Proquazone (Biarison) and indomethacin (Indocid) in the treatment of ankylosing spondylitis. Two comparative, clinical, double-blind studies.

The effect and tolerance of proquazone and indomethacin in patients suffering from ankylosing spondylitis were compared in two separate 3-week clinical, double-blind, randomized studies on total of 60 patients. In the first study 16 patients were treated with proquazone and 14 patients with indomethacin, and in the second study 15 patients were treated in each group. Both drugs were found to have an evident, equally strong effect on pain and functional capacity in daily doses of 900 mg and 75mg respectively. Severe side effects were not noted with either one of the drugs. Patients with previously known intolerance to indomethacin were excluded from the studies. Gastronitestinal disturbances seem to be the most commonly appearing side effect in patients treated with proquazone.

Diclofenac sodium (Voltaren) and naproxen in the treatment of rheumatoid arthritis: a comparative double-blind study.

In a double-blind, between-patient trial the efficacy and tolerability of two new non-steroid anti-inflammatory analgesics-diclofenac sodium (Voltaren) 50 mg b.i.d. and naproxen 250 mg b.i.d.-were compared in hospitalised patients with rheumatoid arthritis. Both drugs had a clearly positive effect on the duration of morning stiffness, bilateral grip strength, pain at rest, and pain on movement. No statistically significant difference between the two drugs was found with respect to clinical efficacy. Three patients treated with diclofenac sodium reported unwanted effects, as compared with seven patients receiving naproxen. These unwated effects led to premature discontinuation of the treatment in one patient on naproxen. Thus, although both drugs were well tolerated, it appeared that diclofenac sodium caused somewhat fewer unwanted effects.

Gold treatment at an early stage of rheumatoid arthritis.

The progression of erosive X-ray changes over a period of 5--6 years was evaluated in 39 patients exposed to a mean dose of 2030 mg aurothiomalate during the maintenance period. The cause for the low dose was the initial high incidence of side-effects. The progression of erosions was highest in patients with the low dose of gold in the initial stages of the disease. The best result in preventing development of erosions was achieved in patients with the high dose of gold in the early phase of the disease. It appears that gold treatment prevents the progression of the erosoins. The earlier the inception of treatment, the better the result.

Effect of gold treatment on the progression of erosions in RA patients.

The progressive of erosive X-ray changes over a period of 5-6 years was evaluated in RA patients with a low or high dose of gold during the follow-up period. The "low gold" group included 18 patients whose treatment was discontinued because of side effects at a mean dose of 254 mg of Myocrisin. The "high gold" group included 32 patients who received a mean dose of 1858 mg of Myocrisin. Both the number of eroded joints in the hands and feet and the X-ray stage had deteriorated more in the "low gold" group. The inter-group difference was statistically significant. Thus, gold treatment has a retarding effect on the progression of erosions in RA patients.

Prognostic value of the type of onset of rheumatoid arthritis.

The type of onset in 235 patients with rheumatoid arthritis (RA) was acute in 69, subacute in 55, and gradual in 111 patients. The radiological destruction of the hands and feet after 7 years from the beginning of the disease was the same in all patient groups. Thus the nature of the onset of RA seems not to have any significant influence on the outcome of the arthritis.

Effect of gold on progression of erosions in rheumatoid arthritis. Better results with early treatment.

The advance of radiological destruction in 57 patients with definite rheumatoid arthritis was observed for 5-6 years. In all patients gold treatment was started 2-36 months after the onset of the disease. In 18 patients gold was discontinued because of side-effects of other reasons before reaching the total dosage of 500 mg, while the remaining 39 patients received a mean dose of 2030 mg of natriumaurothiomalate. The advance of the radiological destruction was statistically significantly less marked in patients treated with the full gold therapy. The earlier the treatment was initiated, the better was the result.

Prolonged treatment with tolfenamic acid in inflammatory rheumatic diseases.

The aim of this study was in the first place to elucidate the tolerance of rheumatic patients to prolonged treatment with tolfenamic acid. 91 patients took part in the trial, most of them suffering from rheumatoid arthritis. The daily dose of tolfenamic acid was 600 mg and the trial lasted 6 months. The side-effects were usually slight: diarrhea occurred in 8, other gastrointestinal disturbances in 11, dysuria in 8 and other side-effects in 3 cases. Six patients broke off their treatment because of side-effects ascribed to tolfenamic acid. However, laboratory tests failed to show any significant changes caused by this drug. One case of reversible thrombopenia was seen in a patient who had also received gold treatment. On the whole, the clinical effect was found to be good, and tolfenamic acid appeared to be well suited for long-term symptomatic treatment of rheumatics.

Comparison of penicillamine and gold treatment in early rheumatoid arthritis.

In a series of 100 adult patients with definite rheumatoid arthritis of at most 3 years' duration and with no previous penicillamine, gold or systemic corticosteroid treatment, 50 patients were treated with D-penicillamine and 50 with gold for one yar. The dose of penicillamine was 600 mg daily. Sodium aurothiomalate was given 50 mg weekly up to a total of 13 mg/kg and thereafter 50 mg once a month. In both treatment groups a statistically significant decrease in the number of painful and/or swollen joints, an increase in haemoglobin and a decrease in ESR, serum ceruloplasmin-, alpha1-acid glycoprotein-, IgG-, IgM- and IgA levels was observed. All the changes in these clinical and laboratory tests were of the same degree in both treatment groups. In the penicillamine group 12 out of 20 seropositive patients became seronegative and in another 5 the Waaler-Rose titre dropped clearly. In the gold group, 7 out of 16 seropositive patients became seronegative, and the Waaler-Rose titre dropped in another 5. An equal increase in the number of eroded joints in hands and toes was seen in the penicillamine and the gold group. Penicillamine was discontinued because of side effects in 13 patients (26%), and gold treatment in 15 (30%). Proteinuria and/or haematuria were the most common causes of discontinuation in the penicillamine group.

Comparison of the analgesic effect of ten nonsteroidal anti-inflammatory drugs.

The analgesic effect of 10 anti-inflammatory drugs was compared using a single-blind method in 90 patients with rheumatoid arthritis. Each patient received two different drugs, for three days each and each drug was evaluated in 18 patients. After the trial, the patients considered which of the drugs they preferred. The greatest relief from pain was achieved by diclofenac, indomethacin, naproxen and tolfenamic acid, each of these being preferred by the majority of patients and being significantly (p less than 0.01) better than the least effective drugs ketoprofen and proquazone. Acetylsalicylic acid, azapropazone, carprofen and ibuprofen were considered intermediate in efficacy.

Extracorporeal irradiation of thoracic duct lymph as immunosuppressive treatment in rheumatoid arthritis.

Thoracic duct drainage and re-infusion of the irradiated lymph was carried out as immunosuppressive treatment in 2 patients with progressive, therapy-resistant rheumatoid arthritis. In both patients, a marked clinical improvement was achieved even during the first days of treatment. A reduced number of T cells in the blood was seen 3 days after onset of drainage, whereas no significant change in the number of B cells was observed. No recirculation of the infused cells could be detected, nor was the radiation removal of T cells accompanied by rapid proliferation of "new" T cells. As clinical improvement and reduction in T cells occurred simultaneously, there is probably a connection between these two events. The beneficial clinical response and the achievement of T cell suppression by thoracic duct drainage--the result of irradiation and re-infusion of irradiated lymph--encourage further clinical trials with this type of treatment in severe therapy-resistant rheumatoid arthritis.