Double-blind, multi-centre trial to compare a once-daily combination of trimethoprim and sulfamethopyrazine with ampicillin 4-times daily in patients with urinary infections.

Sixty-eight patients with urinary infection were allocated at random to receive treatment with either 500 mg ampicillin 4-times daily or a trimethoprim (250 mg)/sulfamethopyrazine (200 mg) combination given once daily after a double, loading dose on the first day. All patients complained of urinary symptoms and showed significant bacteriuria, E. coli being the pathogen most frequently recovered. Clinical and microbiological assessments were carried out on entry and, as a rule, after 3 to 4 days and 1 to 2 weeks of treatment. In the 35 patients receiving trimethoprim/sulfamethopyrazine, 40 (95%) of the 42 original infecting organisms were eradicated. In the 33 patients on ampicillin, the eradication rate was 32 (89%) out of 36 organisms. The course of urinary symptoms was similarly favourable in the two groups. Overall response was considered as 'excellent' or 'good' in 89% of the patients receiving the combination preparation and in 82% of those given ampicillin. Clinical and biological tolerance was satisfactory under both regimens. A longer follow-up control should confirm the value of the new combination in the treatment of urinary infections.

Methotrexate serum-level determinations during low-dose therapy of rheumatoid and psoriatic arthritis.

In 29 patients, 21 suffering from psoriatic arthritis and eight patients suffering from rheumatoid arthritis, methotrexate serum-levels were determined by means of radioimmunoassay. The aim of the investigation was to recognize an eventual dependence of the serum level of methotrexate on the total cumulative dose and to test the possibility of a concomitant therapy control. Beside the determinations of the serum levels of methotrexate, clinical examinations and laboratory tests were done at regular intervals. The values obtained showed no significant increase during the course of therapy compared to the values at the beginning of the treatment. Likewise no correlation to the total cumulative dose, the clinical picture or to the occurrence of side-effects could be found. Nor could any relationship between the changing of laboratory parameters and the methotrexate serum-levels be observed. No differences appeared in the methotrexate serum-levels during therapy of either rheumatoid or psoriatic arthritis patients. In conclusion it seems impossible to monitor a low-dose methotrexate therapy by continuous determinations of the serum levels of the drug.

[Parenteral gold therapy (Tauredon) in chronic polyarthritis]. / Erfahrungen mit parenteraler Goldtherapie (Tauredon) bei chronischer Polyarthritis.

Between 1972 and 1983, 519 patients with rheumatoid arthritis according to ARA criteria underwent basic antirheumatic treatment with Tauredon (sodium aurothiamalate). Patient age was 19 to 78 years, and the disease had been active for 6 months to 8 years. Results of treatment were recorded for periods of 14 days to 8 years. After a test dose of 10 mg intramuscular, patients received weekly injections of 20 to 50 mg for 4 to 6 months and were subsequently placed on a maintenance dose of 50 mg at intervals of 2 to 4 weeks for years. Clinical examinations and laboratory tests were scheduled at weekly intervals in the first month of treatment, at 2-weekly intervals in the next two months and subsequently once every month. In the first years of this trial (up to 1975) response to treatment was evaluated by the criteria reported by Fähndrich [2] and Steinbrocker [10]. Later Ritchie's joint index [6], laboratory parameters (sedimentation rate, CRP and alpha 2 globulin) as well as the consumption of non-steroidal antirheumatics and corticosteroids were equally used. Results were found to be excellent to good in 316 patients (= 60.8%) and satisfactory in 104 (= 20.1%). 99 patients (= 19.1%) were rated as failures. The drug was well tolerated in 391 cases (= 75.37%), but had to be withdrawn in 128 (= 24.6%) because of side effects. Among these, cutaneous and mucosal symptoms, which occurred in 70 patients (= 13.47% of the total), were most prominent. Serious side effects were absent throughout.

[Effect and tolerance of naproxen. Testing of a new Galenic preparation of an anti-rheumatic agent in an open clinical trial]. / Wirksamkeit und Verträglichkeit von Naproxen. Prüfung einer neuen galenischen Zubereitung des Antirheumatikums in einer offenen klinischen Studie.

The non-steroidal antirheumatic drug naproxen has been available in capsule form since 1974. A new formulation, a film-coated tablet, has recently been developed and has various advantages, namely rapid release and absorption of the active substance, a lower volume, and a score-line. The efficacy and safety of the new tablet in a dose of 1000 mg daily was investigated in 30 patients in an open study. The substance was well tolerated, and there was no need to discontinue treatment in any patient. In the majority of patients the efficacy of the preparation was very good to good. An unsatisfactory effect was only obtained in two cases.

[Treatment of acute gout attacks with tolmetin (author's transl)]. / Die Behandlung des akuten Gichtschubes mit Tolmetin.

In an open trial 15 patients with acute gout attacks were treated with Tolmetin. A statistically significant improvement of several pain values measured as well as subsidence of swellings and redness were observed. By summing up the scores "good" and "moderate", the joint judgement of physician and patients established a 90% success of treatment with regard to efficacy and tolerability. During Tolmetin treatment a statistically significant decrease of mean uric acid levels could be seen.

[Chronic polyarthritis and erythema anulare centrifugum Darier]. / Chronische Polyarthritis und Erythema anulare centrifugum Darier.

A casuistic contribution considers possible aethiopathogenetic factors of an erythema anulare centrifugum Darrier in a 47 year-old female patient suffering from a seronegative rheumatoid arthritis. The course is traced until the erythema fades and disseminated leucoderma appears.

[Clinical effectiveness and tolerance of auranofin in patients with chronic polyarthritis. Results of a multicenter long-term study]. / Klinische Wirksamkeit und Verträglichkeit von Auranofin bei Patienten mit chronischer Polyarthritis. Ergebnisse einer multizentrischen Langzeitstudie.

In an open multicenter trial, 90 patients with rheumatoid arthritis were treated with a daily dose of 6 mg auranofin. The duration of the treatment was 12 months. A significant improvement in the following parameters was observed: grip strength, number of swollen and painful joints after the 4th month, blood erythrocyte sedimentation rate decreased significantly after the 2nd month. Of the 90 patients, 56 (62.3%) completed the therapy, in 14 (15.5%) it was discontinued because of side effects and in 8 (8.9%) because of inefficacy. 12 patients (13.3%) stated other reasons for discontinuing the therapy (non compliance). The reported side-effects were mostly gastrointestinal, especially diarrhoea and loose stools. The evaluation of results referring to the duration of the disease shows that patients with a duration of less than 2 years reacted better to the improvement with auranofin therapy than patients with a longer sickness history.