Italian double-blind multicenter study comparing S-adenosylmethionine, naproxen, and placebo in the treatment of degenerative joint disease.

In a double-blind study, the efficacy and tolerability of S-adenosylmethionine (SAMe) were evaluated in comparison with those of placebo and naproxen in the treatment of osteoarthritis of the hip, knee, spine, and hand. Thirty-three centers, 18 rheumatologic and 15 orthopedic, participated in this study. A total of 734 subjects, including 582 with coxarthrosis (hip osteoarthritis) or gonarthrosis (knee osteoarthritis), were enrolled. SAMe administered orally at a dose of 1,200 mg daily was shown to exert the same analgesic activity as naproxen at a dose of 750 mg daily. Both drugs were more effective than placebo (p less than 0.01). Tolerability of SAMe was significantly better than that of naproxen, both in terms of physicians' (p less than 0.025) and patients' (p less than 0.01) judgments and in terms of the number of patients with side effects (p less than 0.05). There was no difference between SAMe and placebo in the number of side effects. Ten patients in the SAMe group and 13 in the placebo group withdrew from the study because of intolerance to the drug.

Scintigraphy with Tc99m-MDP in the diagnosis of stress lesions in bone.

Scintigraphy with Technetium methylene diphosphate gives a positive result in bone tissue in a state of raised metabolic activity. This can be used in the diagnosis of mechanical stress lesions in bone. The authors present several clinical examples confirming the usefulness of this method.

Clinical investigations of tolerance to materials and acrylic cement in patients with hip prostheses.

In forty-two patients with prostheses of the hip followed up after an interval, the authors carried out skin allergy tests against the metals of which the prostheses were composed, and against methacrylate. They found that the tests gave positive results in about 25 per cent of cases. They also investigated whether this finding showed any relationship with loosening or movement of the prostheses. There was no statistically significant relationship, either with loosening or with the passage of time since the operation.

Short-term evaluation of synovectomy in haemophilia.

Twenty-three operations of synovectomy (15 on the knee, 5 on the ankle, and 3 on the elbow) were carried out over a three-year period in 19 patients with severe haemophilia A and B who were followed for an average period of 15 months postoperatively. Short-term evaluation of the results was mainly based on the postoperative incidence of haemarthrosis and on the range of joint motion, which were compared with the preoperative findings. Synovectomy reduced, but did not abolish, the occurrence of haemarthrosis; however, after the operation bleeding episodes were usually less severe and incapacitating. Joint mobility was often reduced despite an intensive and prolonged programme of physiotherapy. Nevertheless, most of the patients were pleased with the results of the operation as they could lead a more active life because of the decreased risk of joint bleeding.In the light of these findings we conclude that synovectomy is not the elective treatment of choice for haemophilic arthropathy. It may be indicated in a few selected cases when conservative treatment has failed to control repeated haemarthrosis and synovitis. Controlled clinical trials and long-term evaluation are needed to establish its effect on the final outcome of haemophilic arthropathy.

A new method for the quantitative determination of osteoporosis in man.

The authors studied a technique based on the use of a radiographic negative in antero-posterior projection of the third lumbar vertebra, from which the index of osteoporosis was obtained quantitatively by spectrophotometric examination. This index is about 0.50 in normal cases and approaches unity in cases of osteoporosis.

Ultrasonography in the early diagnosis of congenital dysplasia of the hip.

The authors discuss the feasibility of using ultrasonography in the early diagnosis of congenital dysplasia of the hip. Having used the methods of Graf and Harcke, they devised a new scan which always reveals the state of the limbus in neonatal congenital dysplasia. This has been used for two years as an additional technique in neonates with a positive Ortolani click to demonstrate the presence of an inverted limbus, which is not revealed in the Graf and Harcke scans although they give a very good overall picture of the femoral head and acetabulum. The disclosure of an inverted limbus at this early stage is of crucial importance in determining the correct treatment to be adopted.

Role of synovectomy in hemophilic arthropathy.

Fifteen knee synovectomies performed in severe hemophiliacs between 1969 and 1971 were reevaluated after a follow-up period ranging from five to seven years. In the majority of cases (53%) there was no recurrence of hemarthrosis; in the others the condition was reduced (40%) or unchanged (7%) and joint scintiscans carried out with 99mTc showed a significant uptake of the tracer. Joint motion was markedly impaired in eight cases despite prolonged and intensive physiotherapy. The majority of patients expressed satisfaction with the operation, which had reduced the frequency and severity of joint bleeding and allowed them to lead more active lives. It is suggested that the possibilities of the conservative treatment presently available should be more extensively explored before establishing the indications for synovectomy.