Gastrointestinal safety of amtolmetin guacyl in comparison with celecoxib in patients with rheumatoid arthritis.

OBJECTIVE: Selective inhibitors of cyclo-oxygenase-2 (COX-2) appear to be safer than conventional NSAIDs on the gastrointestinal (GI) tract. Amtolmetin guacyl (AMG), a NSAID that inhibits both COX-1 and COX-2, has an anti-inflammatory effect comparable to that of traditional NSAIDs, with a better GI safety profile. The primary end-point of this study was to evaluate the gastrointestinal safety of amtolmetin guacyl in comparison with celecoxib in patients affected with rheumatoid arthritis. The assessment of efficacy was the secondary end-point. METHODS: This study was a 24-week, randomized, parallel group, double-blind, double dummy, multicentre trial; 235 patients were enrolled and 180 patients (85 in the AMG group and 95 in the celecoxib group) completed the study. Each patient received twice daily amtolmetin guacyl 600 mg or celecoxib 200 mg. Assessment of safety was performed by upper GI endoscopy, gastrointestinal symptoms evaluation, electrocardiography, blood and urine laboratory tests, adverse events recording. Assessment of efficacy was performed by using the American College of Rheumatology (ACR-20) responder index. RESULTS: Neither amtolmetin guacyl nor celecoxib determined a worsening of baseline gastro-duodenal endoscopy findings. The percentage of patients with normal findings did not significantly change after treatment with both drugs, being virtually identical with AMG (i.e. 75.29%) and increasing from 75.79% to 77.66% with celecoxib. Moreover an evaluation of the other safety parameters did not reveal any difference between the two treatment groups. Therapeutic efficacy was equivalent in both groups, with no statistical difference between the two drugs at all time intervals. CONCLUSIONS: In patients affected with rheumatoid arthritis, AMG and celecoxib proved to be equivalent, showing comparable gastrointestinal safety and therapeutic efficacy of treatment.

Radiologic changes of ischial tuberosity in ankylosing spondylitis.

The objective of the paper was to emphasize the meaning of involvement of ischial tuberosity in ankylosing spondylitis, enriching the clinical picture of the disease and pointing to ankylosing spondylitis, especially when sacroiliitis is absent or less developed. Radiologic examination of ischial tuberosity was performed in 68 patients with different developmental stages of ankylosing spondylitis. There were 66 (97%) men and two (3%) women, aged 30 to 56 years. Anteroposterior radiographs of the pelvis were performed in all patients and independently assessed by two radiologists. The radiologic changes of ischial tuberosity were classified into four stages: 1) stage of minimal changes, 2) stage of destructive changes, 3) stage of reconstructive changes, and 4) stage of ossification of tendon fibers in the form of rumpled tufts. Radiologic changes of enthesitis were found on ischial tuberosity in 31 patients (45.5%, p < 0.01). Stage 1 or minimal changes were found in two (6.5%); stage 2 or destructive changes in 13 (42.0%); stage 3 or reconstructive changes in 11 (35.5%) and stage 4 or "tufts phenomenon" in five (16.0%) patients. The classification of changes is useful for the assessment of disease range and progression as well as for the diagnosis when sacroiliitis is obscurely developed and other radiologic signs are not present.

Primary hypertrophic osteoarthropathy: clinical, radiologic, and scintigraphic characteristics.

BACKGROUND: Our aim was to establish clinical and imaging characteristics of primary hypertrophic osteoarthropathy (PHO). METHODS: A group of 76 patients (71 men and 5 women) with primary hypertrophic osteoarthropathy was examined. Extensive history and status of the locomotor system were determined in all patients. Radiologic and scintigraphic examinations of the bones, thermography, capillaroscopy, gastroscopy, and histologic analysis were also performed. RESULTS: Family history was positive in all 55 patients (100%) summoned for a check-up. Finger clubbing of the hands and feet as well as positive Schamroth test were found in all patients, while hyperhydrosis was found in 65 (85.5%), seborrhea in 39 (51%), and involvement of the joints in 52 (68.5%) patients. Histologic analysis in 18 (23.7%) patients predominantly showed periarticular edema and moderate cellular activity. Periostosis of the long bones was also found in all patients, while scintigraphy, performed in 44 patients, was positive in 18 (33.5%) patients in the active phase of the disease. Thermography, performed in 10 patients, ranged from hypothermia to thermal amputation of feet and hands. Capillaroscopy of hands and feet in 47 (61.8%) patients showed changes in small blood vessels. Gastroscopy indicated abnormalities (ulcer and hypertrophic gastritis) in 21 patients (27.6%). CONCLUSIONS: PHO has special clinical and radiographic manifestations (finger clubbing and periostosis of the long bones) that are associated with some minor manifestations. Development of the disease is gradual (to 20 years) and requires a special diagnostic assessment.

Reactivation of primary hypertrophic osteoarthropathy by bronchogenic carcinoma.

This paper reports 2 cases of primary hypertrophic osteoarthopathy (PHO) which evolved into secondary hypertrophic osteoarthopathy (SHO) under the influence of bronchogenic carcinoma. The patients had a clinical picture of primary hypertrophic osteoarthropathy but without any signs of disease activity until in the last several months when a malignant bronchopulmonary condition developed. This activated all the symptoms: joint swelling; enlarged fingers and distal forearms and legs; moist palms and soles; unpleasant odour of perspiration; and deeper folds of the forehead and nasolabial furrow. A bone scan showed increased accumulation of the radioisotope in specific regions of the skeleton. To our knowledge, no similar cases have been described in the literature.

Radiological changes of the symphysis in ankylosing spondylitis.

PURPOSE: To evaluate the symphyseal changes in patients with ankylosing spondylitis. MATERIAL AND METHODS: Radiological-morphological changes of the symphysis were studied in 68 patients (66 men, 2 women) with ankylosing spondylitis whose age ranged from 21 to 75 years. The duration of the disease was from 2 to 50 years. RESULTS AND CONCLUSION: Changes in the symphysis were found in 16 patients (23.5%) and were less prominent than findings in the sacroiliac joints. We classified these changes into four stages: minimal changes, apparent destruction, reparation and ankylosis. The third and the fourth stages of the changes in the symphsis were found more frequently in patients who suffered from the disease for more than 15 years. Radiological evaluation of symphyseal changes can be helpful in the evaluation of disease progression as well as in establishing a differential diagnosis.

Quantitative analysis of digitopalmar dermatoglyphics in men with ankylosing spondylitis.

Dermatoglyphic pattern analysis, one of the genetic methods, was used to determine digitopalmar ridge count in 40 men with ankylosing spondylitis. Twenty-two variables (ridge count on each of the ten fingers, their sum on five and ten fingers, four traits on each palm, i.e. ridge count between a-b, b-c and c-d triradii, and atd angles on the palms as well as their bilateral sum) were determined. The data thus obtained were compared with digitopalmar prints of 200 healthy men who served as a control group. A significant difference from the control group was found for six variables. The atd angle was reduced on both palms and consequentially in the overall sum. Ridge count was decreased between the b-c triradius on the left palm and increased on the third finger tip bilaterally. Accordingly, a polygenic system identical in some loci to the polygenic system predisposing to ankylosing spondylitis susceptibility might be found responsible for the dermatoglyphic pattern development. That means that they could used, and that is the aim of this study, in the evaluation of the relative risk in family members with positive disease history.

[Ankylosing spondylitis]. / Ankilozantni spondilitis.

Ankylosing spondylitis is a chronic progressive disease of unknown etiology in which genetical and environmental factors are very important. The disease is even now diagnosed relatively late and therefore the treatment is not satisfactory. Well taken history, clinical and radiological findings enable to establish early diagnosis and introduction of modern therapy which can lead to good results and maintenance of satisfactory function of locomotor system.

[Joint symptoms in primary hypertrophic osteoarthropathy]. / Zglobni simptomi u primarnoj hipertroficnoj osteoartropatiji (PHO).

Joint manifestations of hypertrophic osteoarthropathy are arthritis and arthralgia. Those occur at the all joints, but often at the lower extremities and usually are asymmetric. Swelling of the distal parts of the extremities was found in 52 patients (68.4%). Perimaleolar swelling proceed from periostal accumulation. Swollen fists are present in all patients and that phenomenon is characteristic sign of the disease. Swelling of the joints, perimaleolar edema and swelling of the distal parts of the limbs reminds of the other conditions (tumor, osteomyelitis, lues, Reiter's syndrome, psoriasis, lymphangitis, miksedema, thrombophlebitis, Caffey's disease, Engel's disease, hypervitaminosis A, RA, thyroid acropathia etc.), which must be taken into consideration.

[Occurrence of subcutaneous rheumatoid nodules in patients with rheumatoid arthritis in Croatia]. / Ucestalost pojave potkoznih reumatoidnih cvorica u bolesnika s reumatoidnim artritisom u Hrvatskoj.

The subcutaneous rheumatoid nodules (RN) have been recognized by the American Rheumatism Association, both in 1958 and in 1987, as one of the diagnostic criteria (ARA criteria) among other rheumatoid arthritis (RA) symptoms. The aim of this research has been both to provide the incidence of occurrence of RN in patients with RA in Croatia and to determine its significance in making the RA diagnose. The test group comprised 233 patients (182 women and 51 men) with RA, their average age being 48.3 years in the range of 18 to 77. Both the anamnesis and the clinical examination have determined the occurrence of RN in 54 (23.2%) of 233 patients. The range of occurrences was more evident in men (31.4%) than in women (20.8%), though this difference was statistically irrelevant. The most common localization of benign rheumatoid nodules was the exterior side of elbow and PIP hand joints. The obtained results prove that the incidence of RN in our tested patients with RA can be compared with those of the earlier researches done in Croatia (18.1% Jajic, Vlak; 20-25% Jajic), as well as with those obtained in the western European countries (20% Doherty, George; 25% Ziff; 20-25% Miehle; 21% Wolf et al.).

[Effect of nutrition on the clinical picture of rheumatoid arthritis]. / Utjecaj prehrane na klinicku sliku reumatoidnog artritisa.

46 patients with RA, both sex, who had been suffering from RA within 3 and 20 years (average 7 years), were included in our examination. Suffering from the basic disease for various time, 11 patients (23.9%) were stated that some sustenance markedly aggravate disease. Reduction diet, which was started on their own, had markedly positive effect on the symptoms and led to better quality of life. We can conclude that sustenance has an influence on disease and reduction diet markedly positive acts upon clinical expression of disease.

[History of patient education in rheumatic diseases in Croatia]. / Povijesni razvoj edukacije reumatskih bolesnika u Hrvatskoj.

The education of rheumatic patients in Croatia has begun in 1975 by introducing the school of back pain. Soon after that has begun the education of children with scoliosis. The education of patients with rheumatoid arthritis and ankylosing spondylitis was establish in 1985. Along with the courses of patient's education, there were printed a publications dedicated to the same problem. At the beginning there was printed a textbook Rheumatic diseases with training for rheumatic patients (1978.) and then textbook Jogging (1982.) and Reta (1984.). During 1994, there were graduated a publications dedicated to the disease having the same name: Rheumatoid arthritis, Ankylosing spondylitis, Uric arthritis and Psoriatic arthritis, which were reprinted in enlarged form (1997). Protection of the joints in rheumatic disease (1998.) is a new textbook for patients about correctly usage of the joints. Textbook Prevention of back pain and neck pain (1998.) is dedicated to healthy people for the prevention of pain syndromes of vertebra. Thus, the education was introduced in almost all parts of rheumatology and in whole Republic of Croatia.

[Surgical treatment of lumbar disc hernias in athletes]. / Kirursko lijecenje lumbalne diskus hernije u sportasa.

In a 7-year period (1988-1995) a series of 55 patients was surgically treated at our Department for lumbar disk herniation following a certain sports activity, i.e. sports injury. The above number accounts for 2% of the total number of lumbar disk patients operated upon at our Department. The majority of patients in our series were amateur athletes, whereas a few of them were active or professional athletes. The most common cause of disk herniation among our patients was playing soccer (13 cases), which is followed by basketball (8), field athletics (7), tennis (6) and handball (4). In most cases our surgical method of choice was flavectomy (interlaminectomy). Most commonly seen intraoperative finding was intervertebral disk extrusion. In some athletes the onset of symptoms was due to a change of their usual sports activity, for example a tennis player who was injured in skiing. We believe that the onset of disk herniation in athletes is a consequence of numerous micro traumas of the intervertebral disk which are further compounded by the syndrome of overstraining. In the case of a positive indication, surgical treatment leads to a faster recovery in professional athletes.

[Acute psychoses in patients with psoriatic arthritis during treatment with sulfasalazine]. / Akutna psihoza u bolesnice s psorijaticnim artritisom za vrijeme terapije sulfasalazinom.

We present a case of hastily progress of acute psychosis in a woman patient who has been treating with Sulphasine because of psoriatic arthritis. The medicine has been taken for a short time (one month) and in low doses. We bring out this instructive case, which shows a possibility of development of one severe and unusual complication, never noted down in literature.

[Condensing osteitis of the pubic bone]. / Osteitis condensans pubis.

We represent a case with development of osteitis pubis after suffering injuries in a man born 1940. The disease has developed during 10 years. The first symptoms have occurred only after 9 years. This review represent a supplement to better knowledge of etiopatogenesis of osteitis condensans pubis.

Quantitative analysis of digitopalmar dermatoglyphics in women with rheumatoid arthritis.

Quantitative analysis of digitopalmar ridge count was performed in 40 female patients with rheumatoid arthritis to assess the role of genetic factors. Twenty-two variables (ridge count on each of ten fingers, their sum on five and ten fingers, four traits on each palm, i.e. ridge count between a-b, b-c and c-d triradii, atd angles on two palms and their bilateral sum) were determined. The data obtained were compared with digitopalmar prints of 200 control group women. Statistically significant differences from the control group in terms of increased ridge count were found in nine variables, i.e. on the third, fourth and fifth finger bilaterally, and consequentially in the total ridge count on the fingers of the two hands and of both hands taken together. Dermatologyphics as one of the genetic methods could be used in the evaluation of the relative risk in family members with positive disease history.

[Hypoplasia of sacroiliac joints and lumbar spine after radiographic therapy]. / Hipoplazija sakroilijakalnih zglobova i lumbalne kraljeznice nakon provedene rendgenske terapije.

We present the case of hypoplasia of sacroiliac joints and lumbar in 30-year-old male who was submitted to X-ray therapy of the mentioned region because of the carcinoma of colon, at the age of four. Now he complains of back pain, especially during loading it. Physical presence shows disproportion betwen upper and lower put of the trunk.