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The frequency of occurrence of Helicobacter pylori in the antral mucosa was investigated prospectively in a group of 66 patients (17 men, 49 women, mean age 58 +/- 8.4 years) who had been treated with nonsteroidal anti-rheumatic drugs and 33 controls (14 men, 19 women, mean age 60.7 +/- 6.6 years) who had not received these drugs. In the first group the indication for gastroscopy was ingestion of nonsteroidal antirheumatic drugs for at least 8 weeks, irrespective of dyspeptic symptoms (present in 25 patients), while in the second group the reason for endoscopy was either clinical symptoms (n = 18) or the presence of blood in the faeces. Helicobacter pylori was demonstrated by culture in 36 out of the 66 patients who had received nonsteroidal antirheumatics (54.5%); these comprised 24 out of 46 patients (52.2%) with chronic inactive gastritis and 12 out of 15 patients (80%) with chronic active gastritis. In the control group H. pylori was detected by culture in 22 out of 33 patients (66.7%); these included 11 out of 19 patients (57.9%) with chronic inactive gastritis and 11 out of 12 patients (91.7%) with chronic active gastritis. H. pylori was not demonstrated in any of the seven patients who had histologically normal gastric mucosa. In both groups there was significant correlation between demonstration of the microorganism and severity of inflammation. There is hence no evidence that nonsteroidal antirheumatic drugs have any influence on the colonisation of the antral mucosa by Helicobacter pylori.

A 2-week multicentre, double-blind, randomised trial was conducted to evaluate the efficacy and tolerability of diclof enac resinate, a new galenic formulation of diclofenac, versus piroxicam, an established analgesic/anti-inflammatory agent, in patients suffering from acute lumbosacral back pain. Adult male or female patients complaining of moderate to severe pain at rest/on movement were treated with either diclofenac resinate 75mg twice daily or piroxicam 20mg once daily for up to 14 days; the latter group received piroxicam 40 mg/day for the first 2 days. In the 132 patients eligible for efficacy analyses (66 in each treatment group), both drugs led to comparable and clinically significant reductions in mean pain scores commencing after 3 days of treatment. Tests for spinal flexion also showed considerable improvement, as did functional capability, with no significant differences being observed between diclofenac and piroxicam. Overall evaluations of efficacy by the investigators and the patients revealed a positive response rate in 78.8 and 81.8%, respectively, in patients treated with diclofenac compared with 83.3 and 87.7%, respectively, for piroxicam. The incidence of adverse effects, most frequently gastrointestinal, was 19.7% for diclofenac resinate and 18.2% for piroxicam. The results of this controlled study show that diclofenac at a daily dosage of 150mg has efficacy similar to piroxicam 20mg with a loading dose regimen of 40mg for the symptomatic management of acute lumbosacral back pain.

Bronchoalveolar lavage (BAL) was performed on 70 RA patients, 28 without extra-articular manifestations, nine with pulmonary involvement, 13 with sicca-syndrome, 20 with other extra-articular manifestations such as renal involvement, cutaneous vasculitis and rheumatoid nodules. Fifteen patients without rheumatic or pulmonary disease served as the control group. Compared with the control group RA patients showed a statistically significant increase of lymphocytes, especially of activated (DR+)T(CD3+)-helper (CD4+) cells, resulting in a significantly diminished percentage of alveolar macrophages, B(CD21+)-lymphocytes, T-suppressor (CD8+) cells and an increased CD4/CD8 ratio. This cell distribution pattern was more pronounced in RA patients with lung involvement with significant differences to the other RA patients with regard to lymphocytes, DR positive cells and CD4 positive/DR positive cells. It is concluded that these results indicate an altered balance of immunocompetent cells not only in the joints but also in the lung. The changes are more distinct if local manifestations can be diagnosed clinically.

Intraartikulare Injektionen und Punktionen erfordern die sorgfaltige Abwagung von Indikation und Kontraindikation. 1. Der Patient muss vor dem Eingriff uber das Behandlungsverfahren und seine Risiken aufgeklart sein. 2. Der Eingriff muss von einem in der Technik geubten Arzt vorgenommen bzw. uberwacht werden.

Diese Richtlinien wurden auf der Grundlage der als Konsensuspapier der Osterreichischen Gesellschaft fur Rheumatologie in der Zeitschrift TOP-Medizin (in den Nummern 9/95–1/97) veroffentlichten Richtlinien der Basistherapie bei chronischer Polyarthritis erstellt.

A short review on incidence, prevalence, possible causes and pathologic findings in sarcoidosis is given. Especially the symptomatology, differential diagnosis and therapy will be described. Finally some data on 10 patients with this syndrome will be presented.

The drug therapy of osteoarthritis and mainly of the large joints consists in less severe cases in analgesic drugs. Nonsteroidal antirtheumatic drugs with their analgesic and antiinflammatory action are used in more severe cases. In elderly persons their side effects are more serious, therefore strict controls are important. Therapy with so-called chondroprotective substances is not yet established but the glycosaminoglycan-peptid and also the glucosaminosulfate may be able to slow down the arthrotic process. An additional therapeutic possibility are intraarticular injections of hyaluronic acid and the knee-lavage. A drug therapy in osteoarthritis should never be given as a single measure, but always in combination with physiotherapy and general measures like weight reduction or using a cane, etc.

Growth-hormones like Insulin-Like-Growth-Hormone-1 (IGF-1) and Tissue-Growth-Factor-beta (TGF-beta) and Cytokines IL-1, IL-6 and TGF-alpha play an important part in the homeostasis and also degradation of the articular cartilage. IL-1 stimulates the production of proteolytic enzymes and inhibits the synthesis of aggrecan and leads therefore to a degradation of the cartilage. TNF-alpha acts in a similar way, whereas the significance of IL-6 for chondrocytes is not yet fully understood. TGF-beta and IGF-1 in contrast have a positive influence on cartilage metabolism, f. ex. TGF-beta stimulates the synthesis of the natural occurring metalloproteinase-inhibitor (TIMP).

The frequency of occurrence of Helicobacter pylori in the antral mucosa was investigated prospectively in a group of 66 patients (17 men, 49 women, mean age 58 +/- 8.4 years) who had been treated with nonsteroidal anti-rheumatic drugs and 33 controls (14 men, 19 women, mean age 60.7 +/- 6.6 years) who had not received these drugs. In the first group the indication for gastroscopy was ingestion of nonsteroidal antirheumatic drugs for at least 8 weeks, irrespective of dyspeptic symptoms (present in 25 patients), while in the second group the reason for endoscopy was either clinical symptoms (n = 18) or the presence of blood in the faeces. Helicobacter pylori was demonstrated by culture in 36 out of the 66 patients who had received nonsteroidal antirheumatics (54.5%); these comprised 24 out of 46 patients (52.2%) with chronic inactive gastritis and 12 out of 15 patients (80%) with chronic active gastritis. In the control group H. pylori was detected by culture in 22 out of 33 patients (66.7%); these included 11 out of 19 patients (57.9%) with chronic inactive gastritis and 11 out of 12 patients (91.7%) with chronic active gastritis. H. pylori was not demonstrated in any of the seven patients who had histologically normal gastric mucosa. In both groups there was significant correlation between demonstration of the microorganism and severity of inflammation. There is hence no evidence that nonsteroidal antirheumatic drugs have any influence on the colonisation of the antral mucosa by Helicobacter pylori.

Tenoxicam was significantly better tolerated than piroxicam with 0 and 4 patients, respectively, failing to complete the study because of adverse effects. In addition, the incidence of adverse effects was significantly greater in piroxicam compared with tenoxicam recipients (table II). No change in laboratory parameters was observed in either group with the exception of erythrocyte sedimentation rate, which was significantly improved in the patients treated with tenoxicam. The final evaluation of efficacy and tolerability

Sixty-eight patients with urinary infection were allocated at random to receive treatment with either 500 mg ampicillin 4-times daily or a trimethoprim (250 mg)/sulfamethopyrazine (200 mg) combination given once daily after a double, loading dose on the first day. All patients complained of urinary symptoms and showed significant bacteriuria, E. coli being the pathogen most frequently recovered. Clinical and microbiological assessments were carried out on entry and, as a rule, after 3 to 4 days and 1 to 2 weeks of treatment. In the 35 patients receiving trimethoprim/sulfamethopyrazine, 40 (95%) of the 42 original infecting organisms were eradicated. In the 33 patients on ampicillin, the eradication rate was 32 (89%) out of 36 organisms. The course of urinary symptoms was similarly favourable in the two groups. Overall response was considered as 'excellent' or 'good' in 89% of the patients receiving the combination preparation and in 82% of those given ampicillin. Clinical and biological tolerance was satisfactory under both regimens. A longer follow-up control should confirm the value of the new combination in the treatment of urinary infections.

238 PCP-Sera wurden mit dem Antiglobulin-Konsumptionstest und Humankollagen wie Kalbskollagen als Antigen untersucht. Der Unterschied in der Reaktivitat mit diesen beiden Antigenen zeigt, das in PCP-Sera 2 Typen von Kollagenantikorpern vorkommen: Antikorper mit Kollagenspeciesspezifitat, sowie mit allgemeiner Kollagenspezifitat. Statistische Bewertungen und Untersuchungen mit Rattenkollagen bestatigen das Ergebnis. Da diese Antikorperfraktionen auch nach experimenteller Immunisierung mit Kollagen auftreten, mus dem Kollagen im Verlauf der Autoimmunisierung bei PCP eine gleiche Immunogenitat und Spezifitat wie bei experimenteller Immunisierung zugesprochen werden. 88 Sera (37,0%) reagierten negativ, 44 Sera (18,5) fraglich positiv und 106 Sera (44,5%) positiv mit Humankollagen, das sowohl mit speciesspezifischen wie mit allgemeinspezifischen Kollagenantikorpern reagiert. Von 50 Kontrollsera reagierten 5 fraglich positiv oder positiv. Mit Kalbskollagen, das nur mit der allgemeinspezifischen Kollagenantikorperfraktion reagiert, ergaben 129 Sera (54,2%) negative, 47 Sera (19,7%) fraglich positive und 62 Sera (26,1%) positive Resultate. Humankollagen erscheint als Antigen klinischer Routinetestungen geeigneter, da es haufiger und starker positive Resultate herbeifuhrt. Wenn Kalbskollagen als Testantigen eingesetzt wird, dann konnen in 29% der negativen Resultate positive Ergebnisse mit Humankollagen erwartet werden. Positive Resultate mit Kalbskollagen werden jedoch auch mit Humankollagen positiv sein. Zwischen den Stadien der Erkrankung und dem Nachweis von Kollagenantikorpern konnte keine Korrelation beobachtet werden. Eine Korrelation trat jedoch zwischen Aktivitat und Antikorpernachweis auf. Zwischen Rheumafaktoren und Kollagenantikorpern konnte in den 238 untersuchten Seren keine Korrelation festgestellt werden. Die gleichzeitige Untersuchung auf Zellkernantikorper fiel in 67 Sera (28%) positiv aus. Die Patientengruppe ohne Kollagenantikorper hatte den grosten Prozentsatz an negativen Resultaten mit Zellkernantigen, die Gruppe mit starksten Antikollagentitern hatte den grosten Prozentsatz an stark positiven antinuclearen Faktoren. Die Bedeutung dieser Beobachtungen wird in Hinsicht auf das Konzept, die PCP als Kollagenautoimmunkrankheit zu betrachten, diskutiert.

Die Wirkung von Diaminodecan, einem neuen Histaminfreisetzer, auf die Mastzellen der Ratte und Blutbasophilen des Kaninchens wird untersucht. Die Mastzellenzahl im Knochenmark der Ratte erweist sich als sehr empfindlicher quantitativer Index, der die wiederholte Testung am uberlebenden Tier erlaubt. Die Zahlung im Mesenterium ist weniger verlaslich. Durch Antihistaminika wird die Entgranulierung der Mastzellen gehemmt, jedoch nicht aufgehoben. Die Schockerscheinungen werden nicht beeinflust. Die Blutbasophilen beim Kaninchen sind in vivo nicht statistisch signifikant beeinflusbar. Auch in vitro ist der Einflus des Histaminfreisetzers wesentlich geringer als auf Mastzellen. Die Gerinnungszeit der Ratte bleibt trotz massiver Mastzellenzerstorung unverandert, beim Kaninchen kommt es zu einer geringen Verlangerung.

An 157 Patienten wurden Testungen der Allergie vom verzogerten Typ mit verschiedenen Antigenen durchgefuhrt. Eine hochsignifikante Verminderung fand sich bei M.Hodgkin sowie bei Lymphadenosen. Diese Verminderung geht der verminderten Zahl der peripheren Lymphozyten bzw. qualitativen Veranderungen der Lymphozyten parallel. Diese Ergebnisse unterstreichen die zentrale Bedeutung der Lymphozyten bei der Auslosung der allergischen Reaktion vom verzogerten Typ. Bei der primar chronischen Polyarthritis waren signifikante Veranderungen nicht zu beobachten. Nach Prednison-Medikation kam es zu einer masiggradigen Verringerung des Reaktionsausfalles.

1. Die Absolutzahlung der Blutbasophilen ist als zusatzliche Untersuchung in der Schilddrusendiagnostik zu empfehlen. 2. Die Veranderungen der Basophilenzahl bei verschiedenen Schilddrusenfunktionszustanden scheint die Folge einer direkten Wirkung zirkulierenden Schilddrusenhormons auf die Blutbasophilen zu sein. 3. Dieser angenommene Wirkungsmechanismus ist bei der Beurteilung der Untersuchungsergebnisse, insbesondere bei Verlaufsbeobachtungen zu berucksichtigen.

One hundred and fifty patients with rheumatoid arthritis received 6 mg of auranofin daily for 2-24 months. Thirty patients were withdrawn from the study, and 82 patients were observed for 12 months. Statistical evaluation was available for 74 patients at weeks 24, 38, and 48, respectively. The major side effects observed were diarrhea, rash, and alopecia. Significant improvement was noted in the articular index, ESR, pain, and morning stiffness.

Our own results as well as recent data from the literature confirm the already long known fact, that synovial fluid analysis allows only in very few diseases as for example a crystal synovitis a definite diagnosis in the individual case. In the majority of the patients this technique permits only to differentiate between inflammatory and non-inflammatory joint disease as well as an estimation of the local inflammatory activity of joint. The simultaneous histologic examination of synovial membrane according to our experience seems to bring no major additional information which exceeds the information given by each technique alone.

Bei der chronischen Polyarthritis sind DNAStoffwechselanomalien bekannt. In fruheren Arbeiten konnten wir nachweisen, das in den Lymphozyten von Patienten mit chronischer Polyarthritis DNA-Reparaturimbalanzen vorhanden sind (Tuschl u. Altmann, 1976). Auch die replikative DNA-Synthese ist deutlich gesteigert (Klein et al. 1974). Weiters sind auch die Regionen um die Replikationsstellen besonders empfindlich gegenuber einem Abbau durch DNasen, da sie nicht in kompakte Nukleosomen eingebettet sind (Dolejs u. Altmann, 1980). Mit einer 1976 veroffentlichten elektrophoretischen Methode (Sandhofer et al. 1976), haben wir das Se rum-Nukleasemuster bei verschiedenen rheumatischen Erkrankungen bestimmt (Hoffer u. Thumb, 1980). Dabei zeigte sich, das bei Patienten mit chronischer Polyarthritis im Vergleich zu Kontrollpersonen, signifikant haufiger zusatzliche Endonukleasebanden auftraten. Da die an DNA-Reparaturprozessen beteiligten Nukleasen im Chromatin direkt lokalisiert zu sein scheinen (Suciu u. Uray, 1977) haben wir in der vorliegenden Arbeit untersucht, ob auch hinsichtlich chromatin-assoziierter Nukleasen ein Unterschied zwischen Patienten mit chronischer Polyarthritis und gesunden Kontrollpersonen feststellbar ist.

The results of the radiosynoviorthesis with yttrium-90 silicate in 36 joints, are reported. In comparison to the radiogold therapy in 64 joint, yttrium-90 was a little more effective. Additionally, the body distribution of radioactive yttrium after radiosynoviorthesis of knee joints, was measured in 6 patients. It could be shown that the uptake of the regional lymphnodes was between 4 and 5% of the yttrium administered. The radiation dose of the regional lymphnodes certainly exceeds 1000 rad. The results point to the importance of a careful selection of patients for radiosynoviorthesis.

61 patients with rheumatoid arthritis received a total of 80 courses of immunosuppressive therapy with one or more of the following substances: azathioprine, chlorambucil, mannitolmustard, cyclophosphamide, procarbazine. The overall results were excellent or good in 50% of the patients. There was a significant correlation between the efficacy of the different substances and the rate of side effects. Azathioprine was best tolerated, but gave only medium results whereas procarbazine, as a very potent drug, had the highest rate of side effects (especially depression of bone marrow, infections, gastrointestinal manifestations etc.). Serious immediate side effects of the immunosuppressive therapy according to our experience and in literature are infections and leucopenia, whereas the most important late risk is the possibility of an occurrence of malignancy. In our series, which had been followed up to five years, no malignancies have been thus far detected. Also, in the literature, there are only very few patients with malignancies published. Therefore the risk of immunosuppressive therapy in rheumatoid arthritis with regards the incidence of malignancies, seems to be relatively small in contrast to the findings in patients with kidney transplants.

Der derzeitige Stand der medizinischen rheumatologischen Versorgung ist noch weitgehend gepragt von der bisherigen Unterversorgung. Wir haben jetzt zwar endlich den Beschlus des deutschen Arztetages fur die Einfuhrung des Teilgebietes „Rheumatologie“ fur die Innere Medizin und Orthopadie, mit der Einfiihrung selbst ist wegen des langen Weges durch die Landerinstanzen erst im nachsten Jahr zu rechnen. Gewis sind bereits seit langerer Zeit Arzte mit der Qualifikation zum Rheumatologen bei uns tatig, und wir verfugen uber einige auch international anerkannte Rheumakliniken unterschiedlicher Trager mit einem grosen Krankengut. Aber das Fach „Rheumatologie“ mit dem Hintergrund eines ausreichenden Krankengutes wurde an unseren Universitaten bisher praktisch nicht gelehrt. Daruber durfen auch nicht die vor langerer oder kurzerer Zeit eingerichteten rheumatologischen Abteilungen an Universitaten bzw. Hochschulen hinwegtauschen, die oft an andere Fachgebiete angehangt wurden, oder letztlich immunologische Institute mit oft nur geringer Bettenzahl sind. Wir sehen die Rheumatologie in erster Linie als klinisches Fach, zu dessen Beherrschung in erster Linie Erfahrung gehort, die man nur an einer grosen Zahl von Patienten mit den verschiedensten rheumatischen Erkrankungen in allen Stadien unter Berucksichtigung vor allem auch der funktionellen Probleme erwarten kann. Es ist also festzuhalten, das zumindest den derzeit praktisch tatigen Arzten mit Ausnahmen keine hinreichende rheumatologische Grundausbildung zuteil wurde, was sich naturlich in einer nicht optimalen arztlichen Versorgung am Wohnort niederschlagen mus, zumal noch kein Spezialist als Konsiliararzt zur Verfugung steht.

Menzel, J., Steffen, C., Kolarz, G., Eberl, R., Frank, O., and Thumb, N. (1976).Annals of the Rheumatic Diseases, 35, 446-450. Demonstration of antibodies to collagen and of collagen-anticollagen immune complexes in rheumatoid arthritis synovial fluids. Twenty-nine synovial fluids from patients with rheumatoid arthritis (RA) and 10 synovial fluids from patients with other joint diseases were investigated with regard to the presence of antibodies to denatured human collagen and of collagen-anticollagen immune complexes. 12 of the 29 RA synovial fluids showed anticollagen titres from 1: 16 to 1: 512 in passive haemagglutination. Only one patient in the group with no arthritis had a significant anticollagen titre of 1: 32. Digestion of the synovial fluids with bacterial collagenase resulted in an anticollagen titre increase from two to four dilution steps in 9 of the RA fluids, while 6 previously negative RA synovial fluids showed anticollagen titres from 1: 32 to 1: 128 after digestion with collagenase. These results indicate the existence of collagen-anticollagen immune complexes in 15 of the 29 RA synovial fluids investigated.

By means of the exploration of patients suffering from an active, unequivocal rheumatoid arthritis it was possible to show the unequivocal, and antiinflammatory effect of 4-phenyl-1,2-diphenyl-3,5-pyrazolidinedione (feprazone, Zepelin). Moreover, it was documented that thermography is a very suitable medium to furnish proof of this effect and can be used to the advantage of the patients in clinical routine. The physiological processes of the production and distribution of heat must be taken into account to avoid false interpretation of thermograms.