[Leflunomide as a second choice treatment in patients with rheumatoid arthritis]. / Leflunomid jako lek drugiego wyboru u chorych na reumatoidalne zapalenie stawów.

UNLABELLED: Leflunomide is a relatively new disease modifying antirheumatic drug (DMARD) and a number of studies evaluating its effectiveness and safety in daily medical practice is limited. THE AIM OF THE STUDY: Evaluation of effectiveness and safety of leflunomide treatment in patients with active rheumatoid arthritis in whom methotrexate was ineffective or contraindicated. MATERIAL AND METHODS: Eighty one patients (66 women and 15 men) with RA diagnosed according to ARA (The American Rheumatism Association) criteria were included in the study. The mean age was 57.6+/-11.7 years and the mean disease duration was 7.7+/-7.1 years. The inclusion criteria were: disease activity according to DAS28 (Disease Activity Score)>3.2 and contraindications to methotrexate or ineffective methotrexate treatment for at least 3 months. At the beginning of the study 49 of patients were treated with methotrexate in weekly dose of 17+4.2mg and 32 were not treated with DMARDs. Oral glicocorticosteroids in stable doses of 5-15mg of prednisone were given to 66 (77.7%) of them. There was no statistically significant difference in radiological progression of the disease according to Steinbrocker's scale between groups (treated and not treated with methotrexate). Monotherapy with leflunomide was started with loading dose of 100mg for 3 days, and then 20mg daily. Combination therapy was introduced without loading dose. Evaluation was performed monthly and included: duration of morning stiffness, pain and disease activity according to VAS (visual-analogue) scale, the number of tender and swollen joints, blood count, ESR, CRP, aminotransferases activity, and the presence and intensity of adverse reactions. The results of treatment were evaluated after 5 months in 37 of patients and adverse reactions which happened until the end of 5th month were evaluated in all included patients. RESULTS: The mean DAS28 values improved exponentially during consecutive months and the difference between them was statistically significant. Adverse reactions during 5 months of treatment were observed in 36(44,4%) of patients and in 6(7,4%) of cases the treatment had to be stopped because of side effects. The frequency of adverse reactions was similar in monotherapy and combination therapy group. CONCLUSIONS: Leflunomide therapy can be effective in patients with active rheumatoid arthritis in whom methotrexate is contraindicated or insufficient. Combination of leflunomide with methotrexate is safe and does not increase the frequency of adverse reactions.

[Efficacy of glucosamine sulfate treatment in patients with osteoarthritis]. / Ocena skutecznosci leczenia siarczanem glukozaminy w chorobie zwyrodnieniowej stawów.

UNLABELLED: Osteoarthritis (OA) is the most common disorder of human movement system. Glucosamine sulfate, which is precursor of glucosamineglycans synthesis, plays a special role among known disease modifying drugs. THE AIM OF THE STUDY: To assess the efficacy of treatment of OA patients with glucosamine sulfate (Artreum). MATERIAL AND METHODS: 50 patients with OA of the knees (38 pts) or hips (12 pts) entered into study (41 women, 9 men, aged 50-83 yr.). 47 patients completed the study (39 women, 9 men). All patients have been treated with 500 mg of Arthreum three times daily for 12 weeks. All patients had to complete 3 visits during the study that contains of physical examination, WOMAC questionnaire, Lequesne questionnaire and self pain assessment with visual analog scale (VAS). ESR, morphology, glucose and creatinine concentration, amionotransferases activity were also evaluated. RESULTS: We found the significant improvement during treatment in 38 (80.85%) pts. as measured by WOMAC scale and in 36 (70.60%) as measured by Lequesne'a scale. Self assessed pain improved in 35 (74%) of patients. The efficacy of the treatment was characterized as "good" by 60% of patients, and it was similar to physician assessment (Cohen's kappa coefficient of agreement = 0.9359). No clinically significant adverse events were observed. CONCLUSION: In this study we found that Arthreum treatment causes significant improvement in functional status and pain measured by WOMAC, Lequesne'a and VAS scale in OA patients, and is well tolerated.

[Prevalence of cervical spine inflammatory changes in rheumatoid arthritis patients and the value of neurological examination in their diagnosis]. / Czestosc wystepowania zmian zapalnych w odcinku szyjnym kregoslupa u chorych na reumatoidalne zapalenie stawów i rola badania neurologicznego w ich diagnostyce.

The aim of the study was to evaluate prevalence of cervical spine inflammatory changes, especially atlantoaxial pathology, and their possible relation to subjective and objective neurological symptoms in rheumatoid arthritis patients. 100 patients (88 female and 12 male) aged 23 to 85 (61.4 +/- 12.9), with the mean disease duration of 12.5 +/- 9.5 years were included in the study. According to radiological examination (lateral and antero-posterior X-ray of the cervical spine) supplemented by MR of the cervical spine or CT of the atlanto-axial joint in suspected cases, 26% of patients had only inflammation, next 15% of patients presented with instability of the atlanto-axial joint and 9% developed basilar invagination of the dens of axis. 18% of patients presented subaxial cervical instability. Neurological examitation was performed by independent neurologist in 99 patients, only 14 presented abnormalities suggesting cervical myelopathy. Two of them showed no patology of the cervical spine. Remaining patients presented: C1/C2 inflammation in 4 cases, anterior atlanto-axial subluxation (AAS) in two cases, basilar invagination in 4 cases and instability with medullary compression on lower cervical levels only--in two cases. There were 4 cases of coexisting C1/C2 changes with medullary compression due to discopathy and (in 3 of them) instability on lower cervical levels. In 6 cases surgical stabilisation was proposed (5 patients with basilar invagination and 1 patient with AAS and myelopathy). There was statistically significant correlation between symptoms (like: paraesthesiae, intermittent problems with hearing and seeing), neurological examination and degree of radiological damage of atlanto-axial joint. The authors concluded that careful medical history and neurological examination can be useful in making decision of further radiological diagnostic procedures of the cervical spine in rheumatoid arthritis.