Diclofenac in rheumatoid disease.

The clinical activity and side effects of a new phenyl acetic-acid derivative, diclofenac, have been assessed in 24 patients with rheumatoid disease. Diclofenac 25 mg q.i.d. was compared with 750mg of aspirin BP q.i.d. using a double-blind crossover technique involving four weeks on each drug. Benefits were similar for the two preparations but with improvement in morning stiffness and incidence of dyspepsia favouring diclofenac, and a more marked reduction of the sedimentation rate occurring with aspirin. A moderate elevation of liver enzymes was seen in one patient on diclofenac, and of lactate dehydrogenase in one other. It is concluded that diclofenac is a therapeutically active analgesic anti-inflammatory agent.

Ketoprofen (Orudis) in ankylosing spondylitis.

A double-blind cross-over study is described in which ketoprofen (Orudis) is compared with phenylbutazone in 14 patients with ankylosing spondylitis. Results indicated a significant patient preference for phenylbutazone with greater improvement in the ESR. However, the absence of objective and laboratory deterioration with ketoprofen, when compared with the initial, or control, assessments, suggests that it may prove a useful alternative to phenylbutazone in spondylitic disease.

Nabumetone, a new non-steroidal anti-inflammatory drug: a comparison with naproxen.

Nabumetone, 500 mg two nocte, was compared with naproxen, 250 mg two nocte and one mane, in the management of 24 patients with rheumatoid arthritis attending an outpatients clinic. Both drugs were generally well tolerated and were of comparable efficacy in the dose employed. Similar numbers incurred side effects while taking either drug, but severe side effects, requiring withdrawal from the trial in two cases, were restricted to those patients taking naproxen. As patients known to be intolerant to naproxen were excluded from the trial, the results could have been expected to favour naproxen in this respect. Nabumetone may have a useful role in the management of patients with poor tolerance of other anti-inflammatory drugs.

Lateral subluxation of the atlanto-axial joint in rheumatoid arthritis.

Involvement of the cervical spine by rheumatoid disease is common, but lateral subluxation at the atlanto-axial level has not been recorded previously. The condition is due to asymmetrical erosion of the lateral atlanto-axial facet joint, and may be complicated by collapse of the lateral mass of the axis. The condition should be suspected in patients with rheumatoid arthritis (RA) who present with occipital, auricular, and/or facial pain.

Psoriatic arthritis: clinical subgroups and histocompatibility antigens.

Histocompatibility antigens were determined in 60 patients with psoriatic arthritis. The patients were divided into clinical subgroups according to axial or peripheral joint involvement, disease severity based on number of peripheral joints involved, and the presence or absence of bone erosions. The total group showed a significant increase in frequency of HLA-A1, B17, B27, and DR7 when compared with a control population. The subgroup with spondylitis had a significant increase in frequency of HLA-B27 when compared with patients with peripheral arthritis (p less than 0.001). The subgroup with peripheral arthritis alone had a higher frequency of HLA-DR7 than the control group (p less than 0.001). There were also significant associations between HLA-DR7 and chronic severe disease (p less than 0.001) and between HLA-DR4 and the presence of erosions (p less than 0.05).