Fungal arthritis.
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Biomedical subjects
Publications and source records attributed to G E Ehrlich.
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In a double-blind, crossover study, naproxen, 250 mg twice a day, naproxen, 500 mg taken at bedtime, and indomethacin, 25 mg four times a day, were compared in 132 patients with rheumatoid arthritis; six centers participated in the study. Objective indices of arthritis activity, such as number of clinically active joints, walking time, and duration of morning stiffness, were nearly identical for the three treatment regimens. Of particular interest was the observation that efficacy of a single daily dose of naproxen was comparable to that of the twice-daily dosage. Naproxen was better tolerated than indomethacin, as shown by a statistically significant difference in the incidence of CNS complaints.
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Seventy patients with classical or definite rheumatoid arthritis (RA) were studied in an attempt to correlate the serum levels of free DNA with other features. In 26 patients (37%), levels of DNA ranging from 100-540 ng/ml, with a mean of 187 ng/ml, were found. In additional seven patients with a mean of 257 ng/ml, low levels of anti-DNA-antibody were observed. The remaining of 37 patients (53%) had levels of 0-80 ng/ml in their sera, with a mean of 39 ng/ml. All three groups differed significantly (p less than 0.01) from the control group of 61 healthy individuals, who had levels of 0-80 ng/ml with a mean of 13 ng/ml. The high levels of free DNA were commonly found in patients with more severe symptoms who had active RA for less than 10 years, whereas patients with longer duration of disease showed lower levels of DNA. In addition, elevated DNA levels were found more commonly in patients seronegative for rheumatoid factor (RF). Other clinical features did not show significant differences among these patients. The implications of these findings to the pathogenesis of the disease are discussed.
Flurbiprofen and ibuprofen, two propionic acid derivatives with anti-inflammatory and analgesic activity, were compared in a double-blind multiclinic study in 195 patients with osteoarthritis of the peripheral joints. The patients were given 80 mg/day flurbiprofen or 1600 mg/day ibuprofen for six weeks. Pain, subjective evaluation and functional tests improved significantly in both groups. There were no statistically significant differences between the two treatments in any of the responses. Gastro-intestinal side-effects, generally mild, developed in 5-6% of the patients.
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Scintigraphic scanning employing technetium-99m sulfur colloid was used to assess the size of the liver and spleen in 32 consecutive patients with rheumatoid arthritis. The data were correlated with clinical and laboratory assessment. Seven patients had enlarged livers, three enlarged spleens. An expected correlation of liver enlargement with Sjögren's syndrome did not materialize. Splenic enlargement and liver enlargement were discordant. Liver enlargement correlated best with elevations of rheumatoid factor as measured by latex fixation. As liver enlargement is not an appreciated feature of rheumatoid arthritis, these findings suggest that hepatomegaly need not necessarily imply adverse treatment results or the development of lymphoproliferative disorders.
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A syndrome of acute onset of inflammation over interphalangeal joints heralding deforming osteoarthritis may be intermediate between degenerative and rheumatoid joint diseases. The syndrome appears predominantly in women of menopausal age and is remarkably symmetrical. In a prospective study of 170 propositi, later changes more characteristic of rheumatoid arthritis than of generalized or erosive osteoarthritis developed in 15.3%.
In a clinical study of the new nonsteroidal anti-inflammatory drug tolmetin, the urines of 5 patients reacted positively when tested for protein by the standard sulfosalicylic acid method. Pseudoproteinuria, due to the precipitation by acid of the major metabolite of tolmetin, was suspected. The urines were subsequently tested for protein by the following alternate methods: solubility of acid precipitate test, heat coagulation test, Upjohn modification of the sulfosalicylic acid test, biuret test, Albustix, and electrophoresis. All were negative for protein. These results confirmed that the reactions with the sulfosalicylic acid test did not indicate true proteinuria but pseudoproteinuria. It is suggested that patients who receive tolmetin be tested for proteinuria by methods other than those involving acid precipitation.
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