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Therapeutic activity, clinical and gastric tolerance of 20mg daily dose of droxicam in comparison with piroxicam in patients with degenerative joint disease.

The efficacy and safety of droxicam were compared with piroxicam in a pilot study in twenty patients with degenerative joint disease. After a one week washout period a baseline gastroscopy was carried out. Treatment during the following 4 weeks was randomised to droxicam or piroxicam. Safety and tolerance parameters were monitored at weekly intervals. Pain was evaluated with two visual analogue scales (VAS) (patient and investigator). Affected joints, articular index (AI), patient's status and a daily living activities questionnaire were also evaluated. Another gastroscopy was carried out at the end of the treatment period. Droxicam and piroxicam relieved all symptoms significantly without statistically significant clinical differences. Both groups showed no drug related side effects in the laboratory values. In the gastroscopic examinations two patients of the droxicam group and four of piroxicam group had minor gastric erosions after four weeks of treatment without any accompanying clinical symptoms.

Adult↗

Influence of degenerative joint disease on spinal bone mineral measurements in postmenopausal women.

We assessed the impact of various forms of spinal degenerative joint disease (DJD) on bone mineral density (BMD) measured by quantitative computed tomography (QCT) and dual X-ray absorptiometry (DXA) in a group of postmenopausal women. Lateral (T4-L4) and AP (L1-L4) spinal radiographs were reviewed for fracture and DJD in 209 women (mean age 62.6 +/- 6.7). The severity of DJD findings was graded as 0, 1, or 2 on the lumbar films, except for vertebral osteophytes which were graded from 0 to 3. Vertebral fractures were defined semiquantitatively as approximately 20% reduction in anterior, middle, or posterior vertebral height. BMD was measured in all subjects by QCT and DXA, including posteroanterior DXA (PA-DXA), lateral DXA (L-DXA) and midlateral DXA (mL-DXA). When BMD was measured by QCT and mL-DXA in the 168 women without fractures, no significant differences were found between women with and those without DJD. However, BMD by PA-DXA was significantly higher in women with DJD changes, particularly when osteophytes were present at the vertebral bodies or facet joints. BMD by L-DXA was less affected by DJD. For this measurement a significant increase in BMD was only noted in subjects with vertebral osteophytes. Multivariate analysis of variance (MANOVA) showed that BMD by QCT and mL-DXA was not affected by DJD. In contrast, for all women, BMD by PA- and L-DXA was affected more by DJD than by fracture status. Chi-square testing demonstrated no significant relationships between vertebral fractures and any of the DJD changes. We conclude that QCT and mL-DXA are superior to PA-DXA and L-DXA in detecting bone loss in patients with DJD. Thus, for these patients, BMD assessment by QCT or mL-DXA may be advisable.

Absorptiometry, Photon↗

Moberg picking-up test in patients with inflammatory joint diseases: a survey of suitability in comparison with button test and measures of disease activity.

OBJECTIVE: To assess and compare the suitability of Moberg pickup test (MPUT) and button test (BT) as indicators for functional impairment in patients with inflammatory joint diseases. METHODS: Measurements for 369 patients attending a rheumatology outpatient clinic were collected. In addition to MPUT and BT, measurements collected were grip strength, tender and swollen joint counts, visual analog scales for pain and disease activity, Health Assessment Questionnaire, C-reactive protein levels, and erythrocyte sedimentation rates. RESULTS: We found a significant relationship between MPUT and BT. Both tests show the same pattern of correlations with the other parameters, although all correlations are higher for MPUT. There is a significant sex and learning effect for the BT, which implies a confounding of hand function and motor abilities. A significantly higher proportion of patients was unable to complete BT. CONCLUSION: MPUT and BT measure comparable aspects of hand function. In several theoretical and practical aspects, MPUT seems superior to BT in arthritis. It is necessary to evaluate its value in long-term followup.

Activities of Daily Living↗

Pharmacoeconomic study of patients with chronic inflammatory joint disease before and during infliximab treatment.

OBJECTIVE: To evaluate medical and work disability costs for patients with chronic inflammatory joint disease during one year before and one year after institution of infliximab treatment in routine clinical practice. METHODS: Starting from 1999, clinical and laboratory variables for patients treated with biological agents for inflammatory rheumatic diseases were systematically recorded at Helsinki University Central Hospital. From this database clinical information was collected on 96 patients in whom infliximab was started during the period 1999 to 2001. Economic analyses were based on costs incurred because of outpatient and inpatient visits, orthopaedic operations, drugs used, and days on sickness or rehabilitation allowance. Medical and work disability costs were calculated separately for the one year period before (period I) and the one year period after institution of infliximab (period II). RESULTS: Of the study group of 96 patients (arthritis duration 16 years (range 3 to 43)), 74 completed one year of infliximab treatment. Their clinical and laboratory variables improved significantly. The mean increase in medical costs during period II was euro12 015 (95% confidence interval, 6496 to 18,076). A minimal decrease in work disability costs occurred-mean decrease euro130 (-1268 to 1072). CONCLUSIONS: One year treatment with infliximab in patients with longstanding aggressive arthritis showed a good clinical effect but raised medical costs significantly. Work disability costs failed to show a substantial decrease. Starting infliximab in the earlier stages of chronic arthritis could in the long term prevent work disability and thus decrease the total cost to society.

Adult↗

Comparison of therapeutic efficacy of nimesulide and diclofenac in patients with degenerative joint diseases.

The efficacy and tolerability profiles of nimesulide and diclofenac were evaluated in 180 patients suffering from various degenerative joint diseases. The clinical evaluations were performed at 0, 2 and 4 weeks. Nimesulide (100 mg) tablets were administered twice daily and diclofenac (50 mg) tablets were administered thrice daily. The principal efficacy parameters were the improvement in pain assessed through verbal scoring. Evaluation of tolerance was also established through similar method. Final judgment on efficacy was made by the physician. In all evaluations nimesulide showed improved efficacy parameters over diclofenac.

Adolescent↗

Yersinia antibodies in inflammatory joint diseases.

The occurrence of IgM, IgG and IgA class Yersinia antibodies was studied at the beginning of an inflammatory joint disease and one year later in 354 adult patients using an ELISA technique. The control groups consisted of age and sex matched healthy persons living in the same geographical area as the patients, and of 64 patients with chronic rheumatoid arthritis. Yersinia antibodies of any Ig class were found in 9.0% of all the patients at the beginning of the disease, in 4.0% of the healthy controls and in 1.6% of the patients with chronic rheumatoid arthritis. Patients with ankylosing spondylitis, Reiter's disease or other reactive arthritis showed the highest prevalence (19.4%) of Yersinia antibodies, but in the whole material one half of the patients with Yersinia antibodies were clinically classified as rheumatoid or nonspecific arthritis. The elevated prevalence of Yersinia antibodies in patients with probable rheumatoid or nonspecific arthritis may indicate a reactive etiopathogenesis of arthritis also in some cases without previous evidence of gastrointestinal infection. Quantitation of IgG and IgA antibodies to Yersinia is important in the diagnosis of Yersinia arthritis. These antibodies may not be detected by the generally used agglutination test.

Antibodies, Bacterial↗

Inflammatory joint disease: a comparison of liposome scanning, bone scanning, and radiography.

Patients with rheumatoid arthritis, psoriatic arthritis, and osteoarthritis were assessed by clinical evaluation, radiography, and joint scintigraphy using technetium labelled methylene diphosphonate (MDP) and technetium labelled liposomes. Although both scanning techniques were more sensitive than radiographs in detecting joint disease, the liposomes scans were positive only in clinically active inflammatory disease. In patients with rheumatoid arthritis liposome scintigraphy was also able to discriminate between different grades of joint tenderness. In inactive inflammatory polyarthropathies, although the MDP bone scans continued to show increased activity, the liposome scans did not and were therefore a more accurate reflection of the clinical state. The increased uptake in the liposome scans may be due to incorporation of the liposomes into the phagocytic cells of the synovium. This scan may, therefore, by reflecting the activity of cells involved in the disease process, provide a useful way of assessing disease activity and progression.

Arthritis↗

C reactive protein and immunoglobulin G in synovial fluid and serum in joint disease.

C reactive protein (CRP) and immunoglobulin G (IgG) were measured in synovial fluid and serum of 72 patients (29 with rheumatoid arthritis (RA), 17 with osteoarthritis, 11 with crystal synovitis, seven with undifferentiated arthritis, and eight with seronegative arthritis). The synovial fluid:serum (SF:S) ratios were compared with those calculated from the SF:S ratios of transferrin, caeruloplasmin, and alpha 2 macroglobulin, using the binomial test within groups and the Mann-Whitney test between groups. In RA synovial fluid CRP concentrations were lower than expected and IgG concentrations higher than expected. In osteoarthritis CRP concentrations were higher than expected. In seronegative arthritis IgG concentrations were raised. The ratio of CRP:IgG was depressed in RA. These findings are consistent with a role for CRP in the inflammatory process of RA, while the CRP:IgG ratio may be of value in the differential diagnosis of joint disease.

Arthritis↗

Correlation of anti-cytoskeleton antibody activities in synovial fluid with interleukin-6 in patients with osteoarthritis and inflammatory joint disease.

Synovial fluids and sera from patients with rheumatoid arthritis, psoriatic arthritis, yersinia arthritis, Behçet's syndrome, Crohn's disease, and osteoarthritis were tested for antinuclear antibodies and antibodies to five cytoskeletal components in sensitive enzyme-linked immunosorbent assay (ELISA) systems and for IL-6 concentrations in a proliferation assay (IL-6 dependent hybridoma cell line B13.29, subclone B9). Statistically significant correlations between antibody activities and IL-6 levels were found for vimentin antibodies (r = 0.56; p less than 0.05) and actin antibodies (r = 0.44; p less than 0.05). In patients with chronic and active disease like rheumatoid arthritis and psoriatic arthritis, optical densities measured by vimentin- and actin-ELISA were significantly different from those measured in patients with osteoarthritis. To date only a few reports exist concerning the incidence of antibodies in synovial fluids. We have shown to our knowledge for the first time that IL-6 seems to induce synovial fluid antibody activities restricted to cytoskeletal components of synoviocytes (i.e., vimentin and actin). Synovial fluid antibody activities against vimentin and actin appear to be markers of activity in patients with inflammatory joint disease.

Actins↗

Evaluation of the Norberg angle threshold: a comparison of Norberg angle and distraction index as measures of coxofemoral degenerative joint disease susceptibility in seven breeds of dogs.

OBJECTIVE: To evaluate the thresholds of 2 radiographic methods used to determine coxofemoral joint laxity in 7 breeds of dogs. ANIMALS: Three hundred and fifty clinically normal dogs. STUDY DESIGN: Retrospective study. METHODS: Hip radiographs from 7 breeds of dogs were randomly selected from a database. None of the dogs had radiographic evidence of degenerative joint disease (DJD). Distraction index (DI) and Norberg angle (NA) were measured on these radiographs and compared with DI and NA thresholds for diagnosing DJD susceptibility derived from the literature and from evaluated Borzois. Dogs with a NA<105 degrees and a DI of < or =0.32 were considered false-positives and dogs with a NA> or =105 degrees and a DI of >0.32 were considered false-negatives. RESULTS: Mean age of all dogs was 22.9 months. Mean NA for all dogs was 99.37 degrees, and mean DI for all dogs was 0.44. Borzoi mean DI of was significantly less than the mean DI of the other 6 breeds. The highest (most hip laxity) Borzoi DI was 0.32, and the lowest (most hip laxity) Borzoi NA was 99 degrees. False-positive and false-negative diagnoses were identified in 6 of the 7 breeds. CONCLUSIONS: Using the NA threshold of 105 degrees (literature established threshold of susceptibility to DJD) resulted in a high percentage of false-negative and false-positive diagnoses. Breeds like the Labrador Retriever and Rottweiler would have large numbers of hip dysplasia susceptible dogs remain in the breeding population based on this NA threshold. False-positive diagnoses were common in breeds like the Australian Shepherd, Borzoi, and German Shepherd effectively eliminating hip dysplasia nonsusceptible dogs from the breeding population. CLINICAL RELEVANCE: The NA was not an accurate predictor of DJD susceptibility in these 7 breeds of dogs when using a NA threshold of 105 degrees.

Animals↗

Efficacy and tolerability of etodolac in aged patients affected by degenerative joint disease (osteoarthritis) in its active phase.

Three-hundred-and-fifteen patients, aged 60 or more years, affected by degenerative joint disease (DJD) in the active stage, the majority with concomitant pathological conditions of various organs and systems and undergoing various combined drug treatments, were treated with 300 mg b.i.d. etodolac in order to assay its efficacy and safety profile in an aged population more exposed to the occurrence of adverse events. In a subset of these patients, the impact of etodolac treatment on cognitive function and mood was studied. All clinical assessments revealed highly significant improvement after etodolac treatment. Significant improvement was found also for what concerns mood, whereas only the less aged patients showed improvement in cognitive abilities after treatment with etodolac. Only 30 patients (9.5%) showed side-effects, resulting in suspension of treatment in 10 cases (3.17%). In all cases, adverse reactions subsided with no consequences. Laboratory tests performed at the end of the study yielded mean values comprised within the normal range and were not statistically different from the same examinations performed before starting treatment. Occult blood in stool turned positive after treatment with etodolac only in six patients (2%). In conclusion, etodolac proved to be effective and well-tolerated in the treatment of risk-aged patients with active DJD.

Administration, Oral↗