes-1.43%), confirmed form (including the classical) in 0.80 per cent of the males and 1.12 per cent of the females (a total of 0.98% for both sexes). With two positive New York diagnostic criteria are 1.12 per cent of the males and 1.30 per cent of the females (a total of 1.21% for both sexes). With three and four positive New York criteria are 0.45 per cent of the males and 0.76 per cent of the females (a total of 0.62% for both sexes). Only 60 per cent of the subjects with confirmed (including the classical) rheumatoid arthritis are with three or four New York diagnostic criteria. The Roman diagnostic criteria define sometimes subjects with polyarthritis as patients with rheumatoid arthritis, whereas New York criteria fail to detect the cases with rheumatoid arthritis with asymmetric joint involvement.