Search

To the average arthritic patient, pain relief is usually his or her first priority in treatment. Thus, analgesics still have a part to play in the treatment of most arthritic conditions, even though the non-steroidal anti-inflammatory drugs (NSAIDs) have the major therapeutic role in most cases. In the treatment of acute gout, the NSAIDs are the most important, and simple analgesics are relatively unimportant, but in the treatment of rheumatoid and osteoarthritis and other arthropathies, analgesics taken as and if required to cover the more painful periods of a day do have a role, usually in conjunction with NSAIDs and other agents. In general, the simple analgesics are better tolerated than the NSAIDs and less likely to produce gastrointestinal irritation. Although many clinicians consider that simple analgesics have little part to play in the treatment of rheumatoid arthritis and other inflammatory arthropathies, the patient often takes them without the physician's knowledge, in addition to the prescribed treatment. Some recently introduced analgesics bridge the gap between the simple analgesics and the more potent potentially addictive drugs such as pethidine and morphine, which are only indicated in extremely painful crises or after traumatic episodes and surgical operations.

Using arthritis in referring to inflammatory and arthrosis in referring to degenerative conditions of the joints 179 conditions are noted in which 1 or the other or both or allied conditions occur. There are a large number of bacteria which can infect articular structures and arthropathies due to viruses are more common than had been believed. There are numerous postinfective arthropathies traumatic arthropathies and arthropathies due to dietetic causes. Certain drugs have also been known to cause arthropathies. Rheumatic symptoms and serological abnormalities induced by oral contraceptive drugs have been reported. The oral contraceptives appear to be capable of causing the hydrallazine (or reversible systemic lupus) syndrome.

Pain threshold was measured in 106 patients with rheumatoid arthritis, 50 with ankylosing spondylitis, and 50 normal controls using Keele's algometer. In rheumatoid arthritis patients with a low pain threshold had more severe pain for a greater part of the day and required more tablets for pain relief. In ankylosing spondylitis the pain threshold was higher and was not related to pain or analgesic requirements. There was no evidence that pain threshold affected the course or outcome of rheumatoid arthritis in any way.

Adams,Cliffe, Lessel, andNicholson (1963) reported* thebiological properties ofa newsubstance, 4-isobutylphenyl acetic acid(Ibufenac). As assessed bytheultra-violet erythema test inguineapigs (AdamsandCobb,1958), itproved tohavetwo tofourtimes theanti-inflammatory effect ofaspirin, andits analgesic activity asmeasured byamodificationofthemethodofRandall andSelitto (1957) wasofthesameorder.Their worksuggested that thissubstance mightbea useful substitute for acetylsalicylic acid.Inhumansubjects, after doses of640mg.bymouth,detectable amountswere present inthebloodwithin 30to60minutes, rising toamaximumof2to4mg./100 ml.in2to4hours, andsmall butdetectable amountswerestill present 8hoursafter ingestion ofthedose(Adams, 1963). Chalmers (1963) reported thatIbufenac indoses of 30gr.daily appeared tobeaseffective asaspirin in doses of60gr.daily inthecontrol ofsymptoms in patients withrheumatoid arthritis, side-effects being fewer withIbufenac thanwithacetylsalicylic acid. Tudhope (1964), using the51chromium technique previously employed byScott, Porter, Lewis, and Dixon(1961) andWood,Harvey-Smith, andDixon (1962) withsalicylates, foundIbufenac considerably lessproductive ofgastro-intestina l haemorrhage