Search

We performed a randomized, double-blind, controlled clinical trial comparing intravenous pamidronate and placebo for pain relief in recent osteoporotic vertebral compression fractures (VCF). Patients suffered from recent (<21 days), painful, osteoporosis-related VCF. They were randomized to receive daily intravenous infusions of either placebo or 30 mg pamidronate for three consecutive days (total pamidronate: 90 mg). The main criterion for efficacy was improvement in standing pain on a 100-mm visual analogical scale (VAS) at day 7. Secondary criteria were standing pain at days 3 and 30; supine pain at days 3, 7, and 30; patients’ overall assessment of improvement; mobility index; and number of “20% responders” and “50% responders” (respectively, 20% and 50% improvement in standing pain at days 7 and 30). Statistical analysis with non-parametric tests was carried out on an intention to treat basis. Thirty-two patients were enrolled in the study; 16 were given placebo and 16 pamidronate. Thirty-one patients were evaluated at day 7 and 26 patients at day 30. VAS pain decreased significantly in both groups at day 7 (placebo −23 mm, pamidronate −42 mm, p<0.01). The difference in pain scores between groups was −23.25 mm (confidence interval (CI) [−42.3; −4.2], p=0.018) at day 7 and −26 mm at day 30 ( p=0.03), in favor of pamidronate. At day 7, there were 4 versus 12 “50% responders,” respectively, in the placebo and in the pamidronate groups (likelihood ratio: 8.372; p=0.004) and 9 versus 14 “20% responders” (likelihood ratio: 4.038; p=0.044). At day 30, there were 5 versus 10 “50% responders,” respectively, in the placebo and in the pamidronate groups, and 7 versus 11 “20% responders.” Patients’ overall assessment of improvement at day 7 was 37±26 mm in the placebo group and 59±30 mm in the pamidronate group ( p=0.019), and 42±26 mm and 72±21 mm at day 30 ( p=0.07). The two groups did not differ significantly at days 7 and 30 for supine pain, Schober index, or finger–ground distance. No significant adverse reaction related to treatment occurred. Pamidronate provides rapid and sustained pain relief in patients with acute painful osteoporotic VCF and is well tolerated. Further investigations are needed to better define the place of pamidronate in the management of painful recent osteoporotic collapse. [ABSTRACT FROM AUTHOR]

The pharmacokinetic profile of total and free methotrexate (MTX) and the effect of piroxicam on MTX pharmacokinetics was studied in 20 rheumatoid arthritis patients receiving a stable dosage of MTX (10 mg/week). Plasma protein bindingranged from 25 to 55%. To describe the variations with time of the unbound fractions a mathematical characterization relationship between the total and free MTX was used. Total and free MTX were correlated with the sigmoid maximum effect model. The slope factor (gamma) was proportional to the number of binding sites. The free fraction for a given patient canbe evaluated from this relationship. Total clearance of MTX was not statistically different with piroxicam (8.01/h for total MTX, 13.71/h for free MTX) vs without piroxicam. Likewise, there were no significant difference in (, area under the plasma concentration vs time curve, distribution and elimination half-lives, mean resonance time, and volumes of distribution. Although the highest observed total MTX concentration was significantly lower with piroxicam, there were no significant pharmacokinetic interactions between low-dose MTX and piroxicam. [ABSTRACT FROM PUBLISHER]

Seronegative spondylarthropathies are disorders with the same predisposing antigen, namely HLA B27, a class I molecule of the HLA system. The mechanisms of the different diseases are unknown, and there is no proof of immune system participation. We have investigated patients with spondylarthropathies in order to search for an immunological component in the pathophysiology of these disorders, by measuring the serum level of two inflammatory cytokines-IL1β and TNFα-by a radioimmunological assay and the serum level of two soluble T cell activation markers-soluble IL2 receptor and soluble CD8-by an enzyme-linked immunosorbent assay. The choice of soluble CD8 can be explained by the strong link between HLA B27 and spondylarthropathies. Our series compared 24 patients to 24 healthy matched controls. A similar IL1β serum level was observed in both groups, while in the patients there was a nonsignificant increase in the TNFα level, a significant decrease in the soluble IL2 receptor level and a significant increase in the soluble CD8 serum level. The normal or moderately increased serum IL1β and TNFα levels in the disease group do not exclued a local role for these cytokines in the synovium or other inflammatory areas. However, we found a higher soluble CD8 serum level in the patient group. Most of these patients were in clinical excerbation of their disease. As the serum level of soluble CD8 is well correlated with T CD8 lymphocyte activation, our data suggest that this lymphocyte subset is stimulated and consequently probably involved in seronegative spondylarthropathies. [ABSTRACT FROM AUTHOR]

Most therapeutic tests of osteoarthritis treatments are assessed by criteria based either on fundamental data or on clinical data, which is often subjective. A quantified analysis of locomotion can be used to determine the spatiotemporal indices (stride length and duration), kinematic indices (walking speed, velocity peak), and symmetry criteria that are relevant to the assessment of locomotor handicaps in patients with osteoarthritis. This study examined the progression of locomotor abilities in 11 subjects aged 49-69 (mean 60.9) years with knee osteoarthritis before and after treatment with a non-steroidal anti-inflammatory drug. Naproxen sodium (1100 mg) was given once a day for seven days. The condition before and after treatment was evaluated by quantitative analysis of locomotion, estimation of pain on a visual analogue scale, and assessment of the degree of functional disability. Significant improvement in locomotor indices (proportional increase in walking speed 17.8%) and in degree of pain (proportional decrease 27%) as estimated on the analogue scale was found after non-steroidal anti-inflammatory drug treatment. The lack of a significant correlation between the decrease in pain experienced by the patients and the objective improvement of their functional capabilities emphasises the need in further studies of new treatments to accompany the patients' own assessments of self improvement with a quantitative analysis of the way in which they walk. [ABSTRACT FROM PUBLISHER]

A 63-year-old woman presented with mild arthralgias and inability to stand and walk without other significant neuropsychiatric abnormality. Neurological explorations showed intrathecal oligoclonal immunoglobulin production in CSF and numerous bright foci at brain MRI. A primary Sjögren's syndrome was concomitantly evidenced and was thought to be the cause of the astasia-abasia symptom by multiple brain involvement. Patient's condition gradually improved with hydroxychloroquine and corticosteroid therapy. Central nervous system involvement by primary Sjögren's syndrome is discussed. [ABSTRACT FROM AUTHOR]

A 68 year old man presented with a clinical and biological picture that suggested polymyalgia rheumatica. Temporal artery biopsy disclosed no inflammatory change but massive light chain amyloid deposits in the media. Further exploration showed a malignant lymphoplasmacytic haemopathy with a triclonal gammopathy and a muscular, rectal, and probable cardiac amyloidosis. Cryoglobulinaemia and high concentrations of soluble interleukin 2 receptor (sIL-2R) were also found. This is the fifth case with confirmed involvement of the temporal artery. The especially high sIL-2R concentration was thought to reflect the tumour mass rather than lymphocyte activation. [ABSTRACT FROM PUBLISHER]