[Pathogenesis of dystrophic joint diseases and the effectiveness of their treatment with rhumalon].
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Connective tissue is ubiquitous and subject to alterations that result in changes in the extracellular matrix of vessels and tissues leading to the long-term complications of diabetes. This article reviews only those abnormalities of interstitial connective tissue involving skeleton, joints, skin, and periarticular tissues. Abnormalities in the skin and periarticular tissues result in syndromes limiting joint movement, including limited joint mobility, Dupuytren disease, flexor tenosynovitis, carpal tunnel syndrome, stiff-hand syndrome, and shoulder-hand reflex dystrophy. Of these, only limited joint mobility and stiff-hand syndrome occur exclusively in patients with diabetes. In all of these conditions, advanced glycation end products are thought to form as a result of nonenzymatic reaction of glucose with proteins, causing stiffening.
OBJECTIVE: The suitability of magnetic resonance imaging (MRI) for serial monitoring of bone pathology in the guinea pig stifle joint, an in vivo model of osteoarthritis, was investigated. METHODS: MR images were compared with histologic features and radiographs of 1-mm-thick sections to determine the MR correlates of the bone changes. Ten guinea pigs were then imaged on 7 occasions over the first year of life, enabling serial measurements of subchondral bone thickness, subchondral pseudocysts, and osteophytes. RESULTS: The signal intensity of trabecular bone in MR images accurately reflected the degree of osteopenia and trabecular thinning noted around the cruciate ligament insertions. The extent of subchondral sclerosis and the development of marginal osteophytes were also accurately represented. Serial observations revealed that MRI can detect highly significant progression of lytic bone lesions, subchondral sclerosis, and osteophyte size over periods of 6 weeks. CONCLUSION: MRI is not only a reliable technique for the assessment of bone pathology but is also a useful tool for monitoring the progression of bone damage in osteoarthritis.
Valdecoxib, a COX-2 inhibitor, has recently been introduced as a gel formulation. The present study was conducted to evaluate the efficacy, safety and tolerability of valdecoxib gel in adult patients with painful inflammatory joint conditions. The present study was a 10-day prospective, open, multicentric (6 centres) trial. Patients with clinical and radiological diagnosis of painful inflammatory joint conditions were treated with valdecoxib gel (1%). Efficacy was assessed by visual analogue scale (VAS), patient's and physician's global assessment of pain relief. Grading of associated clinical manifestations such as stiffness, swelling, tenderness and restriction of mobility was done. Tolerability and safety was assessed by physical examination, laboratory parameters and evaluation of adverse events. There was a statistically significant decrease in the mean pain visual analogue score (p<0.05). Onset of pain relief was within 15 minutes. There was a reduction of 58.8%, 57.2%, 65.4% and 60.2% in mean scores of stiffness, swelling, tenderness and mobility respectively from the baseline which was statistically significant. The laboratory values were within normal limits. The drug was well tolerated. There was no report of any hypersensitivity reaction. This study confirms that valdecoxib gel (1%) is an effective and safe option for the management of painful inflammatory joint conditions.
Over the past 3 years the Swanson great toe prosthesis was used in an interpositional arthroplasty at the carpometacarpal joint in 21 thumbs of 19 patients with rheumatoid arthritis and three thumbs of two patients with lumpus arthritis. In selected patients with advanced disease, this prosthesis has the advantage of allowing for correction of deformity while preserving carpal stock which may be important if a surgical procedure is required at the wrist. Stable capsular closure does not require reinforcement by adjacent tendon. Twenty-two thumbs of 19 patients were improved, although in three the prosthesis was malpositioned. Two patients required reoperation and removal of the prosthesis: one for infection, and one for failure to correct deformity. Overall functional results often were affected by the status of disease in other joints, but in general were acceptable.
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