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Radiological gout manifestations are detectable in the early stage, but also especially in the chronic stage of gout. Whereas in the early stage only soft tissue mutations (bursitis inflammation) and light calcium deposits are usually discernible, chronic gout leads to asymmetrical, diverse forms of osseous destruction, favouring smaller joints, but also affecting larger ones, which are caused by the intra-articular and extra-articular deposit of tophus material, corresponding to the progression and degree of severity of the illness. Radiologically-detectable changes in other organs, such as the kidneys, will be addressed. The high number of, and to some extent very characteristic, osseous mutations are compared with those mutations which are very similar to the diagnoses of other syndromes affecting the joints. Specifically, problems in differentiating diagnosis of rheumatoid arthritis, arthritis psoriatica, chondrocalcinosis, and other diseases of the joints will receive special mention. Reference is also made to the extreme diagnostic difficulties resulting from the rare but nevertheless conceivable influence of gout on the spine or sacroiliac joints. The method of magnetic resonance imaging for gout shows a characteristic signal behaviour of the tophus material. It has been determined that, through magnetic resonance tomography, interosseous tophi can be detected earlier and in a more widespread manner than with the aid of native X-ray images, such that an increase in the use of this method is to be expected.

Glucosamine sulfate is able to stimulate proteoglycan synthesis by chondrocytes and has mild anti-inflammatory properties. In clinical trials, glucosamine sulfate was more effective than placebo in controlling the symptoms of osteoarthritis (OA). In order to better characterize this therapeutic activity, we conducted a randomized, double-blind, parallel-group study of glucosamine sulfate 500 mg t.i.d. vs ibuprofen 400 mg t.i.d., orally for 4 weeks. The study included 200 hospitalized patients with active OA of the knee, symptoms for at least 3 months and a Lequesne's index of at least 7 points. Patients were evaluated weekly. Response was defined as a reduction in the Lequesne's index by at least 2 points if the enrollment value was higher than 12 points, or by at least 1 point if the enrollment value was 12 or less points, together with a positive overall assessment by the investigator. The improvement tended to be sooner under ibuprofen (48% responders vs 28% after the 1st treatment week; P = 0.06, Fisher's Exact test), but there was no difference from the 2nd week onward, with a success rate of 52% in the ibuprofen group and of 48% in the glucosamine group (P = 0.67) at the end of treatment. The average Lequesne's index at enrollment was around 16 points and decreased by over 6 points in both groups, again with the above described trend. On the other hand, 35% of patients on ibuprofen reported adverse events, mainly of gastrointestinal origin, vs 6% adverse events with glucosamine (P < 0.001, Fisher's Exact test). The number of adverse event related drop-outs was different between the two groups (7% vs 1%, respectively; P = 0.035). Glucosamine sulfate was therefore as effective as ibuprofen on symptoms of knee OA. These data confirm glucosamine sulfate as a safe symptomatic Slow Acting Drug for OA.

1. Patients suffering from rheumatoid arthritis received oral doses of 600 mg racemic ibuprofen (n = 25; RAC) or 400 mg (S)-ibuprofen (n = 25; S-IBU) in a double-blind, randomized parallel-group study. 2. The pharmacokinetic parameters of (S)-ibuprofen were not statistically different between treatments (P > 0.05). Comparing (S)- and (R)-ibuprofen within the group receiving the racemate significantly higher Cmax (20.3 +/- 5.3 vs 17.7 +/- 4.4 micrograms ml-1; P < 0.02; 95% confidence interval for differences (CI): 0.5-4.6), AUC (86.2 +/- 23.5 vs 67.6 +/- 26.6 micrograms ml-1 h; P < 0.001; CI: 9.5-27.6), mean residence time (4.5 +/- 1.1 vs 4.1 +/- 1.2 h; P < 0.01; CI: 0.1-0.6) and renal clearance (0.8 +/- 0.6 vs 0.0 +/- 0.0 ml min-1; P < 0.001; CI: 0.5-1.0) values were observed for the (S)-enantiomer. 3. No difference was found (P > 0.05) between treatments in the percentage of the dose recovered in the urine as (R)- or (S)-ibuprofen plus metabolites (S-IBU: 80.2 +/- 8.47 vs RAC: 74.1 +/- 14.0%). 4. Interindividual variation in the pharmacokinetics of (S)-ibuprofen following administration of the racemate was similar to that following the administration of the single isomer suggesting that chiral inversion is not a major factor contributing to variability in the disposition of this drug.

In a multicenter placebo-controlled double-blind study in patients with degenerative or inflammatory rheumatic diseases the prostaglandin analogue misoprostol, in a dose of 200 micrograms twice daily after meals, was administered for the treatment of NSAID-induced lesions and symptoms of the upper gastrointestinal tract. Treatment with an NSAID was continued. Misoprostol treatment was demonstrated to be clearly superior to placebo in respect of reduction of gastroduodenal lesions and gastrointestinal pain. In addition, the physician's global assessment of gastrointestinal complaints was also statistically significantly better. No difference between the groups was found with respect to antirheumatic action of the NSAIDs.

Glycosaminoglycan polysulphate (GAGPS, Arteparon) is effective as a fundamental therapeutic agent in arthrosis (osteoarthritis). Patients with gonarthrosis and coxarthrosis of activity grade II received intramuscular Arteparon forte injections and physical therapy (group 1, n = 69) or physical therapy only (group 2, n = 46). In group 1 23 patients (33.3%) became free of pain as compared to 3 patients (6.5%) in group 2. No therapeutic success was obtained in 6 patients of group 1 (8.7%) and in 14 individuals (30.4%) of group 2.

In an open, comparative multicentre trial, 96 patients with arthritis of the large joints were treated with 75 mg diclofenac in one single dose in the morning, 50 mg diclofenac given twice daily, or 250 mg naproxen administered twice a day. It was noted that the length of history of pain was significantly longer in this naproxen group. Duration of the study was 14 days. Clinical parameters showed that the best degree of improvement was obtained with the diclofenac 50 mg twice-daily dosage regime. Diclofenac, in this study, showed better tolerability than naproxen.

Perforation of Nasal Septum in Systemic Lupus Erythematosus: Report of a Case and Review of the Literature. Perforation of the nasal septum in systemic lupus erythematosus (SLE) is rare. Report of a case and review of the literature revealed the total of 13 patients with this lesion. There was only one male. The complication is most likely to occur during an exacerbation of SLE months or years after the diagnosis has been established. Epistaxis is a constant initial symptom. A frequent association with the Raynaud's phenomenon favours speculations, that the lesion may be due to local vasospasms following exposure to cold inspired air. The septum perforaton gradually increases in most cases virtually independent from drug treatment and favouring conservative management.

In clinical rheumatology, the hazardousness of mixed preparations containing cortisone is being stressed even more, their use is only recommended in very special cases and only for short periods. Dolo Visano Supp. sine codeino and Dolo Visano Supp. are remedies which are indicated, like other mixed preparations not containing steroids, in cases of painful muscular overstrain and psychomuscular kinesalgia (symptom range of non-articular rheumatism). In our study, they were used in acute and severe pain conditions in intermediate or short-term therapy until complaints improved. Dolo Visano Supp. sine codeino and Dolo Visano Supp. (with codeine) can contribute in limiting the use of the risky preparations containing cortisone, which have hitherto been applied so frequently.

The aim of this study was to investigate the course of gastric and duodenal ulcers under ranitidin and antacid treatment during continuous NSAID therapy, and to answer the question of whether ulcers are an absolute contraindication for NSAID treatment. A total of 21 patients (17 females; four males; average age 58 years) with rheumatoid arthritis (18 patients), ankylosing spondylitis (two patients), and cervical spine syndrome (one patient) with gastric and/or duodenal ulcers, demonstrated by endoscopy, entered the study. Because of the severe course of the rheumatic disease present in every patient, there was a need to continue NSAID therapy. Gastric or duodenal ulcers were treated with 300 mg ranitidin and an aluminium-magnesium-hydroxide-containing antacid with an acid binding capacity of 280 mval/day. The course of healing of the ulcers was checked endoscopically and in part by biopsies (gastric ulcers). Within the period of 31 +/- 11 days, all duodenal ulcers under observation had healed. Of the gastric ulcers, 50% had healed completely while the others showed definite improvement. NSAID-induced ulcers were located in or close to the pylorus, contrary to the location of peptic ulcers. These data show that NSAIDs--if administration is absolutely necessary because of the severe course of the rheumatic disease--can be continued even in the presence of gastric or duodenal ulcers when administered with ranitidin and antacids. Because of hemorrhage and perforation in NSAID-induced ulcers, close clinical and endoscopic checks are necessary. Failures, even with the use of H2-blockers, have also been described.

Enelbin-Rheuma-ointment and a reference ointment were compared with regard to effectiveness in a double-blind trial in 100 patients with gonarthrosis, osteoarthrosis of the spine and humeroscapular periarthropathy. Both ointments showed good results regarding spontaneous pain, pain on pressure and motion, reduction of mobility, swelling and muscular tension. The success of treatment was statistically significantly better in the Enelbin-Rheuma-ointment treated patients.

Forty patients with osteoarthritis of the hips or knees entered a double-blind crossover study, in which 50 mg t.i.d. indomethacin was compared to a single daily dose of 600 mg benoxaprofen. Patients were randomly allocated to either indomethacin or benoxaprofen for four weeks and then transferred to the alternate drug without a washout period. Thirty-one patients completed the entire trial period. Both indomethacin and benoxaprofen led to a statistically significant improvement (alpha less than or equal to 0.05) of the subjective (measured by a pain score) and the objective joint status (range of motion evaluation) as compared to the pretreatment status. With regard to efficacy, there was no statistically significant difference between the two drugs. Benoxaprofen proved to be the better tolerated compound, causing four dropouts. Six patients were excluded from the indomethacin treatment due to severe gastrointestinal side effects. There also was a higher number of other side effects with indomethacin, but none severe enough to discontinue treatment. With the doses used, both compounds proved to be similar in efficacy in osteoarthritic conditions although benoxaprofen was the better tolerated drug.

The effectiveness of Biarison vs. placebo was compared in an inter-individual double-blind study on 30 hospitalized patients with possible, definitive and classical rheumatoid arthritis. The time of comparison was 3 weeks; the dose used 900 mg (up to maximally 1500 mg)/day. The clinical index and the index of activity according to Lansbury were improved with Biarison and with placebo. The superiority of Biarison could be confirmed statistically (p less than 0,01). The effectiveness of Biarison was shown in reference to parameters of pain (number of painful joints and intensity of joint pain, pain on motion and at rest). Biarison was essentially well tolerated. Side effects were all gastro-intestinal. In 3 patients adverse reactions were slight and subsided spontaneously when treatment was continued. In 2 individuals Biarison had to be withdrawn in the 3rd week of treatment. In the placebo group 3 patients were taken off treatment due to no therapeutic effectiveness.

Investigations using 3H-Arteparon (3H-glycosaminoglycan polysulfate, 3H-GAGPS) showed that in humans with degenerative joint disease an intramuscular administration of 125 mg GAGPS (0.5 ml Arteparon forte) produces GAGPS concentrations within the joint, which in a biochemical assay inhibit cartilage degrading lysosomal enzymes. The dosage was determined from animal experiments that had indicated the relationship between the applied quantity of the drug and the resulting biological concentrations. Preliminary results of treatment with 0.5 ml Arteparon forte in 15 patients are reported.

In a double-blind study the effectiveness of benorylate and indomethacin was compared in patients suffering from cervical spine syndromes. From a total of 60 patients, 30 individuals (group A) received 100 mg of indomethacin/day and 30 (group B) were treated with 6 g of benorylate per day. Clinical improvement as judged by several given criteria occurred in 80% of the patients in group A and in 76.7% of the patients in group B. If strict objective criteria (ie. increased mobility) were used, 53.3% improved in both groups, while subjective criteria revealed improvement in 76.7% in both groups. Neurological signs improved in 36.7% in group A and in 30% in group B. In two patients treatment with indomethacin was discontinued because of severe side effects. In the benorylate treated group 3 patients had to be taken off treatment for the same reason. Side effects were mainly gastro-intestinal. The study indicates that with regard to clinical effectiveness benorylate is comparable to indomethacin in patients suffering from cervical spine syndromes; the substance is cheap and relatively tolerable.

In a multicenter, placebo-controlled and randomized double-blind trial 119 patients with rheumatoid arthritis were treated with thymopentin, an immunoregulating drug. The data of 107 patients were complete enough to be evaluated: 51 were given intravenous injections over ten minutes of 50 mg thymopentin three times weekly, 56 were similarly treated with a placebo solution. Significant improvement of five among nine clinical criteria were obtained with thymopentin after the third week of treatment. The response rate (improvement of a clinical parameter by at least 40%) was significantly greater for all clinical parameters in the thymopentin group. Regression to a functionally more favourable class (Steinbrocker's classification) occurred in seven thymopentin-treated, but in none of the placebo-treated patients. The improvement gradually subsided over four weeks after the end of treatment. There were no changes during the trial with respect to immunological, biochemical or haematological findings. Except for one systemic allergic reaction there were no side effects.

In two multicenter double-blind cross-over studies efficacy and safety of flurbiprofen and indomethacin were compared. Nineteen patients with rheumatoid arthritis and twenty with osteoarthrosis of the knee were treated. Both drugs were effective and almost equal. Also safety was good, however three patients on indomethacin and one on flurbiprofen had to be withdrawn from the trial because of side-effects.

Of 100 patients suffering chiefly from soft tissue rheumatism 48 were treated in a double-blind study with an ointment containing flufenamic acid (Mobilisin) and 52 with a control preparation. The test ointment brought about good to very good results in 43 patients (89,5%) whereas only 26 patients (50%) of the control group showed a therapeutic effect. Either product was tolerated well; no side-effects have been observed in any of the cases.