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Biomedical subjects

H Mielants

Publications and source records attributed to H Mielants.

At least 145 records · Page 8Linked to original sources
PubMed1984

Thymopoietin pentapeptide (thymopentin, TP-5) in the treatment of rheumatoid arthritis. A compilation of several short- and longterm clinical studies.

Thymopentin (TP-5), the active side of thymopoietin, was shown to affect immunoregulation. The effect of this drug in the treatment of rheumatoid arthritis (RA) was evaluated. Three trials were performed: a six month double-blind trial comparing TP-5 administered subcutaneously to placebo at 3 different dosages, an open longterm study in which the same dosage of the drug was administered subcutaneously, and a shortterm (3 weeks) double-blind trial in which the drug was given intravenously at a high dosage (100 mg/day). In none of these 3 studies were statistically significant improvements registered in the TP-5 treated patients, although there were important improvements in individual patients. Serious side effects were not encountered, but the majority of patients did not improve or were withdrawn because of ineffectiveness. The beneficial effect of TP-5 on the clinical evolution of RA, reported elsewhere, could not be confirmed by these studies.

Arthritis, Rheumatoid↗
PubMed1984

Clinical trials on the efficacy and toxicity of slow acting antirheumatic drugs.

Rheumatologists must constantly ensure that the balance between the activity and the toxicity of slow acting antirheumatic drugs is always to the patient's advantage. Trials must be continued long enough to permit evaluation of activity of these drugs. Double-blind testing with placebo provides information about the influence of a new compound on the natural course of the disease. Comparative studies determine the indications of new drugs and their place in the therapeutic arsenal of rheumatoid arthritis. Patients are selected on the basis of inclusion and exclusion criteria, but the choice of the patient also plays a role. It is still impossible to divide a rheumatoid arthritis population into subgroups in which patients respond to this or that drug. The variability of the natural course of the disease makes it necessary to study large numbers of patients, thus making multicentre studies frequently necessary. The evaluation of disease activity is based principally on subjective measurements (morning stiffness, pain scale, joint counts); objective data are limited to grip strength and laboratory tests which often do not entirely correspond with the subjective variables. The occurrence of adverse reactions depends in great part on the way investigators' questions are formulated. Adverse reactions necessitating interruption of drug administration are particularly important. Withdrawals for inefficacy must be avoided as much as possible in double-blind trials with placebo.

Adolescent↗
PubMed1983

Immunoregulatory changes in autoimmune disease.

Peripheral blood T cell subpopulations were determined in patients with various rheumatic diseases [rheumatoid arthritis (RA); ankylosing spondylitis (AS); reactive synovitis (RS)]. No significant variation in OKT3+ cells was found among these groups. In RA, an increased percentage of OKT4+ was found in relation to the control group. For the other groups no difference was observed. In RA, a decreased percentage of OKT8+ cells was observed. Thus, the immunologic imbalance found in RA was not encountered in AS and RS although these disease--as well as the other pathologic disorders--are characterized by serum hypergammaglobulinemia. Furthermore, the decreased number of T suppressor cells found in peripheral blood of patients with active RA was not observed in their synovial fluid. Therefore we propose a failure of localization mechanism of T suppressor-cytotoxic lymphocytes in the synovial membrane of RA. Single doses of prednisolone produced a temporary decrease in peripheral blood total lymphocytes, T cells, T helper-inducer cells, and a less marked decrease in T suppressor-cytotoxic cells, in effect, a normalization of the immune balance, characterized by a decreased T helper/T suppressor ratio. In a similar fashion, patients receiving long-term levamisole exhibited a decrease in total lymphocytes, T lymphocytes, T helper cells, and T suppressor cells 6 and 24 hr after drug intake with a subsequent normalization of the OKT4+/OKT8+ ratio.

Adult↗
PubMed1983

Peripheral blood T lymphocytes subpopulations in HLA-B7 related rheumatic diseases: ankylosing spondylitis and reactive synovitis.

The etiology of B lymphocyte hyperactivity in ankylosing spondylitis (AS) and in reactive synovitis is unknown and data available on the cellular immune system are controversial. We therefore evaluated peripheral blood T cell populations in AS patients and patients with reactive synovitis (RS) using monoclonal antibodies, previously shown to react with all T cells (OKT3), the inducer-helper T cell subset (OKT4) and the suppressor-cytotoxic T cell subset (OKT8). Results were compared with a normal control group and a group of rheumatoid arthritis (RA) patients. In AS an increase of OKT4+ cells was found, but the total number of T helper-inducer cells in peripheral blood was not different from the normal group and the group of patients with RS. Contrary to the results found in RA, where the helper-inducer/suppressor-cytotoxic ratio (OKT4+/OKT8+) was significantly increased, the immunoregulatory ratio in AS and in RS was normal suggesting another mechanism leading to B cell hyperactivity than in RA.

Adult↗
PubMed1982

Gastrointestinal blood loss after intake of benoxaprofen.

In order to study gastrointestinal irritation caused by the intake of Benoxaprofen, blood loss in stools before and after intake of the drug was measured by labelling red blood cells with 51Cr. The results were compared with previous studies in which the same method was used to determine fecal blood loss after intake of other non-steroidal anti-inflammatory drugs. Anti-inflammatory drugs inhibiting prostaglandin synthetase caused abnormal fecal blood loss in 20 to 60% of the patients. Benoxaprofen which is a weak prostaglandin synthetase inhibitor and acts on the leukotrienes, entailed no abnormal fecal blood loss. It was concluded that with respect to microbleeding, Benoxaprofen had no harmful effect on the gastrointestinal tract in this population.

Anti-Inflammatory Agents↗
PubMed1982

Clinical response to therapy with thymopoietin pentapeptide (TP-5) in rheumatoid arthritis.

The effect of thymopoietin pentapeptide (TP-5) was evaluated in patients with rheumatoid arthritis (RA). Ninety-two patients were divided into 3 groups, namely, placebo, TP-5 intramuscularly (IM) 1 mg, TP-5 intravenously (IV) 50 mg, and were evaluated for 6 measures of disease activity at the beginning of the study and at 3 and 6 months. No difference was observed between the placebo group and the group treated with TP-5 IM 1 mg. However, in the group treated with TP-5 IV 50 mg a statistically significant improvement of all parameters except the ESR was observed.

Arthritis, Rheumatoid↗
PubMed1982

Long-term functional results of the non-surgical treatment of common bacterial infections of joints.

Thirty patients with acute bacterial infection of a peripheral joint were treated with intravenous antibiotics, daily closed needle aspiration and early mobilization therapy. Joint mobility, expressed as a percentage of normal mobility, was evaluated at the end of the reconvalescence period and again after 42 to 65 months (mean: 50 months). The functional outcome was excellent and joint mobility normal in 2/3 of the cases as revealed by the short- and long-term evaluation results. Factors that affected joint mobility were: delayed treatment, joint disorders prior to treatment, and ease of access to the joint for needle aspiration. Poor results were found in the presence of hip infections. In the long term, deterioration of joint mobility can occur in the same aggravating conditions. Treatment of septic arthritis with daily needle aspiration and early mobilization gave very good functional results.

Anti-Bacterial Agents↗
PubMed1981

Comparison of serum salicylate levels and gastro-intestinal blood loss between salsalate (Disalcid)and other forms of salicylates.

In a first stage the effect of a single dose of 3 g of salsalate on serum salicylate level was compared with a single intake of 3 g of soluble or enteric-coated acetylsalicylates in 12 healthy subjects. Salsalate seems to resorb faster than the enteric-coated forms but more slowly than the soluble forms of acetylsalicylate. However, in comparison with these latter forms, salsalate activity is more protracted. In the second part of the study, 42 patients were admitted to a trial in which 3 to 5 g of salsalate was given daily and in which serum salicylate levels and blood loss in stools were measured using the method of labelling red blood cells with Cr51. The ideal dosage to obtain a serum salicylate level of 20 mg/100 ml seems to lie between 3 and 4 g of salsalate a day. Salsalate caused abnormal gastro-intestinal blood loss in only 2 of the 42 patients studied, which is significantly fewer compared with the soluble, intravenous or enteric-coated forms of acetylsalicylates.

Aspirin↗
PubMed1978

A study of the hematological side effects of levamisole in rheumatoid arthritis with recommendations.

Agranulocytosis, which must be differentiated from leukopenia, was seen as the most severe side effect of levamisole in the treatment of rheumatoid arthritis (RA). By sending a detailed questionnaire to each investigator known to have been confronted with leukotoxic side effects, data were collected on 88 patients with agranulocytosis, 43 patients with leukopenia and three with thrombocytopenia. The presence of HLA B27 in seropositive RA patients was found to be an important predisposing factor for agranulocytosis. This blood dyscrasia caused by levamisole was similar to the agranulocytosis found with other antirheumatic and anti-inflammatory drugs and could be classified as agranulocytosis of the immunological type. In this form no bone marrow toxicity occurred and the agranulocytosis was always spontaneously reversible on discontinuation of the drug. Although the incidence of agranulocytosis did not seem to be reduced by any of the treatment schemes, high risk patients could be detected by the single day per week regimen. Treatment with 150 mg levamisole on one day per week, with leukocyte count 10 hours after each intake of the drug, undoubtedly appeared to be the most efficient way to prevent agranulocytosis and makes this drug safe in the treatment of RA.

Agranulocytosis↗
PubMed1978

Experience and recommendations for treatment schedule of levamisole in rheumatoid arthritis.

A review is presented of the different treatment regimens of levamisole used in rheumatoid arthritis (RA). A large double-blind EULAR multicentre trial has shown that the beneficial effects obtained with continuous (150 mg per day) and with intermittent (3 days per week, 150 mg) treatment are comparable in RA. Unfortunately with both regimens a high frequency of agranulocytosis was observed. Recent data of another double-blind trial have shown that a treatment schedule of 150 mg one day per week gives equally good results as both previous regimens. Furthermore regular control of white blood cell counts 10 hours after intake of the drug can detect early high risk patients for agranulocytosis. Results of longterm use of levamisole in RA are also presented and the different kinds of responses are discussed. Finally the authors propose a treatment scheme. This consists of one single weekly dose of 150 mg; if no response is obtained after 6 or at most 9 months, a final trial can be performed with two intakes of 150 mg each week.

Agranulocytosis↗
PubMed1977

HLA and juvenile chronic polyarthritis.

HLA antigens were determined in 38 patients with juvenile chronic polyarthritis (JCP) and in 1,000 normal controls. The incidence of the antigen B27 in JCP (55.3 per cent) was higher than in the controls (6.7 per cent). Patients with JCP could be further subdivided into four groups: (1) JCP evolving to ankylosing spondylitis (AS) (N = 3); (2) JCP with sacroiliitis (SI) (N = 18); (3) JCP without SI (N = 10); and (4) juvenile rheumatoid arthritis (JRA) characterized by positive seroloty (N = 7). Groups 1 and 2 had a high incidence of B27 (20/21), as contrasted to groups 3 and 4 (1/17). The sex distribution in groups 1 and 2 was similar to that found in AS in adults, whereas in groups 3 and 4 it was similar to that found in rheumatoid arthritis in adults. It is concluded that if B27 positives develop JCP, they also have a high risk of developing SI and acute uveitis. The authors propose using the term Still's disease for the overall group of children presenting with JCP before the age of 16 years. Subsequent follow-up permits classification into juvenile AS, JCP with SI, JCP without SI, or as JRA.

Adolescent↗
PubMed1977

Longterm evaluation of intermittent levamisole treatment in rheumatoid arthritis.

Twenty-one patients with rheumatoid arthritis were treated discontinuously with levamisole overa prolonged period (150 mg/day, four days per week). Disease activity was completely suppressed or markedly improved in 18 patients, while three patients showed no improvement. Overall, a statistically significant improvement was recorded after six months in morning stiffness, Ritchie index, grip strength, and sedimentation rate. After 12 months treatment, the morning stiffness, Ritchie index, grip strength, and sedimentation rate were still significantly improved. After 18 months treatment, only the morning stiffness was still improved as compared to the initial evaluation. Improvement in the other indices was no longer significant. The beneficial effect of levamisole therapy occurred slowly, reaching a maximum after six months. Similar improvement was observed in patients with advanced disease as in the early stages. Intermittent levamisole administration would appear to be as effective as continuous treatment. While minor side effects occurred just as frequently as with continuous administration, the discontinuous treatment used in this study was free of serious side reactions.

Arthritis, Rheumatoid↗