Spiritual healing as adjunct therapy for rheumatoid arthritis.

At the request of the Confederation of Healing Organizations (CHO) the addition of spiritual healing (SH) to conventional therapy has been compared with conventional therapy alone in 29 patients with rheumatoid arthritis (RA) using a parallel group design. Clinical and biochemical assessments were recorded at intervals while subjects received a 6-month course of spiritual healing. Initial psychological assessment was also performed. The addition of SH produced no significant improvement in any of the relevant clinical or laboratory parameters assessed; although groups were not exactly matched at the start, those requesting SH had more active disease. Between-group comparison showed only an improvement in summated change score (SCS) in favour of SH at week 16, which was lost by week 24. Individuals displaying the most improvement in pain score or SCS with SH did not have a significantly different psychological profile from those patients who showed the most deterioration. Although our study was small the results do not persuade us to proceed to a larger study for which there would be difficulties in study design.

Factors predisposing to the resort of complementary therapies in patients with fibromyalgia.

This study examined the factors influencing the use of complementary therapies in patients with fibromyalgia. A postal questionnaire was sent to 90 patients who had attended a rheumatology out-patient clinic in West Yorkshire for their diagnosis or treatment of fibromyalgia. Seventy-one percent of fibromyalgia patients had used or were using complementary therapies. Patients who were using complementary therapies were of a higher socio-economic group (p < 0.001). The most popular therapy was oral supplementation. The duration of complementary therapies ranged from 3 months to 26 years (median = 3). The number of therapies used by each patient ranged from 1 to 10 (median = 3). The duration of fibromyalgia was associated with both the duration of complementary therapies (p < 0.001) and the number of therapies used (p < 0.05). The most popular source of advice for the decision to use complementary therapies was from a magazine (40%). Patients using complementary therapies were less likely to be satisfied with their current hospital treatment and turned to complementary therapies in the chance of relief from their fibromyalgia. The relatively high cost and lack of information on complementary therapies appeared to dissuade those patients who chose not to use it.

Alternative therapy for rheumatic diseases.

The wide variety of alternative therapies available for rheumatic diseases attests to the inability of the medical profession to provide patients with adequate cures. Many patients resort to alternative remedies even if these are not always declared to the physician. Our own studies have included assessments of injectable enzyme preparations, vitamins and the use of healing in conjunction with the Confederation of Healing Organisations. Other well controlled trials have been made of diet, nutritional supplements and natural remedies such as green lipped muscle preparations. Unfortunately, the controlled scientific evidence of efficacy is often eclipsed by extravagant advertising claims for subjective enthusiasm of patients who suffer from a variety of conditions, many of which undergo a natural cyclical variation in severity. The clinical assessments used in such trials require critical appraisal.

Failure of selenium-ace to improve osteoarthritis.

Selenium-ACE, a formulation containing the trace element selenium with three vitamins, is widely promoted for the treatment of arthritis. A controlled double-blind trial of Selenium-ACE in osteoarthritis failed to demonstrate any significant efficacy for the compound over placebo at 3 or 6 months though there was a non-significant trend to improvement in some clinical parameters in both groups. Side-effects were more frequently seen in the placebo group.

The use of a pharmacological indicator to investigate compliance in patients with a poor response to antirheumatic therapy.

Twenty-six patients with rheumatoid arthritis which was poorly controlled despite high dose D-penicillamine were studied. Compliance was assessed by standard methods (return tablet count and interview). In addition low-dose phenobarbitone was included in the penicillamine formulation as a pharmacological indicator of compliance. Using these techniques incomplete compliance was apparent in 11 patients (42%). All such patients were identified by the pharmacological marker. Only one admitted poor compliance at interview and only six returned more than a few tablets too many. The reason for the high incidence of poor compliance in this selected group is not apparent but it may represent a significant cause of failure with D-penicillamine therapy. The use of low-dose phenobarbitone may have wider applications in the investigation of patients with other conditions who fail to respond adequately to treatment.

A pharmacokinetic comparison of tenoxicam in plasma and synovial fluid.

In view of the paucity of information of the synovial fluid pharmacokinetics of nonsteroidal anti-inflammatory drugs with a long half-life, we have compared the pharmacokinetics of tenoxicam (TILCOTIL, MOBIFLEX) in plasma and synovial fluid in six patients with polyarthritis causing knee effusion. Plasma and synovial fluid concentrations of tenoxicam were measured up to 96 hours after an oral dose of a single 40 mg tablet. A full pharmacokinetic analysis was performed. Tenoxicam passed into synovial fluid attaining a peak concentration significantly later than that for plasma. However, the mean half-life for synovial fluid (45 hours) was not significantly different from that for plasma (42 hours). Comparison of area under the curve (AUC) indicated the total exposure of the synovial fluid to tenoxicam was consistent in different patients, comprising 50-60% of the corresponding plasma levels in every case. In the case of tenoxicam, synovial fluid exhibits the pharmacokinetic properties of a peripheral "tissue" compartment.