Inflammatory disease and its control in rheumatic disorders

Nimesulide in the short-term treatment of osteoarthrosis: a pilot study for assessing the minimal effective dose

Eleven patients suffering from osteoarthritis of the cervical spine were admitted to a pilot study aimed at establishing the effective dose and the tolerability of Nimesulide. The patients received a basic treatment of Nimesulide 100 mg/day, increasable up to 300 mg/day, in conformity with the patient's need. The treatment over a period of 15 days showed that Nimesulide 200 mg/day has good anti-inflammatory and analgesic properties. Several critical parameters were significantly improved. The incidence of usually mild side-effects was very low.

Indoprofen in knee joint osteoarthritis: a double-blind, crossover clinical trial

A double-blind, crossover clinical trial has been carried out in subjects with knee joint osteoarthritis to assess the activity of two nonsteroidal antiinflammatory drugs. Eighteen outpatients with a severe systemic form were given orally indoprofen (800 mg/day), indomethacin (80 mg/day), and placebo for one week without interval between treatment periods. Significant improvement was seen in subjective and objective signs and symptoms after both drugs, which gave similar results. No significant differences between drugs were noted as to patients' opinions and preferences, which were in agreement with clinical indexes. No improvement in most cases and deterioration in a few subjects followed placebo administration, probably because the majority of the sample was made up of placebo non-reactors. Consequently, the activity data of the trial might be interpreted as expression of the pure pharmacologic activity of the tested drugs. Safety was very satisfactory: patients complained only rarely of trivial and clinically unimportant side effects; no variations in laboratory tests were noted.

Which antirheumatic drug?

Successful therapy in a chronic rheumatic disease means choosing the right drug for the right patient with the right condition at the right time. In the treatment of gout three different types of treatment are given: for the acute episode, suppression and long-term therapy. Misuse of long-term therapy for acute gout will often aggravate the condition. As regards rheumatoid arthritis, in the absence of a known aetiology, treatment is essentially empirical and palliative; the use of milder well-tolerated anti-inflammatory agents for the less severe cases, more effective and more toxic agents for the more severe cases, and slow acting long-term agents for those not responding to previous measures is discussed. Night pain and morning stiffness has its own therapy. The place of corticosteroids throughout the whole field of rheumatology is evaluated. In the treatment of systemic lupus erythematosus corticosteroids still hold first place, but the cytotoxic (immunosuppressive) agents also play a part, though an arguable one.