Systemic treatment of sarcoidosis.

PURPOSE: To compare the evidence base and systemic treatment strategies for sarcoidosis. METHODS: Medline and EMBASE literature search on "sarcoidosis AND treatment", "sarcoidosis AND uveitis AND treatment", and "sarcoidosis AND eye AND treatment". The search was limited to randomized controlled trials (RCTs) and meta-analyses. RESULTS: A total of 19 RCTs for the systemic treatment of extraocular sarcoidosis were identified. The majority were on corticosteroid-oral and inhaled. There were two meta-analyses on corticosteroid, including a Cochrane review. Only two RCTs were indentified for the treatment of intraocular sarcoidosis, one on etanercept, and the other from 1967 on prednisolone or oxyphenbutazone vs. placebo. There were no meta-analyses. Due to the paucity of RCTs other treatment studies were included but these were limited to only a few immunosuppressive agents and on small numbers of patients. CONCLUSION: Limited high-quality evidence exists for the systemic treatment of sarcoidosis, in particular intraocular disease.

Antirheumatic effect of pirfenidone in a double blind clinical pilot trial in humans.

The antirheumatic effect of pirfenidone was compared with a positive control drug, oxyphenbutazone which is used in patients suffering from rheumatoid arthritis, in a double blind clinical trial in humans. The data collected in this pilot project revealed that pirfenidone was more effective (p < 0.025) than oxyphenbutazone in providing relief from arthritic pain. In addition, a greater number (p < 0.025) of patients reported favorable response to oral pirfenidone than oral oxyphenbutazone. However, there were no significant differences in the number of patients who dropped out from the trial and the number of patients who tolerated the drugs for 21 days of the trial between the pirfenidone and oxyphenbutazone groups. It was concluded from this pilot study that pirfenidone potentially offers a novel therapeutic modality for the management of rheumatoid arthritis with little or no adverse effects unlike steroidal and non-steroidal anti-inflammatory drugs which are frequently used for this chronic debilitating disease.

Mondor's disease. A forgotten cause of anterior chest pain.

A 50-year-old woman sought a rheumatological consultation for anterior chest pain of three weeks duration. The diagnosis of superficial phlebitis of the anterior chest wall (Mondor's disease) was made. This was confirmed thereafter by the pathological report. She was treated with a non-steroidal anti-inflammatory drug Oxyphenylbutazone (Tanderil) and made a prompt recovery.

Clinical experiences in the treatment of pain in rheumatology.

Meclofenamic acid is an analgesic endowed with anti-inflammatory properties. Its main activity is the combined inhibition of leukotrienes and prostaglandins synthesis, yet it is also able to antagonize the peripheral effects of prostaglandins. This particular feature explains why the effect of this drug is so fast, especially when administered orally. The pharmacological properties and good tolerability of meclofenamic acid propose the use of this drug for the treatment of various types of pain, particularly at osteoarticular localization. Recent comparative studies with meclofenamic sodium versus placebo, indomethacin, oxyphenbutazone, and diclofenac confirmed that meclofenamate sodium is very effective, significantly reducing pain as well as the subjective and objective symptoms accompanying it. The findings of these studies have also highlighted a particularly favorable safety profile. Our study primarily focused on assessing the effectiveness and tolerability of this drug in 82 patients affected with extraarticular rheumatism localized in various sites. Meclofenamic acid (as a sodium salt) was orally administered in doses of 100 mg twice daily for 2 weeks. The assessment of the drug's clinical effectiveness took into account the various aspects of pain (spontaneous, on motion, due to active contrasted movements) and quantified it using a 5-point rating scale (0 = absence of pain; 5 = very intense pain). At the end of the 2-week observation period, both the investigator and the patient gave their opinion as to the effectiveness and tolerability of the drug. The treatment was found to be highly effective in reducing pain in 59.7% of the patients, regardless of the nature and location of the rheumatic process. Tolerability was rated good-to-excellent in 72% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Hydroxypropyl methylcellulose in extracapsular cataract surgery with intraocular lens implantation: intraocular pressure and inflammatory response.

We studied prospectively the effects of 2% hydroxypropylmethylcellulose (HPMC), instilled in to the anterior chamber during extracapsular cataract extraction with posterior chamber intraocular lens implantation in 122 patients. Significant pressure rise was noted at 12 and 24 hours post-operatively when HPMC was not removed at the end of surgery. This was prevented by washing HPMC from the anterior chamber at the end of surgery, or by using either acetazolamide or a combination of oxyphenbutazone and vitamin C without washing HPMC. There was no difference in intraocular inflammation between controls and the HPMC groups. The group receiving combined oxyphenbutazone and vitamin C had the least, the differences between these two groups being sufficient.

Estudo duplo-cego em diversas patologias reumáticas com uso de oxifembutazona versus ácido acetilsalicílico: avaliaçäo dos efeitos colaterais em treze dias de uso consecutivo / A double-blind study with oxyphenilbutazone versus acetylsalicylic acid in various rheumatic diseases: an assessment of side effects after 13 days of therapy

Os autores realizaram um estudo duplo-cego näo cruzado em 80 pacientes com patologias reumáticas diversas, comparando a eficácia e a tolerabilidade entre o ácido acetilsalicílico e um composto de oxifembutazona, paracetamol e hidróxido de alumínio pelo prazo de 13 dias consecutivos. Ambas as drogas mostraram-se eficazes, com ligeira superioridade do composto de oxifembutazona, paracetamol e hidróxido de alimínio, o mesmo näo ocorrendo com relaçäo aos efeitos colaterais que foram predominantes nos pacientes em uso dos salicilatos principalmente no que se referiu a intolerância gástrica. Em ambos os grupos nenhuma alteraçäo laboratorial hematológica, hepática ou renal ocorreu após os 13 dias de uso das drogas

Heterotopic ossification with total hip endoprostheses in various models of thrombosis prophylaxis.

The influence of thrombosis prophylaxis on the occurrence of heterotopic ossification after implantation of total hip endoprostheses was analyzed in a series of randomized studies. When low-dose heparin or dextran 40 was administered, the rate of ossification was comparatively high (30.1% and 65.1%). When a combination of acetylsalicylic acid and an antirheumatic (oxyphenbutazone) or low-dose heparin with an antirheumatic (indomethacin) was administered, the ossification rate became significantly lower (6.2% and 16.7%). No severe ossification (Arcq degree III) was observed in the groups given an antirheumatic in addition to thrombosis prophylaxis.

Role of ceruloplasmin in inflammation: increased serum ceruloplasmin levels during inflammatory conditions and its possible relationship with anti-inflammatory agents.

Serum ceruloplasmin (CPN) levels under different types of acute and chronic experimentally-induced inflammatory conditions in rats and the effect of anti-inflammatory drugs viz. oxyphenylbutazone and hydrocortisone on serum CPN levels were investigated. Significant increase of serum CPN levels was observed in all experimental animal models with induced inflammatory conditions. Treatment with oxyphenylbutazone and hydrocortisone failed to inhibit the raised serum CPN levels. The concurrent increase of serum CPN level during induced inflammatory conditions suggest the involvement of serum CPN as one of the body's inbuilt defensive mechanism against noxious responses or inflammation. It is suggested that the increased serum CPN levels may be a complimentary factor associated with inflammatory conditions.

Anti-inflammatory drugs in experimental atherosclerosis. Part 6. Combination therapy with steroid and non-steroid agents.

The pathological changes which accompany enhanced cholesterol deposition in atherosclerosis include inflammatory responses mediated by the prostaglandin cyclooxygenase and lipoxygenase-leukotriene metabolite of the arachidonic acid cascade. Cortisone suppresses arachidonic acid release, whereas non-steroid anti-inflammatory drugs inhibit principally the cyclooxygenase enzyme. Groups of New Zealand white rabbits were fed a 1% cholesterol diet for 12 weeks. Diets of selected groups were further supplemented daily with the non-steroid anti-inflammatory drugs phenylbutazone (100 mg), oxyphenylbutazone (240 mg), flufenamic acid (100 mg), either singly or in combination with cortisone acetate (10 mg or 5 mg), or 9-alpha-fluorohydrocortisone (30 micrograms or 200 micrograms). Serum lipid levels were measured at 0, 4, 8 and 12 weeks, and atherosclerotic plaque intensity in thoracic aorta was measured at 12 weeks using a planimetric technique: serum cholesterol levels in control groups increased from 38 +/- 5 to 1190 +/- 139 mg/100 ml. Neither the rate of increase nor the final lipid values attained were significantly changed by the non-steroid drugs. The non-steroid drugs reduced plaque coverage by about one third (phenylbutazone 34 +/- 10%, flufenamic acid 36 +/- 11%) compared to controls. In combination therapy, addition of cortisone acetate resulted in further plaque suppression. Cortisone 10 mg + phenylbutazone gave 100% suppression; cortisone 5 mg + phenylbutazone gave 82 +/- 18%, and cortisone 5 mg + flufenamic acid gave 84 +/- 3%.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of prostaglandin antagonists on radiation therapy of carcinoma of the cervix.

In a random trial of 160 women undergoing radiation therapy for carcinoma of the cervix of all stages 76 individuals were treated with 3 X 100 mg oxyphenbutazone daily and 84 individuals served as controls. Reevaluation shows a significantly better 5- and 10-year-survival rate of 70 and 62% in the treatment group, compared to 55 and 44% in the control group. The mode of action of oxyphenbutazone consists of the inhibition of prostaglandin synthesis. Improvement of survival rates is explained by two theories: (1) slowing of tumor spread by inhibition of necessary prostaglandins; and (2) improvement of cell repair after radiation therapy.

Naproxen suppositories in postoperative pain and swelling after joint surgery. A comparative, double-blind study.

Altogether 105 rheumatic patients, 35 in each of three groups, took part in a double-blind parallel study comparing naproxen (Naprosyn, Syntex) 500 mg suppositories with oxyphenbutazone (Tanderil, Geigy) 250 mg suppositories and placebo in postoperative pain and swelling after joint surgery. Medication was administered twice daily for 3 1/2 days, starting the night before operation. Ketogan (Ketobemidonhydrochloride, 3 dimethylamino-1-diphenylbuten-(1)-hydrochloride) injections and Paralgin Forte (Paracetamol, codein phosphate) tablets were allowed as escape medication. Each day clinical assessments including pain-score, oedema-score and circumference of operated joint were performed and amount of escape medication recorded. A physical test was performed on day seven after operation. No statistically significant difference between groups was observed for most parameters. In general the tendency for all parameters seems to favour naproxen. For pain-score the difference was significant (p = 0.02) in arthrodesis/arthroplasty patients day 1 and for need for Ketogan injections (p less than 0.001) in all patients day 0. Only two side effects were recorded during the study. In the present study no significant difference between the groups could be observed for most parameters measured. The tendency seems to favour naproxen, but a larger number of patients will be needed to investigate whether this observation is of significance.

[Comparative double-blind study of Bi-Profenid and oxyphenbutazone in sports pathology]. / Etude comparative à double insu di Bi-Profénid et de l'oxyphenbutazone en pathologie du sport.

Effectiveness and tolerance of ketoprofen in sustained-release tablets (Bi-Profenid 150 mg) were investigated in a double blind trial in 44 athletes who had recently sprained an ankle. Patients were given either 300 mg Bi-Profenid or 400 mg oxyphenbutazone daily for seven days. Treatment regimens were assigned at random. Results were assessed as excellent or good in 85% of patients given Bi-Profenid and 50% of those given oxyphenbutazone. Spontaneous pain resolved in 19 patients receiving Bi-Profenid and in 6 under oxyphenbutazone. Decrease in pain upon physical examination and in articular circumference was significantly greater with Bi-Profenid as compared with oxyphenbutazone. The chance of rapidly resuming sport was better with Bi-Profenid. Tolerance was excellent in 68.2% of patients with Bi-Profenid and 59% of those with oxyphenbutazone. This investigation thus emphasizes the value of Bi-Profenid in sport pathology.