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Purpose: To compare the evidence base and systemic treatment strategies for sarcoidosis., Methods: Medline and EMBASE literature search on "sarcoidosis AND treatment", "sarcoidosis AND uveitis AND treatment", and "sarcoidosis AND eye AND treatment". The search was limited to randomized controlled trials (RCTs) and meta-analyses., Results: A total of 19 RCTs for the systemic treatment of extraocular sarcoidosis were identified. The majority were on corticosteroid-oral and inhaled. There were two meta-analyses on corticosteroid, including a Cochrane review. Only two RCTs were indentified for the treatment of intraocular sarcoidosis, one on etanercept, and the other from 1967 on prednisolone or oxyphenbutazone vs. placebo. There were no meta-analyses. Due to the paucity of RCTs other treatment studies were included but these were limited to only a few immunosuppressive agents and on small numbers of patients., Conclusion: Limited high-quality evidence exists for the systemic treatment of sarcoidosis, in particular intraocular disease.

The antirheumatic effect of pirfenidone was compared with a positive control drug, oxyphenbutazone which is used in patients suffering from rheumatoid arthritis, in a double blind clinical trial in humans. The data collected in this pilot project revealed that pirfenidone was more effective (p < 0.025) than oxyphenbutazone in providing relief from arthritic pain. In addition, a greater number (p < 0.025) of patients reported favorable response to oral pirfenidone than oral oxyphenbutazone. However, there were no significant differences in the number of patients who dropped out from the trial and the number of patients who tolerated the drugs for 21 days of the trial between the pirfenidone and oxyphenbutazone groups. It was concluded from this pilot study that pirfenidone potentially offers a novel therapeutic modality for the management of rheumatoid arthritis with little or no adverse effects unlike steroidal and non-steroidal anti-inflammatory drugs which are frequently used for this chronic debilitating disease.

A 50-year-old woman sought a rheumatological consultation for anterior chest pain of three weeks duration. The diagnosis of superficial phlebitis of the anterior chest wall (Mondor's disease) was made. This was confirmed thereafter by the pathological report. She was treated with a non-steroidal anti-inflammatory drug Oxyphenylbutazone (Tanderil) and made a prompt recovery.

Meclofenamic acid is an analgesic endowed with anti-inflammatory properties. Its main activity is the combined inhibition of leukotrienes and prostaglandins synthesis, yet it is also able to antagonize the peripheral effects of prostaglandins. This particular feature explains why the effect of this drug is so fast, especially when administered orally. The pharmacological properties and good tolerability of meclofenamic acid propose the use of this drug for the treatment of various types of pain, particularly at osteoarticular localization. Recent comparative studies with meclofenamic sodium versus placebo, indomethacin, oxyphenbutazone, and diclofenac confirmed that meclofenamate sodium is very effective, significantly reducing pain as well as the subjective and objective symptoms accompanying it. The findings of these studies have also highlighted a particularly favorable safety profile. Our study primarily focused on assessing the effectiveness and tolerability of this drug in 82 patients affected with extraarticular rheumatism localized in various sites. Meclofenamic acid (as a sodium salt) was orally administered in doses of 100 mg twice daily for 2 weeks. The assessment of the drug's clinical effectiveness took into account the various aspects of pain (spontaneous, on motion, due to active contrasted movements) and quantified it using a 5-point rating scale (0 = absence of pain; 5 = very intense pain). At the end of the 2-week observation period, both the investigator and the patient gave their opinion as to the effectiveness and tolerability of the drug. The treatment was found to be highly effective in reducing pain in 59.7% of the patients, regardless of the nature and location of the rheumatic process. Tolerability was rated good-to-excellent in 72% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

We studied prospectively the effects of 2% hydroxypropylmethylcellulose (HPMC), instilled in to the anterior chamber during extracapsular cataract extraction with posterior chamber intraocular lens implantation in 122 patients. Significant pressure rise was noted at 12 and 24 hours post-operatively when HPMC was not removed at the end of surgery. This was prevented by washing HPMC from the anterior chamber at the end of surgery, or by using either acetazolamide or a combination of oxyphenbutazone and vitamin C without washing HPMC. There was no difference in intraocular inflammation between controls and the HPMC groups. The group receiving combined oxyphenbutazone and vitamin C had the least, the differences between these two groups being sufficient.

In a double-blind between-patient study of 69 patients with sports injuries of the knee, diclophenac sodium (Voltaren) was significantly superior to oxyphenbutazone (Tanderil) and placebo in improving the degree of swelling and the condition of the injured knee. Both drugs were superior to placebo with regard to analgesia by the second day of treatment. In addition, diclophenac sodium significantly improved the condition of the injured knee by the end of the trial. Three patients dropped out of the trial for reasons not related to the drug. Two patients in the diclophenac sodium group failed to complete the trial due to rapid recovery and 1 each in the diclophenac sodium and oxyphenbutazone groups because of poor tolerability. Nine patients who completed the trial reported mild to moderate side-effects, consisting mainly of drowsiness and nausea.

In a random trial of 160 women undergoing radiation therapy for carcinoma of the cervix of all stages 76 individuals were treated with 3 X 100 mg oxyphenbutazone daily and 84 individuals served as controls. Reevaluation shows a significantly better 5- and 10-year-survival rate of 70 and 62% in the treatment group, compared to 55 and 44% in the control group. The mode of action of oxyphenbutazone consists of the inhibition of prostaglandin synthesis. Improvement of survival rates is explained by two theories: (1) slowing of tumor spread by inhibition of necessary prostaglandins; and (2) improvement of cell repair after radiation therapy.

A total of 847 cases of cold injury occurred within the short space of 2 weeks during the Indo-Pakistan conflict in Kashmir in December 1971. The management of these cases and their end results are described. A combination of drugs consisting of low-molecular-weight dextran, an anti-inflammatory agent, and a vasodilator was tried with encouraging results. A conservative attitude towards ablation of necrosed tissues paid good dividends.

Thirty-one patients who suffered from various cancers in the pelvic region were treated in a double-blind clinical long-term study either with placebo, N-(2-methyl-3-chlorophenyl)-anthranilic acid (tolfenamic acid, Clotam) or oxyphenbutazone in order to diminish the local reactions after telecobalt therapy. The results were difficult to judge and no clear differences were seen between the groups. The side-effects were slight and unspecific, except gastrointestinal distresses, which occurred with both tolfenamic acid and oxyphenbutazone, but were more severe with the latter. No significant changes were seen in the blood counts, liver or kidney function tests with tolfenamic acid. In the oxyphenbutazone group S-ALAT, S-AFOS and direct bilirubin were slightly elevated. Blood in feces was more frequent in the drug-treated than in the placebo group. In the light of the present and earlier studies tolfenamic acid appears to cause less side-effects than oxyphenbutazone in prolonged treatment.

Breast lesions were diagnosed in 1518 patients among 8432 who had had mammography [ 19%]. In 324 there was the characteristic appearance of "secretory disease" . Additional uni- or bilateral galactography was performed in 458 womenbecause of breast secretion. A normal milkduct system was found in 29.6% of them; ductalectasia with a lumen above 3 mm diameter was present in 14.6%. The most common cause ofsecretions was small cysts as part of a small-cystic mammary fibrosis or fibrocysticdisease of the breast [ 32.6%]. Intraductal proliferation was present in 21% of allgalactograms, occult carcinoma in 3 [ 0.7%]. It would seem that a secreting breast isnot as common an early symptom of mammary carcinoma as sometimes stated. The most commoncomplication of galactography was mastitis [ more or less severe], almost always re-sponding to oxyphenbutazone administration.

In 257 patients with primary or secondary infertility, tubal occlusion or impeded tubal patency was found. The patients received Bactrim or Tandearil and the tubal patency was retested. In a control group of 74 cases, 2 tubal patency tests were done without treatment. Following treatment with Bactrim, 40,4% of the previously occluded fallopian tubes were patent. Following treatment with Tandearil, 34% of the previously occluded tubes were patient. In the non-treated group, 25% of the cases showed tubal patency at the second patency test. The results were more striking for the cases with impeded tubal patency. The success rate was 73,3% following treatment with Bactrim, 50% following treatment with Tandearil and 26,7% in the untreated control group.

In a randomized double-blind study efficacy and tolerance of diflunisal, 375 mg twice daily, and oxyphenbutazone, 200 mg twice daily, were compared in 40 patients (aged 21 to 70 years, average 38 years), with moderate or severe complaints after spraining or dislocating ankle or wrist. The drugs were given for five days. Both proved to be highly efficacious, diflunisal slightly more so. Among the 20 patients in the diflunisal group one developed diarrhoea, another gastritis; in the oxyphenbutazone group one developed gastritis, another herpetiform pustules. There were no clinically significant abnormalities in routine biochemical tests.

Ninety-four patients with typhoid fever were treated, at random, with three therapeutic regimens: chloramphenicol alone, chloramphenicol plus oxyphenbutazone, and ampicillin plus oxyphenbutazone. The results are evaluated analyzing the body temperature graph and by serial blood had bone marrow cultures taken at intervals until they became negative. Bacteriologic diagnosis was confirmed by blood culture (39.3%) and/or bone marrow culture (77%). The mean duration of fever was 3.3 days for the group treated with chloramphenicol-oxyphenbutazone, 4.3 for those with chloramphenicol alone and 5 days for the group ampicillin-oxyphenbutazone; at the same time, blood cultures became negative at 4.4, 5.5 and 4.4 days respectively. Negativization of bone marrow cultures was not influenced by the addition of oxyphenbutazone. It is concluded that the influence of oxyphenbutazone in shortening the febrile period or in the negativization of blood cultures is not significant. It is considered that oxyphenbutazone is not an important therapeutic tool in this group of diseases.

227 patients with psoriasis and various forms of arthritis have been kept under review. Psoriasis and inflammatory arthropathy was present in 168 patients, of whom 94 have been followed up for more than 10 years. An arthritis indistinguishable from rheumatoid disease was present in 78%, distal joint arthritis in 16-6%, and deforming arthritis in 4-8%. There was a female predominance in the sex ratio of patients, although males predominated in the distal joint group (male:female 1-5:1). The peak age of onset was between 36 and 45 years, although in the deforming group the arthritis began before the age of 20 three times as commonly as it did in the indistinguishable group. Onset was acute in nearly half of the patients. At onset the distal joints were affected in one-third of the distal joint group. A synchronous onset of skin and joint changes was uncommon. Skin lesions usually preceded the arthritis but occurred after onset in 16%. Apart from in the deforming group, the arthritis was mild, judged by the number of admissions to hospital for treatment of the joint disease, and the time off work. Deterioration clinically and radiographically occurred in only a small portion of the distal joint and indistinguishable groups. Antimalarial drugs have been used in 7 patients, with deterioration of the skin condition in 4. Uveitis occurred particularly in the men of all three groups, but was most frequent in those with deforming arthritis. A family history of psoriasis was obtained in 26% of first-degree relatives and 13% of second-degree relatives. A history of polyarthritis was most common in patients in the deforming group. The sheep cell agglutination test was negative in the majority, but was positive in 16% of the indistinguishable group, fluctuating in a further 10%. A small number of joints only deteriorated radiographically (10% of the distal and indistinguishable groups). The men in the distal group showed greater radiographic changes and more deterioration in the terminal interphalangeal joints of the fingers than the women. Similarly they showed more deterioration of the metatarsophalangeal joints than the women. 18 patients died, one with gastric haemorrhage resulting from treatment of exfoliative psoriasis with immunosuppressive therapy, and 2 from bronchopneumonia thought to be related to immobility caused by the arthritis.

The results of a set of experiments conducted on a new non-steroid antirheumatic preparation--pyrasanone (Carudol)--are presented and its indications in the general management of the disease are noted. The pharmacokinetics and therapeutic efficacy of the new drug are described. Statistical analysis showed it to be more effective than hexahydropyrazine, diphenylbutazone, indomethacin and oxyphenbutazone. A basic therapeutic approach is suggested in accordance with the pharmacodynamic aspects of the drug and the results observed in a clinical trial on 719 subjects. Pyrasanone has low toxicity and is well tolerated. Due caution in the administration of antirheumatic drugs should nevertheless be maintained during its use.

Fifty-nine patients on long-term treatment with phenylbutazone or oxyphenbutazone for chronic rheumatic conditions were switched to treatment with naproxen and followed-up for 6 months in a compliance study. All patients were started on 500 mg naproxen twice daily but adjustment of the dosage was permitted. During the 6 months of the study only 3 patients returned to treatment with phenylbutazone. Of the remaining 56 patients, 45 were still taking naproxen after 6 months, 9 were changed to other non-steroidal, anti-inflammatory drugs and 2 were lost to follow-up. The study demonstrates that in routine general practice, phenylbutazone and oxyphenbutazone can be successfully replaced by less toxic drugs.

A combined cholestatic-hepatocellular injury and noncaseating granulomas occurred in two patients 1 and 4 weeks after phenylbutazone therapy. Both patients were jaundiced, one had a macular rash, and both had peripheral blood eosinophilia. Symptoms and signs subsided, and abnormal findings from tests of hepatic function rapidly returned to normal following withdrawal of the drug. Sections of liver biopsy specimens 6 months later showed no granulomas or other pathologic changes. Previously reported cases are reviewed.

A single-blind trial of diflunisal (Dolobid) against osyphenbutazone (Tanderil) was performed in a randomised series of 50 patients undergoing various orthopaedic operations. The patients were screened for the known contra-indications to both drugs. All those admitted to the trial had considerable pain on the first post-operative morning. Diflunisal was found significantly more efficacious in the relief of orthopaedic post-operative pain. No significant side-effects were recorded for either drug.

Sulindac, a new non steroidal antiinflammatory agent has been compared with acetylsalicylic-acid in a six week controlled double blind study in 28 patients with rheumatoid arthritis. In continuation of this study all patients have been treated with Sulindac up to 18 months. Sulindac has proved to be statistically significant superior to acetylsalicylic-acid as regarding the achieve of pain during the day, of morning stiffness, of gripping of the right hand and evaluation of patients response to the drug. Moreover markedly fewer adverse reactions especially of the gastrointestinal tract were seen. During the following long term study, when 19 patients were treated with Sulindac, a further statistically significant improvement of all controlled parameters up to the complete relief of complaints was observed. A reduction of the daily dose could be established. Laboratory evaluations as well as controlls of EKG and blood pressure showed no evidence of any organ toxicity of this drug.

One hundred out-patients with inflammatory process of dental tissues due to tooth extraction, root abscess alveolitis and periodontitis, were randomly assigned, according to a double-blind design, to one of two treatment groups with nimesulide (200 mg/day) or oxyphenbutazone (400 mg/day). By means of a self-rating record, each patient rated his pain, difficulty of chewing, redness and swelling before starting, during and at the end of treatment. Nimesulide and oxyphenbutazone were both well tolerated and effective, but the improvements during the first and the second day of treatment were of greater magnitude in the nimesulide-treated patients. Nimesulide, being well tolerated, rapid acting and effective, could be considered as a drug of choice for the treatment of inflammatory process of dental tissues.