European journal of rheumatology and inflammation最新文献

The gastric tolerability of nimesulide, a new nonsteroidal anti-inflammatory drug (NSAID), was compared with diclofenac, an established NSAID for the treatment of osteoarthritis (OA). A randomised, double-blind parallel group study was undertaken comparing the tolerability and efficacy of nimesulide (100 mg bds) with diclofenac (50 mg tds) over a one month period. Gastroduodenal endoscopy revealed that after 30 days 4 patients had developed ulcers (1 nimesulide patient) and 6 patients had developed erosions (4 nimesulide patients). However, there was no statistically significant difference between the two treatments. Both drugs were clinically very well tolerated and only 10 patients withdrew from the study due to adverse events (5 in each group). Efficacy was assessed by measuring pain on visual analogue scales, by means of the functional index of Lequesne and by scoring spontaneous pain, pain on passive movement and functional impairment. Nocturnal pain was also checked. All efficacy parameters showed a significant improvement during the study without any observed treatment differences.

Nabumetone, a novel nonsteroidal anti-inflammatory drug, has aroused considerable interest due to mounting evidence suggesting a diminished potential for causing gastrointestinal mucosal irritancy. In the present study, rats were administered equally effective oral suspensions of either nabumetone (79mg/kg), ibuprofen (88mg/kg), diclofenac (11.5mg/kg), or a control suspension (n = 8 or 9 per group) daily for one month and subsequently assessed for various indices of anti-inflammatory activity, gastrointestinal irritancy, and prostaglandin inhibitory activity. Daily doses were five times the ID25 for carrageenan-induced paw inflammation as obtained in previous studies. At the end of the administration period, nabumetone maintained effective antiinflammatory activity, but was devoid of gastrointestinal irritancy. In contrast, ibuprofen and diclofenac were associated with marked and significant gastrointestinal mucosal damage. The findings of the present study support published preclinical and clinical studies establishing nabumetone as an effective anti-inflammatory agent with a favourable gastrointestinal safety profile.

Geriatric rheumatology and the epidemiology of musculoskeletal diseases in elderly persons constitute a new field. Although difficult to estimate, the prevalence rate of disabling joint diseases increases as people age. Osteoarthritis (OA) is the most common type of joint disease in geriatric patients. Symptomatic OA has a much lower prevalence rate than does radiographic OA. However, symptomatic disease is important in that it may motivate a patient to seek medical attention. The prevalence of rheumatoid arthritis (RA) also increases with advancing age. The onset of RA in both large and small joints in patients older than 60 years is more frequent and begins with greater disease activity as compared to patients younger than 60. Moreover, RA runs a more severe course in older than in younger patients. Thus, epidemiologic data suggest that elderly individuals could be major consumers of nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in the management of musculoskeletal disorders. The prevalence of these disorders increases with advancing age and, coupled with increasing longevity, poses a growing challenge to practicing physicians in their treatment of these patients.

As the number of elderly patients with rheumatic conditions continues to increase, rheumatologists are faced with the challenge of providing more effective but safer therapy to their geriatric patients. In 1991, nonsteroidal anti-inflammatory drugs (NSAIDs) accounted for more than 29 million prescriptions worldwide. The elderly are at increased risk for NSAID-associated toxicity, particularly gastrointestinal side effects. Predisposing factors include age-related physiologic changes, underlying conditions, and polypharmacy. Clinical experience shows etodolac, 300 mg twice daily, given to elderly patients with osteoarthritis for 4 weeks, to be effective and well tolerated in this population. Additionally, etodolac may favourably affect mood and cognitive function. With judicious individualisation of therapy and careful monitoring, NSAID therapy can provide a favourable risk-benefit ratio in elderly patients.

The predictive value of synovial fluid (SF) analysis and some other variables for the efficacy of intra-articular corticosteroid therapy of knee joints in 20 patients with spondylarthropathy and hydropsy in a knee joint was estimated in a prospective study. The knee joints were initially aspirated and 30 mg triamcinolone hexacetonide injected intra-articularly. The tenderness scores and the circumferences of the knee joints were measured at the start and after the two months follow up period. Between the patients with and without improvement in tenderness scores of the knee joints SF protein (p = 0.021), SF lactate (p = 0.033), SF IgG (p = 0.018) and SF IgM (p = 0.047) differed significantly, all being lower in patients with improved tenderness scores. There were no significant differences in the variables between patients with at least 2 centimetres decrease of knee joint difference and those with less during follow up.