[The treatment of ankylosing spondylitis with auranofin (Ridaura)]. / Zur Behandlung der Spondylitis ankylosans mit Auranofin (Ridaura).

Auranofin has no influence on axial skeleton manifestation of ankylosing spondylitis, neither on clinical complaints, nor on function and inflammatory parameters. Peripheral arthritis is possibly influenced positively, but this cannot be stated definitely because of the low number of cases in this study. This question must be analyzed in larger collectives, as alternatives to conventional therapy are needed for the treatment of peripheral joint involvement of ankylosing spondylitis.

[Ultrasound of the knee joint: normal values and changes in rheumatoid arthritis]. / Sonographie des Kniegelenks: Normalbefunde und Veränderungen bei rheumatoider Arthritis.

The bursa suprapatellaris, infrapatellaris, the patella tendon, condylar cartilage, menisci and fossa poplitea were examined sonographically in 56 healthy persons in defined sections. References for normal findings are given. The examination of 22 patients with rheumatoid arthritis revealed joint effusions, Baker cysts, synovial hypertrophy, intraarticular septae and changes in the echogenicity of the synovial fluid.

[Transient osteoporosis or femur head necrosis? Early diagnosis using MRT]. / Transitorische Osteoporose oder Femurkopfnekrose? Frühdiagnose mit der MRT.

Transient osteoporosis of the hip is a syndrome that does not seem to be widely known; this is also true for its radiological appearance. It is often mistaken for avascular necrosis of the femoral head, metastatic or inflammatory disease. These differential diagnoses lead to more or less invasive procedures, although transient osteoporosis does not require more than immobilisation for complete remission. MRI was done in 38 patients with acute hip pain, 13 had femoral head necrosis and 8 transient osteoporosis. Follow-up studies via MRI in patients with transient osteoporosis revealed 3 stages (diffuse, focal, residual) during the clinical course of which stage II is similar to femoral head necrosis but always without the typical sclerotic rim.

Longterm results of auranofin therapy.

The results of longterm therapy with the oral gold preparation auranofin in patients with rheumatoid arthritis (RA) were evaluated based on the following data: 1) Two multicenter open uncontrolled studies (MTC06) and (162EMUA-RA), 2) the reevaluation of these data for the MTC06 study after 4 years from the beginning of the study and 3) the results of a postmarketing surveillance program (PMSP) of patients on auranofin therapy. The specific rheumatologic documentation and information system (IKR inhaltkodierte rheumatologic) serves as the basis of the follow-up studies and longterm observations. The first year data on 207 patients (MTC06) indicating that duration of the disease less than 2 years was the only discriminating factor regarding a positive treatment outcome were confirmed by the two-year (151 patients). Patients, who responded favourably to Auranofin did usually well for the four-year or longer observation period. The data base of these two studies and the PMSP failed to outline any new severe or threatening side effects. Diarrhea and loose stools were more common at the beginning of the treatment. The overall withdrawal for untoward events was 11.2%. Patients who did or did not respond to previous DIMARD therapy either on i.m. gold, D-Penicillamine or Chloroquine, did usually well when treated with Auranofin, even if severe side effects leading to withdrawal had occurred on previous therapy. The favourable safety profile was confirmed by the PMSP data.

Auranofin: first choice for remission-inducing drug (RID) therapy in rheumatoid arthritis?

Numerous studies have demonstrated that auranofin (AF) causes less severe side effects than other disease-modifying antirheumatic drugs (DMARDs) such as injectable gold (IG) and D-penicillamine (DPA). As the efficacy of AF appears comparable to that of IG, AF could be the first choice for early and long-term therapy for rheumatoid arthritis (RA). A total of 444 patients were enrolled in 2 uncontrolled, open, multicenter studies in Germany, Austria, and Switzerland; data were evaluated from 300 patients with RA treated for 12 months and 179 patients treated for 24 months. Patients with disease duration of 1 year or less had greater improvement in grip strength, joint index, morning stiffness, and activity index when compared with patients whose disease duration was more than 2 years. Drug treatment prior to AF included IG in 46, DPA in 36, chloroquine in 57, and antineoplastic agents in 5. Within this group, subpopulations were isolated who were withdrawn from prior DMARD therapy due to lack of efficacy or adverse events, and the results of subsequent AF therapy evaluated. Adverse events observed with previous DMARDs, particularly proteinuria, did not necessarily recur with AF. The data from these 2 studies suggest that auranofin can be initiated early in the course of RA and can be used successfully in patients who have experienced lack of efficacy or adverse events with other DMARDs.

Oral gold therapy with auranofin (SK&F 39162). A multicenter open study in patients with rheumatoid arthritis.

One hundred and fifty patients with rheumatoid arthritis received 6 mg of auranofin daily for 2-24 months. Thirty patients were withdrawn from the study, and 82 patients were observed for 12 months. Statistical evaluation was available for 74 patients at weeks 24, 38, and 48, respectively. The major side effects observed were diarrhea, rash, and alopecia. Significant improvement was noted in the articular index, ESR, pain, and morning stiffness.

Comparative study of quantitating 99mTc-EHDP uptake in sacroiliac scintigraphy.

Quantitative sacroiliac (SI) scintigraphy was performed 3 h after an i.v. injection of 16 mCi 99mTc-EHDP. The resulting images were recorded and processed and on an ON data system 150. Five technical approaches for objective digital assessment of abnormal uptake of the tracer at the sacroiliac joints were employed. SI indexes from the ratio of radioactivity in the SI joints and in the os sacrum, determined either by a region-of-interest technique or by a profile-scan technique measuring the maxima of the curve over a defined base line, proved to be the best parameters in discriminating normal from abnormal uptake of the radiotracer in the SI joints. The quantitative scan technique appears to be useful as an objective tool in interpreting SI scans.

[The "rubtest" and RAST]. / "Reibtest" und RAST.

The "rubtest" to induce an immediate reaction with various inhalative and ingestive allergens has proved to be a very reliable, easily demonstrable and extremely simple method for detection of allergy-type I, especially of the "highest-sensitivity-type". Recent examinations confirmed the clinical importance and the high correlation between the "rub-test", the IgE-titre (RAST) and the endpoint-skin test-titration.

Back pain: osteoarthritis.

Back pain is one of the chief complaints of the elderly. It may be either a chronic deep skeletal muscular pain or an acute circumscribed pain arising from nerve-root irritation. The main causes of back pain in older people are: 1) degenerative changes (spondylosis, osteoarthritis, ankylosing hyperostosis); 2) malignancy (multiple myeloma, metastases from carcinoma or lymphoma); and 3) metabolic disorders (osteoporosis, osteomalacia, chondrocalcinosis, Paget's disease). Mechanisms and variations are discussed in detail.