Flurbiprofen in rheumatoid arthritis therapy.

Preliminary findings are reported from an open study of 300 mg flurbiprofen daily in 24 patients and from 6 out of 30 patients treated so far in a double-blind crossover comparison of 300 mg flurbiprofen daily and 150 mg indomethacin daily in the treatment of rheumatoid arthritis. The results indicate that flurbiprofen is effective in relieving symptoms and is better tolerated than indomethacin. Using an experimental model in rats to assess the anti-inflammatory activity of flurbiprofen, data suggest that flurbiprofen is unable to prevent an immunological type of inflammation but is capable of modifying the type and extent of cellular infiltration.

Antibacterial antibody pattern in seronegative spondyloarthropathies (SNSA).

The occurrence of some anti-bacterial antibodies was studied in sera from 31 healthy donors (HD) and 101 patients with different rheumatic diseases. The cases investigated included 7 Psoriatic Arthritis (PA), 35 Rheumatoid Arthritis (RA), 17 Undifferentiated Seronegative Spondyloarthritis (U-SNSA), 13 Behçet's syndrome, 18 Enteric Arthropathies (EA), 7 Ankylosing Spondylitis (AS) and 4 Reiter's syndrome. A complement fixation test was carried out to detect the presence and to evaluate the titer of the specific antibodies against the relative bacterial antigens. The antigens used were prepared for the complement fixation test by Virion Laboratories: Yersinia Enterocolitica 0:3 type (YEC), Yersinia Pseudotuberculosis (YPT), Campylobacter Jejuni (CJ) and Campylobacter Intestinalis (CI), Chlamydia Trachomatis (CT). The results indicate a statistically significant difference between the HD group and the seronegative polyarthritis one (PA, U-SNSA, Behçet, EA, AS, Reiter as a whole) as far as antibody production against YEC, CI and YPT is concerned. On the contrary, a significant difference between the HD group and RA patients for specific anti bacterial antibodies was only found against CT. Further detailed analysis of the behavior of the antibody pattern in any disease groups was carried out to identify a possible specific and featured antibody profile for some given rheumatic disorder.

Anti-enterobacteria antibodies in psoriatic arthritis.

The occurrence of certain antibacterial antibodies was studied in the sera of 22 healthy donors (HD) and 66 patients with different diseases. The cases investigated included 22 rheumatoid arthritis (RA), 22 non-arthritic-psoriasis (NAP), and 22 psoriatic arthritis (PA) patients. A complement fixation test was used with Yersinia enterocolitica 0:3 type (YEC), Yersinia pseudotuberculosis (YPT), Campylobacter jejuni (CJ), and Campylobacter fetus (CF) antigens; the detection of anti-Chlamydia trachomatis (CT) antibodies was carried out using an immunoperoxidase colorimetric slide test that allowed the detection of isotypes of specific antibodies. It was found that the synthesis of anti-CF, CJ, YEC, and YPT antibodies in NAP patients does not differ significantly from that of the HD group; on the contrary, the antibody levels were statistically higher in PA than in the other disease groups or in the healthy controls, although only anti-CF antibodies seemed to significantly differentiate (p = 0.000003) the PA group from the others. Anti-CT IgA antibody titers were found to be significantly higher in the PA as well as in the RA groups when compared with the controls, while the antibody levels in NAP patients showed no clear-cut difference with respect to those of either the arthritic patients or the healthy controls. By showing that anti-enterobacterial antibodies are increased in PA but not in NAP patients, our data furnish additional support to the thesis of a pathogenic role of bacterial infections in psoriatic arthritis.

Incidence of Yersinia enterocolitica antibodies in patients with inflammatory joint diseases.

Agglutinating antibodies against Yersinia enterocolitica serotypes 0:3, 0:8 and, to a minor extent, 0:6 were found in 18 out of 93 patients with inflammatory joint diseases. Patients with undifferentiated arthritis showed the highest prevalence of antibodies against Yersinia enterocolitica. The possibility that serotypes other than 0:3 may be involved in triggering arthritis is discussed.

Isolated sternoclavicular joint arthritis in heroin addicts and/or HIV positive patients: three cases.

The authors describe three patients in whom septic arthritis of the sternoclavicular joint (SCJ) occurred, drug addiction and human immunodeficiency virus (HIV) infection representing the predisposing conditions. Infectious arthritis is well known in intravenous drug users, but it is rare in HIV positive patients, who are prone to bacterial infections from usual or unusual microorganisms. In one case, staphylococcus aureus methicillin sensitive was responsible for septic arthritis. In another case, SCJ infection was associated with pneumonitis.

Monoclonal antibody investigation in rheumatoid arthritis: presence of a T cell subpopulation bearing a double marker.

Using a double marking technique of peripheral blood lymphocyte (PBL) from 23 patients suffering from rheumatoid arthritis (RA) and 12 normal healthy subjects (NHS), the authors were able to demonstrate that there was no alteration in the OKT8 + ve population of RA patients, when compared with NHS. On the contrary, an increased percentage of the subpopulation of lymphocytes OKT4 + ve was detected. Finally, the presence of a subpopulation of T cells carrying both the receptors for monoclonal antibodies OKT4 and OKT8 has been detected.

Multicentre double-blind study of the efficacy, safety and tolerance of pirazolac compared with sulindac in patients with rheumatoid arthritis.

Of the 160 patients (80 pirazolac/80 sulindac) who entered the study through 14 investigators, three-quarters completed a 12-weeks therapy and three-fifths completed the entire 24-weeks therapy. In the pirazolac group 15% of the patients and in the sulindac group 11% dropped out from the study due to adverse clinical experience. The drop-out rates due to unsatisfactory therapeutic response were respectively 15% and 16% in the pirazolac and the sulindac groups. Both treatment groups showed significant improvement from baseline for all parameters except for the erythrocyte sedimentation rate at weeks 4, 8, 12 and 16 for the sulindac group and weeks 4 and 8 for the pirazolac group. The two treatment groups were comparable as to effectiveness; however, the improvement rates in 36 out of 41 efficacy measurements based on the definition of clinically relevant changes in relation to baseline were estimated to be superior for the group under pirazolac therapy. The rate of improvement for the American Rheumatism Association functional class at the end of the study was 23% in the pirazolac group and 9% in the sulindac group (p less than 0.05). Of the patients in the pirazolac and sulindac groups, 45% and 44% respectively reported no adverse effects at all throughout the whole 24-weeks study. The rates of patients reporting at least one adverse reaction in a body system were not different between the two groups. An exception was the body as a whole where ten patients (12.5%) in the sulindac group and only two (2.5%) in the pirazolac group reported adverse reactions (p = 0.03). No differences occurred between the two treatment groups with regards to intensity, causality or the number of occurrences of adverse clinical experiences. One death in the sulindac treatment group was reported during the study. In both treatment groups, alterations in laboratory tests were minor or negligible or associated with abnormal pre-treatment values and, generally speaking, without any clinical relevance. There were some patients, who had increases from baseline in alkaline phosphate in both treatment groups. However, these were usually transient, occasionally complemented by a slight increase of serum glutamic oxaloacetic acid transaminase.

[Evaluation of the efficacy of orgotein in a series of patients with hydrarthrosis of the knee]. / Valutazione della efficacia della orgoteina in una casistica di idrartro del ginocchio.

A study was carried out to verify the efficacy of intra-articular orgotein in patients with different forms of hydrarthrosis of the knee. The results confirm the value of orgotein for the local treatment of osteoarthritic joint swellings. However in the presence of marked exudative synovitis processes (chronic primary polyarthritis), the use of orgotein is of limited value.

Prevention of NSAID-induced ulcers by the coadministration of misoprostol: implications in clinical practice.

The guiding principle of ulcer therapy for many years has been "No acid, no ulcer" and many still adhere to it. Nonsteroidal anti-inflammatory drugs (NSAIDs) appear to cause ulcers primarily through prostaglandin depletion rather than through an acid-based mechanism. These ulcers affect a large number of patients and give few warning signs, often none, until it is too late. The profound relief offered to arthritis patients by NSAIDs, in the absence of equally effective remedies, means that rheumatologists must continue to deal with specific and quantifiable risks of NSAID-related gastrointestinal (GI) ulceration and its associated complications. The prostaglandin analog, misoprostol, may address many of these concerns because it reverses the patient's prostaglandin depleted condition. It is effective in preventing NSAID-induced ulcers, and does not interfere with the desired analgesic or anti-inflammatory effects of NSAIDs. The tools to assess the risk of NSAID-related hospitalization or death due to GI complications are available and patients at greatest risk can be identified. Physicians whose patients are at risk may wish to consider therapy with misoprostol 400 to 800 micrograms/day in divided doses. It is recommended that misoprostol be coadministered with the NSAID after meals. The most common side effects that the patient may experience are some mild and transient diarrhea and cramps upon initiation of misoprostol therapy and these can be minimized by taking misoprostol with meals and avoiding magnesium-containing antacids. For misoprostol's protective role to be demonstrated, it should be coprescribed with the NSAID for the duration of the NSAID therapy.(ABSTRACT TRUNCATED AT 250 WORDS)