[Risk factors in arthrosis. Hierarchy and modes of action].
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Biomedical subjects
Publications and source records attributed to J Peyron.
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The direct effects on the cartilage articular surface of three anti-inflammatory drugs (Diclofenac, Pirprofen and acetyl-salicylic acid) and of a polysulfated glycosaminoglycan (Arteparon), were studied using an in vitro system in which BALB-c mouse femoral heads were incubated with the drugs. After incubation and labeling of the negative charges of the articular surfaces with cationized ferritin, the femoral heads were examined by electron microscopy. In addition, the effect of the drugs on the aggressive action of collagenase on the articular surface was tested using the same in vitro system. Diclofenac, Pirprofen and the polysulfated glycosaminoglycan did not alter the structure or the charge properties of the surface. Acetyl salicylic acid produced a slight disruption of the articular surface. The drugs studied had no effect on the disruptive action of collagenase.
The labeling of the articular surface with cationized ferritin (CF), an electron-dense marker, visualizes the anionic sites and may disclose abnormal penetration of the large CF molecule into the subsurface layers. Various areas of cartilage selected by unaided eye examination were taken from femoral heads excised in three cases of osteoarthritis and two cases of hip fracture. The fragments were examined by optical microscopy and by electron microscopy after labeling with CF. The labeling with and the penetration of CF were correlated with the morphological features of the surface. The surfaces belonging to the erosion border were disrupted and the CF penetrated approximately 2 microns into the matrix along the collagen fibers and in areas containing a patchy dense material. Prefixation with Karnovsky's fixative prevents CF penetration. The fragments taken at a distance from the erosion border showed at electron microscopical examination either an intact appearance of the surface that was labeled without penetration or a disrupted surface with penetration of the label. The osteophytes and the regeneration buds surface were labeled showing little or no penetration. The fragments from cartilage of hip fractures had either an intact surface regularly labeled or a slightly or moderately disrupted surface with moderate penetration of CF. The penetration of large molecules of CF in damaged cartilage demonstrates important permeability changes that may be significant for the pathogenetic mechanism of osteoarthritis. Similar permeability changes were previously shown in mice femoral heads treated in vitro with collagenase or trypsin and labeled with CF.
One hundred and eighty three patients suffering from osteoarthritis of either the hip or the knee were treated during two successive two-week periods by 800 mg/day of pirprofen and 300 mg/day of ketoprofen (two dosages). The order of the treatments was determined randomly. This cross-over was conducted in double blind in 9 rheumatological centers. The efficacy and tolerance of the treatments were evaluated after the first two weeks and at the end of the trial. Pirprofen and ketoprofen showed a definite and comparable efficacy in 70% of patients. The tolerance was acceptable in 86% of patients in the pirprofen groupe and 87% for ketoprofen. Side effects, primarily digestive, were noted with equal frequency (32%). The findings of our study are that a daily dose of 800 mg of pirprofen in the treatment of osteoarthritis of the knee and hip provides an efficacy identical to that of 300 mg/day of ketoprofen with an equally good tolerance.
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