An observer-blind crossover study to compare the efficacies of flurbiprofen, indomethacin and naproxen given orally and rectally in the relief of night pain and morning stiffness due to rheumatoid arthritis.

An observer-blind three-period crossover study of flurbiprofen, indomethacin and naproxen was carried out in 56 patients with rheumatoid arthritis. The drugs were scheduled as two oral doses early in the day with a rectal suppository at night. The aims were to compare efficacy, principally as relief of night pain and morning stiffness, and safety. Flurbiprofen was clearly the most beneficial drug. Advantages over the comparators were demonstrated in terms of shorter duration of morning stiffness, reduced severity of night pain (compared with naproxen) and in the improvement in sleep quality experienced by the patients. Excellent tolerability of flurbiprofen was seen, it being equivalent to naproxen and superior to indomethacin. The results demonstrate that nocturnal and early daytime provision of flurbiprofen is a highly effective strategy for controlling the nocturnal pain and morning stiffness of rheumatoid arthritis.

[The concept of basic therapy of chronic polyarthritis with D-penicillamine: clinical experiences over 10 years]. / Konzept der Basistherapie der chronischen Polyarthritis mit D-Penicillamin: klinische Erfahrungen über 10 Jahre.

Rheumatoid arthritis is a chronic lifelong disease, facts which must be considered when concepts of therapy are developed. This paper reports retrospectively analyzed results of long-term therapy using D-penicillamine. One-hundred-sixteen patients were selected for critical analysis from among 257 treated patients. Judgment was made according to the parameters: inflammation activity, radiological progression, remission rate, clinical outcome-measurement. The results show that the clinical course of the disease is influenced by the treatment and they confirm the need for long-term therapy with an emphasis on immunomodulation.

[Soft-tissue rheumatism--diagnosis and therapeutic concept]. / Weichteil-Rheumatismus--Diagnose und Therapiekonzept.

The term fibrositis or soft tissue rheumatism, provides a label to describe a symptom-complex which is common in practice, but the name is suggesting a defined entity that has not been demonstrated. The complaints known as soft tissue rheumatism can be defined as painful states which arise in the muscle and fibrous structures of the body. The patients complain of pain and stiffness in the neck-shoulder girdle and extremities which are worse with work or stress, better with rest or diversion. Physical examination is normal, as are those of x-rays, laboratory tests and biopsies. Numerous forms of therapy, physical and pharmacological, have been employed. Several theories of causative factors are discussed in this paper. Therapy and diagnosis are compared with many theories.

[Eosinophilic fasciitis]. / Eosinophile Fasziitis.

We describe 4 patients with clinical and pathologic features of eosinophilic fasciitis showing serologic and systemic abnormalities. Biopsies and blood samples were taken and differentiation is made to raise the question of the fundamental nature and the relationship of eosinophilic fasciitis to scleroderma. The term eosinophilic fasciitis is chosen because of the distinct histologic changes occurring in the deep fascia and prominence of eosinophils in the inflammatory reaction. Therapeutic response to steroids is good. Despite the good prognosis in all cases prolonged follow-up is necessary.

[Retropatellar knee pain and chondropathy patella]. / Der retropatellare Knieschmerz und die Chondropathia patellae.

The phenomenon of the painful knee occurring at the patellofemoral joint of the adolescent knee is known as chondromalacia patellae. The constellation of signs and symptoms that fall with in the generally accepted criteria for this diagnosis may well cover more than one pathologic process. Chondromalacia patellae is a term descriptive of changes present on the patellar articular surface and not a single pathologic entity.

[Arthrosis. Degenerative diseases of supporting and locomotor apparatus]. / Die Arthrosen. Degenerative Erkrankungen des Stütz- und Bewegungsapparates.

Degenerative joint disease is an extremely common, noninflammatory, progressive disorder of movable joints and is characterized pathologically by deterioration of articular cartilage and by formation of new bone in the subchondral areas and at the margins of the joint. The main objectives of therapy considering the pathogenesis are relief of pain, restoration of joint function and progression of the disease.

The neuropsychiatric disorder in systemic lupus erythematosus: evidence for both vascular and immune mechanisms.

As part of a prospective survey of systemic lupus erythematosus (SLE) a detailed collaborative study of the clinical, psychiatric, and laboratory features in 15 patients with nonfocal neuropsychiatric disease has been undertaken. In addition to conventional clinical and psychometric evaluation, electroencephalograph, and cerebrospinal fluid analysis, the study included the assessment of cerebral blood flow with oxygen-15 brain scans and serological testing for the presence of antineuronal and lymphocytotoxic antibodies. Of the 15 patients 12 had psychiatric manifestations, while 13 had various neurological abnormalities. All except 2 episodes of cerebral disease were transient. Striking abnormalities in cerebral blood flow and metabolism were seen in 12 patients, even in the presence of subtle clinical features. Sequential scans showed that improvement in clinical features was accompanied by a reversal of scan abnormalities. All sera contained brain-reactive antibody, either antineuronal IgG antibody (13) or lymphocytotoxic IgM antibody (12) or both (10), though there was an inconsistent association between clinical features and antibody titre. It is suggested that transient disturbances of cerebral vascular function in SLE might allow brain-reactive antibodies from the circulation access to cerebral tissue. In this way the nature of the neuropsychiatric abnormalities would depend on both vascular and immunopathogenic mechanisms.

[Neuropsychiatric manifestations in patients with systemic lupus erythematosus]. / Neuropsychiatrische Manifestationen bei Patienten mit Lupus erythematosus disseminatus.

Psychological and neurological assessment of patients with systemic lupus erythematosus has identified 15 with definite evidence of non-focal cerebral involvement. During the period of neuropsychiatric disease, cerebral blood flow was measured using 15O2 brain scans and sera were tested for the presence of 2 brain-reactive antibodies: antineuronal and lymphocytotoxic antibodies. 12 patients had psychiatric symptoms, while 13 had various neurological abnormalities. Striking abnormalities in cerebral blood flow were observed in 12 patients. All sera contained at least one brain-reactive antibody; 13 contained antineuronal antibody, although there was an inconsistent association between clinical features and antibody titre, while 12 contained lymphocytotoxic antibodies. According to these investigations the nature of the neuropsychiatric abnormalities would depend on both vascular and immunopathogenic mechanisms.