Effects of tramadol on synovial fluid concentrations of substance P and interleukin-6 in patients with knee osteoarthritis: comparison with paracetamol.

Both the analgesic drugs tramadol and paracetamol are widely used for the symptomatic therapy of osteoarthritis (OA). The aim of this double-blind, randomised study in patients with knee OA was to compare their effects on synovial fluid concentrations of interleukin (IL)-6 and substance P (SP). Moreover, we evaluated plasma and synovial fluid concentrations of tramadol and its active metabolite (O-desmethyl-tramadol, M1) after oral treatment with this drug. Twenty patients were enrolled. A group of 10 patients received tramadol (50 mg three times a day), and another group of 10 patients were treated with paracetamol (500 mg three times a day) for 7 days. Both drugs significantly reduced the intensity of joint pain. The synovial fluid concentrations of SP were significantly reduced only by the treatment with tramadol. In this group of patients, IL-6 synovial fluid concentrations were slightly, but not significantly, decreased. Paracetamol did not significantly change the synovial fluid concentrations of SP and IL-6. After oral administration, a considerable amount of tramadol was measurable in synovial fluid. Both in plasma and synovial fluid the concentrations of M1 were markedly lower than those of tramadol, with a T/M1 ratio of 14.7+/-4.6 and 9.3+/-3.9, respectively. These data demonstrate that the activity of tramadol may involve the modulation of inflammatory mediators. Moreover, they indicate that after oral treatment with tramadol, both the parent drug and its active metabolite can penetrate into synovial fluid.

The assessment of quality of life as a measure of gold salts treatment efficacy in rheumatoid arthritis.

BACKGROUND: In the evaluation of functional status of patients with rheumatoid arthritis (RA) the health related quality of life is currently considered important because of its approach to various components of life, such as social, psychological, and physical aspects. We used the Stanford Health Assessment Questionnaire (HAQ) to assess the improvement of functional status in patients with RA treated with gold salts. METHODS: In a prospective investigation 91 patients with RA in anatomical stage I, II, or III, 66 females and 25 males, with a mean age of 53.17 years, were evaluated during medical treatment in a 1-year follow-up. The treatment consisted in sodium aureothiosulphate, plus corticosteroids and NSAID. The assessments were done during ambulatory visits, at baseline and after 6 and 12 months of treatment, by HAQ as well as by other parameters such as Ritchie Index, visual analog scale (VAS), and morning stiffness. A group of 19 RA patients included by the same criteria and treated only by corticosteroids and NSAID was used as control for the first 6 months of the study. RESULTS: HAQ scores and other parameters were significantly lower (p=0.0001) at the 6th and 12th month measurements when compared with baseline. In the control group only a significant difference in the VAS score was detected. CONCLUSIONS: All the parameters measured in our study were useful in detecting clinical improvement in RA patients treated with sodium aureothiosulphate plus corticosteroids and NSAIDs, but the HAQ provides a more global assessment of the patient's status.

[Association of Lynch syndrome and non-Hodgkin's malignant lymphoma. A case report]. / Associazione di sindrome di Lynch e linfoma maligno non-Hodgkin. Descrizione di un caso.

A patient is described, with Lynch syndrome, typified by hereditary appearance in young age of synchronous and metachronous proximal colorectal cancer, without polyposis, and often associated with extracolonic cancer, particularly ovarian and endometrial carcinomas. The study of our patient's pedigree showed the occurrence of eleven colonic cancers. Our patient had ovarian carcinoma, tumor of the rectum and non-Hodgkin's lymphoma.

Chromosome changes in lymphocytes of patients with scleroderma.

The authors have analyzed cytogenetically 28 cultured lymphocytes from females with Diffuse Scleroderma and 28 female controls between 30 and 70 years of age. Recurrent chromosome abnormalities were +8, +X, -X, and the PCD(X) phenomenon. Triplo X cells were significatively more frequent in patients than in controls. The incidence of +X and PCD(X) was significatively higher in the patients between 30 and 50 years of age, while the frequency of -X cells was higher in controls than in patients. None of these chromosome changes was correlated with the presence of anticentromere antibodies (ACA) in the patients' serum. Random structural chromosome abnormalities were also observed in the patients, but no break point clustering was observed. The incidence of chromosome breaks was significatively higher in patients than in controls. These data suggest a general tendency of females with Scleroderma to develop X polisomies and +X and the PCD(X) phenomenon may be considered Scleroderma related in younger patients.

Short courses of intravenous clodronate in the treatment of Paget's disease of bone: a long-term follow-up trial.

The effect of short-term treatment with intravenous clodronate (300 mg daily for 10 days) was assessed in 12 patients with active Paget's disease of bone. The treatment was found to be associated with a marked reduction in serum alkaline phosphatase levels, from 330 U/l +/- 247 (S.D.) at baseline to 225 +/- 86 on day 11. These levels decreased further during the subsequent 2 months, to stabilize thereafter within the normal range (30-100 U/l)during the entire 1-year follow-up period. No changes were observed in serum calcium and phosphorus levels, whereas serum parathyroid hormone increased significantly on day 11. It is concluded that short-term i.v. treatment with clodronate provides an effective alternative to oral treatment and achieves complete remission of Paget's disease for at least 1 year.

[Wernicke-Korsakoff syndrome caused by prolonged infusion therapy during the postoperative period]. / Sindrome di Wernicke-Korsakoff da terapia infusionale prolungata in periodo postoperatorio.

Wernicke-Korsakoff's syndrome (W.K.S.) is a complication of alcoholism and malnutrition and usually presents acutely and is characterized by disturbances of consciousness, paralysis of the external ocular muscles, ataxia and disorder of retentive memory. The disease results from deficiency of vitamin B1, or thiamine, an essential coenzyme in intermediate carbohydrate metabolism. We report a seriously ill, nonalcoholic surgical patient, who developed W.K.S. in the postoperative period as a result of thiamine deficiency, during prolonged intravenous therapy. It is recommended that malnourished patients receive 100 mg parenteral thiamine especially when glucose infusions are administered.

A seasonal pattern in the onset of polymyalgia rheumatica.

The seasonal distribution in the onset of polymyalgia rheumatica (PMR) was determined in 58 patients with the disease and compared with that in 44 patients affected by rheumatoid arthritis of elderly onset (EORA). Thirty six (62%) cases of PMR developed during May to August; by contrast, only 14 (31%) cases of EORA developed in the same months, this latter disease failing to show any seasonal clustering. The monthly distribution of PMR correlated with outside temperature and hours of sunshine. These data suggest that PMR might be triggered by such factors as actinic damage of superficial vessels or infective agents with a seasonal cycle. Finally, the summer clustering of PMR may be helpful in the differential diagnosis from EORA.

[Monoclonal gammopathy of uncertain significance in rheumatic disease]. / Le grammapatie monoclonali di incerto significato nelle malattie reumatiche.

Among 358 patients with rheumatic diseases, the incidence of monoclonal gammopathy of undetermined significance (MGUS) as detected by immunofixation was 4.4% (11 of 248 patients) in rheumatoid arthritis (RA), 3% (1 of 32 patients) in systemic lupus erythematosus (SLE), 6% (3 of 49 patients) in Sjögren's syndrome (SS) and 3% (1 of 29 patients) in progressive systemic sclerosis (PSS). Solid tumor was present in 4 (36%) of the 11 RA-MGUS patients. In these cases the monoclonal component could be related to a paraneoplastic syndrome rather than to rheumatic diseases. The association of rheumatic diseases, MGUS, solid tumor and immunological disorders are discussed.

[Cutaneous side effects induced by D-penicillamine in the treatment of rheumatoid arthritis]. / Gli effetti collaterali cutanei indotti dalla D-penicillamina nel trattamento della artrite reumatoide.

After considering the cutaneous side effects of D-penicillamine in rheumatoid arthritis management, a few cases of cutaneous adverse reaction observed in 5 (13%) of 38 patients, who received the drugs, are described. Two patients had an early rash; one showed a late rash; one had a late rash with symptoms of initial pemphigus and drug-induced LES (presence of antinuclear and anti-dsDNA antibodies). Finally, one patient showed a drug-induced pemphigus with high titre of reticular anti-skin antibodies. All these manifestations required definitive discontinuance of the drug.

[Agranulocytosis caused by dipyrone. Case reports]. / Agranulocitosi da dipirone: contributo casistico.

Two cases of dipyrone-induced agranulocytosis are described. In the first one, the disease was due to a single administration, in the second one, to prolonged therapy. The possible pathogenic mechanism is discussed, which can be immunologic and/or toxic. The effectiveness of some of the drugs and general supportive measures applied is discussed. Health education of the patient, in conjunction with careful attention by the physician, may play an important role in the prevention of this pathological condition.