[Plasma and tissue concentrations of biphenylacetic acid following 1 week oral fenbufen medication and topical administration of Felbinac gel on the knee joint]. / Plasma- und Gewebekonzentrationen von Biphenylessigsäure nach einwöchiger oraler Fenbufenmedikation bzw. topischer Anwendung von Felbinac-Gel am Kniegelenk.

In an randomised study 30 patients were treated during one week before undergoing an elective surgery of the knee joint with 1 or 2 g respectively of 3% Felbinac gel (biphenylacetic acid gel) or oral 300 mg Fenbufen thrice daily. Biphenylacetic acid (BPAA) is the therapeutically active metabolite of the non-steroid anti-inflammatory drug Fenbufen. Plasma concentrations were measured before, during therapy and at the time of the operation. During the surgery of the knee joint specimens of synovial fluid and -membrane, of cartilage, muscle and tendons as well as of the skin and the subcutaneous fatty tissue were obtained and the BPAA concentrations measured. There was a large variance of the obtained values in all groups. It seems that mainly methodical problems are responsible for this. At the time of surgery, the plasma concentrations following oral administration were with 10,080 ng/ml 20 to 50 times higher than those after topical administration. The tissue concentrations reached 1/8 to 1/2 of the plasma concentrations. The relation of tissue concentrations to plasma concentrations of BPAA was smaller in patients treated with oral administration than in patients treated with topical administration. Therefore a partial direct penetration of Felbinac into the deeper tissue compartments can be assumed. There was no significant difference in plasma-, synovial- or tissue concentrations between the two groups treated with the topical administration. The tissue concentrations were 1 to 2 orders of magnitude lower than those after oral administration. Only in the skin the concentrations were with 9160 respectively 3830 ng/g higher than those obtained after oral application (2110 ng/g).

[D-penicillamine--a retrospective view]. / D-Penicillamin--ein Rückblick.

D-penicillamine was discovered in 1943. At the beginning of the 1960s it was introduced into the treatment of rheumatoid arthritis. Since then, its efficacy and adverse effects have become very well known. According to this experience, D-penicillamine, similarly to gold, is acknowledged as a disease-modifying drug in the treatment of rheumatoid arthritis.

Results of a phase-II clinical trial on treatment of rheumatoid arthritis with recombinant interferon-gamma.

In an open, non-randomized clinical trial conducted at multiple centres, 49 patients with rheumatoid arthritis were treated with recombinant interferon-gamma for 20 days. The study was carried out in two sub-studies. In the first, the total daily dose of interferon-gamma was 50 micrograms; in the second, 100 micrograms. Of the 49 cases, 40 were evaluable for statistical analysis; 24 of these patients (60%) responded to therapy, according to the criteria of a successful outcome laid down in the study protocol, and were classified as responders. In responders, the clinical parameters investigated improved with both dosages. The lower dosage differed from the higher one in having a markedly lower incidence of side-effects. The results lead to the conclusion that a randomized double-blind phase-III clinical trial should be performed.

[Enzyme therapy in comparison with immune complex determinations in chronic polyarthritis]. / Enzymtherapie im Vergleich mit Immunkomplex-Bestimmungen bei chronischer Polyarthritis.

42 patients with definite or classic rheumatoid arthritis were treated with an enzyme mixture (Wobenzym) for 6 weeks. Circulating immune complexes were investigated with a Clq-solid phase RIA in weekly intervals and also rheumatoid factors were determined together with other routine laboratory tests. The condition of patients after therapy was recorded together with amount of circulating immune complexes during treatment. 26 (61.9%) patients improved, 13 (30.9%) patients remained unchanged, and 3 (17.1%) showed impairment. No side effects were observed. Patients who primarily showed no immune complexes or patients who had immune complexes which became negative during enzyme therapy, showed improvement more often than patients which had immune complexes and remained positive during the entire course of therapy.

[Comparative drug therapy study with scintigraphic control research]. / Vergleichende Arzneimittelstudie mit szintigraphischen Kontrolluntersuchungen.

By means of the 99m-Tc-pertechnitate joint scintigraphy the authors try to document the effect of antirheumatic drugs in 62 patients with rheumatoid arthritis. By measuring the changes of the synovial blood circulation, conclusions are drawn as to the degree of inflammation. When trying to make a quantitative assessment of the changes of inflammation as compared with a standardised reference region, particularly on the wrist joint, it was found that the activity increased on the reference region on the forearm and that proved to be a possible source of error. The reason for this may be the early involvement of vessels in rheumatoid arthritis. For further calculations it will be necessary to set up joint and radio-nuclide-specific standards as reference points.

[Comparison between ambulatory or stationary treatment systems for patients with rhematoid arthritis with reference to the development of the family situation]. / Vergleich des ambulanten und des Kurbeha ndlungs-systems für chronische Polyarthritiker im H inblick auf die Entwicklung der familiären Situation.

UNLABELLED: The evaluation of a detailed questionaire which was issued to 44 German female rheumatoid arthritis patients (family mothers) who underwent "Kur" treatment courses and a comparable group of Dutch patients who had ambulatory treatment only shows little advantage to the "Kur" system). The "Kur" patients had adjusted somewhat better to their illness and had retained more easily the extra-familial social contacts. In contrast, statistically significant advantages were clearly evident in the Dutch ambulatory treatment programm: 1. Over-all reduction in "feeling ill" 2. Reduced stress in association with the objectively reduced joint mobility 3. Reduced stress in association with pain 4. The support of the patient by immediate family members and other relatives is generally better 5. Better patient support possibilities by family friends 6. Reduced negative effects on family life 7. Reduced disruptive effects in relationships between the patients and their husbands and children 8. Higher degree of satisfaction with physicians and the treatment. IN CONCLUSION: Even if national behavioral differences are taken into consideration, the ambulatory system as practiced in Holland seems to hold significant advantages to the "Kur" system.