Italian double-blind multicenter study comparing S-adenosylmethionine, naproxen, and placebo in the treatment of degenerative joint disease

In a double-blind study, the efficacy and tolerability of S-adenosylmethionine (SAMe) were evaluated in comparison with those of placebo and naproxen in the treatment of osteoarthritis of the hip, knee, spine, and hand. Thirty-three centers, 18 rheumatologic and 15 orthopedic, participated in this study. A total of 734 subjects, including 582 with coxarthrosis (hip osteoarthritis) or gonarthrosis (knee osteoarthritis), were enrolled. SAMe administered orally at a dose of 1,200 mg daily was shown to exert the same analgesic activity as naproxen at a dose of 750 mg daily. Both drugs were more effective than placebo (p less than 0.01). Tolerability of SAMe was significantly better than that of naproxen, both in terms of physicians' (p less than 0.025) and patients' (p less than 0.01) judgments and in terms of the number of patients with side effects (p less than 0.05). There was no difference between SAMe and placebo in the number of side effects. Ten patients in the SAMe group and 13 in the placebo group withdrew from the study because of intolerance to the drug.

Multicenter double-blind randomized clinical trial of imidazole salicylate versus ibuprofen in patients with osteoarthrosis

Imidazole salicylate (750 mg t.i.d.) was compared with ibuprofen (400 mg t.i.d.) in a 30-day multicenter double-blind clinical trial in patients with osteoarthrosis. Both drugs were effective in relieving joint pain and in reducing the duration of morning stiffness. A statistically significant reduction of the severity of these symptoms was observed already one week after the start of treatment, lasting until the end of the study. No significant differences in efficacy were demonstrated between the two drugs throughout the trial. The systemic tolerability, assessed by changes in tests of hematological, liver and kidney function, was excellent with both treatments. The incidence of side effects (mostly gastrointestinal complaints) was fairly low in both groups, and lower in the group treated with imidazole salicylate.

Double-blind study of dothiepin versus placebo in the treatment of primary fibromyalgia syndrome

A double-blind study comparing the efficacy and tolerability of dothiepin with that of placebo in the treatment of primary fibromyalgia syndrome was carried out. Dothiepin was shown to improve significantly the condition of patients with primary fibromyalgia syndrome and there was a significant difference between dothiepin and placebo in all the clinical variables measured. Only mild and transient side-effects were reported. Further controlled studies are required to define the effects of dothiepin on fibromyalgia.

[Endoscopic evaluation of the effects of diacerhein and naproxen on the gastroduodenal mucosa]

The potential capacity of diacerheine (DAR), a new drug known to have no anti-prostaglandin effect and therefore a different action mechanism from the standard non-steroid anti-inflammatory drugs, to cause damage to the gastroduodenal mucosa was compared with that of a well-known NSAID, naproxene. Gastroscopic examination of 10 + 10 patients before and 4 weeks after treatment showed that DAR produced endoscopic lesions without subjective symptoms in 10% of the patients whereas naproxene produced lesions of varying size in 50%, with or without symptoms.

Timegadine: long-term open study in rheumatoid arthritis

The efficacy and tolerability of Timegadine, a new antirheumatic agent, administered at a dose of 250 mg twice daily was evaluated in an open trial of 24 weeks' duration in 31 patients with active rheumatoid arthritis. The subjective and objective clinical parameters improved significantly from the 2nd to 6th week of treatment. For some of the parameters further improvement was observed during the continuation of the treatment. At 6 weeks the ESR was significantly decreased, and a further reduction of the ESR was seen with the continuation of the treatment. At the end of the treatment period other humoral parameters of the disease were significantly modified. Moreover, in 65% of the patients with seropositive rheumatoid arthritis a reduction of the rheumatoid factor titre by at least two dilutions was observed. Five of the 31 patients were withdrawn from treatment due to the appearance of side effects. Although the study was open and the number of patients relatively small, the observed changes in the laboratory parameters of disease activity encourage further investigations to assess the potential of Timegadine as a remissive drug.

[Proglumetacine in rheumatoid arthritis]

Proglumetacin, 450 mg/day, was administered during 1 month to 32 rheumatoid arthritis patients in anatomical and functional stage II or III. Overall, more than 50% of pts responded to the treatment, in particular those in stage II, in whom Ritchie's articular index, nightly and daily pain significantly decreased. Those pts in stage III who did not respond to proglumetacin even when administered at high dose, did not respond to indomethacin, either. Tolerance resulted very good, as only 3 complaints of mild and transient epigastric pain and 1 of skin rash were observed, but no one related to the C.N.S. High efficacy and good tolerance set therefore proglumetacin aside from indomethacin, A.S.A. and most of the recent non steroidal anti-inflammatory agents.

Indoprofen in rheumatic patients with acute episodes: a multicentre trial

The results are reported of an open multicentre trial in 228 rheumatic patients with flare-ups. Fourteen centres adopting the same investigational protocol collaborated in the study. Indoprofen was administered for 1 week at a daily dosage of 1000 mg according to a treatment schedule used with success in acute gouty arthritis: a 400 mg i.v. bolus was followed by 200 mg (1 tablet) t.i.d. Subjective (pain) and objective variables were used for reliable assessment of activity. Marked reduction of pain intensity was already noticeable on day 1 of treatment and was followed by progressive improvement in subjective and objective variables for all the diagnoses considered. According to the patients' own overall assessments, results were good or very good in more than 50% of cases. The best outcomes were obtained in low back pain, acute gout and psoriatic arthritis. At the end of treatment only 7.4% of patients experienced no change or deterioration of symptoms. Adverse reactions, consisting mostly of mild and reversible gastrointestinal disturbances, were reported by 9.2% of patients, but only in 1.8% was treatment discontinued. Indoprofen administered according to the above schedule is an appropriate treatment for acute episodes of rheumatic diseases.

Rifamycin SV in the Treatment of Knee Synovitis

Rifamycin SV, injected intraarticularly at dosages of 500 mg weekly, induced a complete removal of persistent knee effusions in 57 of 60 rheumatoid patients, and in all patients with effusions due to juvenile rheumatoid arthritis (three), ankylosing spondylitis (three), psoriatic arthritis (10), intermittent hydrarthrosis (two) and chondromatosis (two). One rheumatoid patient did not respond to treatment, and two dropped out because of local side effects. The number of infiltrations varied between three and 12, and was correlated with activity grade of local synovitis (P < .05). As of this writing, 50 out of 57 rheumatoid patients and 19 out of 20 belonging to the other groups have not had a relapse of effusions after 25 to 36 months and 12 to 20 months respectively. While the changes in the synovial fluid and membrane of the rheumatoid subjects, and the results obtained from experimental arthritis in guinea pigs, confirm the hypothesis that Rifamycin has a local antiinflammatory action in arthritic knee joints, they also suggest that this property alone of the drug is not entirely responsible for its therapeutic action.

Bioavailability study on a new slow-release formulation of ketoprofen

Four healthy subjects volunteered for a crossover bioavailability study to compare the rate and extent of absorption of plain capsules and new slow-release capsules of ketoprofen. The formulations were administered in two consecutive 4-day periods at the following dose schedules: 2 x 50 mg plain capsules t.i.d. and 150 mg slow-release capsules b.i.d. The plasma levels profile of unchanged ketoprofen was assessed by GLC during the 4th day of treatment with each formulation. The absorption from slow-release capsules was slower and more sustained than from plain capsules but almost complete. The bioavailability properties of new slow-release capsules of ketoprofen appear suitable for clinical use with reduced frequency of daily dosing.

Rheumatoid knee synovitis successfully treated with intra-articular rifamycin SV

Thirty rheumatoid patients with persistent knee effusion were treated intra-articularly with rifamycin SV, 500 mg weekly, or with saline solution, 10 ml, in a double-blind study. A complete disappearance of effusion and an impressive clinical improvement was observed in the patients on rifamycin. The synovial fluid and membrane underwent some changes. In 2 patients the rifamycin caused a painful local reaction. After a follow-up of 5 years only one patient has experienced effusion relapse, 5 months after the termination of rifamycin SV treatment. The patients on saline showed no significant change. On the basis of the results obtained from the monoarthritis experimental model and from clinical trials it is tempting to consider that rifamycin has an antimitotic effect, impeding the synthesis of RNA and DNA polymerases in immunocompetent cells.

Intravenous indoprofen for prompt relief of acute gout: a regimen-finding study

The results of an open exploratory trial with different regimens of indoprofen in patients with acute gouty arthritis are described. Two main daily regimens were assessed: (a) indoprofen 200 mg as an intravenous bolus, followed by slow infusion of 100 mg/hour for about 4 hours (24 attacks treated in twenty-three patients); and (b) indoprofen 400 mg as an intravenous bolus (13 attacks treated in twelve patients). In both regimens intravenous indoprofen was supplemented with 400-600 mg daily of indoprofen by mouth. The patient's response, as judged by pain, tenderness, local heat, redness, range of motion and joint circumference, was dramatic in both series, with no significant difference between them at any time of observation. Substantial improvement was apparent for subjective variables already within 2 hours after the beginning of treatment, and a complete resolution was obtained in 35 of 37 attacks within 48 hours. A mild adverse reaction was recorded in one patient for each group (dizziness and gastric pain, respectively). Intravenous indoprofen appears to afford an extremely rapid relief of acute gout; of the two regimens assessed, the second should be preferred in that it seems to be at least equally effective but less troublesome for the patients.

Gastroscopic evaluation of anti-inflammatory agents

Gastroscopy was performed in 164 patients with rheumatoid arthritis (RA) and 85 with osteoarthritis (OA) to assess the effects of anti-inflammatory agents on the stomach. The main criterion for entry into the trial was the absence of active gastric lesions on pretreatment endoscopy. The patients were divided into groups to receive one of 12 anti-inflammatory drugs or combinations of these. Gastroscopy repeated at three to six and at 12 months disclosed gastric lesions in 78 cases (31%), patients in both disease categories being similarly affected. Lesions occurred in 41 of the 177 patients (23%) receiving a single drug and in 37 of the 72 (51%) receiving combined treatment. All the anti-inflammatory drugs caused gastric damage, the greatest offender being aspirin (13 out of 26 patients) and the least sulindac and diflunisal (two out of 19 (11%) and two out of 20 (10%) patients respectively). Corticosteroids caused gastric damage in only three out of 21 patients (14%), a lower incidence than expected.The indiscriminate prescribing of anti-inflammatory drugs to patients with OA is to be deplored. A lack of correlation between the patients' subjective complaints of gastric discomfort and the gastroscopic findings emphasises the unreliability of patients' complaints and the importance of gastroscopy in assessing gastric tolerance. It was not possible to assess minimal prescribing doses or minimum periods of treatment below which gastric damage may be guaranteed not to occur.

Plasma and synovial fluid pharmacokinetics and prostaglandin inhibitory effect of indoprofen in patients with rheumatoid arthritis

Indoprofen was given intravenously (bolus followed by infusion) and orally to 7 patients suffering from active rheumatoid arthritis with knee joint effusion. Indoprofen readily penetrated into synovial fluid in amounts which were directly correlated with areas under curves of plasma drug levels. Synovial fluid acted as a compartment distinct from the central (plasma) compartment. Indoprofen caused a substantial decrease in E2 and F2 alpha prostaglandin concentration in synovial fluid.

An electromyographic investigation of subluxation of the patella

An electromyographic investigation of patients with subluxation of the patella has been carried out on the parts of the extensor apparatus which actively contribute to the alignment of the patella, both before and after the operation to correct this disorder. The electromyographic pictures have revealed a sharp fall in the activity of the vastus medialis, with full recovery to normal values after a corrective operation. Even if the aligning function of the patella is altered by a variety of factors, the present study confirms the importance of the vastus medialis in the pathogenesis of malalignment of the extensor mechanism.

[Drug therapy of osteoarthrosis of the hip (author's transl)]

Experience in therapy with sulindac and S-adenosyl-L-methionine (SAMe) is reported. Sulindac is an indene derivative which is particularly indicated in degenerative skeletal diseases and is essentially free from the well-known side-effects of traditional analgesics. The results of therapy were good in 75%. SAMe is the most important methyl group donor and is consequently responsible for the methylation (inactivation) of histamine, upon which its antiphlogistic action is based. SAMe is also particularly involved in the transfer of sulfate groups in the body. Sulfur compounds are esentially involved in the synthesis of cartilage. The short-term trials with SAMe were altogether more favorable than the longterm trials, yet there was a longterm effect in about half the cases.

Pharmacokinetic studies of indoprofen in healthy volunteers and in patients

The pharmacokinetics of indoprofen in healthy subjects after single oral and i.v. administrations is reviewed. During repeated administration of indoprofen to 6 normal subjects (200-mg tablet every 8 hours for 6 days) no variations in the disposition of the drug were found in comparison with single dose administration. In 6 inpatients, with rheumatoid arthritis, the pharmacokinetics of indoprofen was studied after single oral (tablet) and i.m. administration. As for oral doses, no difference in main kinetic parameters was detected between the patients and normal subjects except for a higher volume of distribution in the former population. The bioavailability of the drug given by i.m. injection was not significantly different from that observed after oral administration.