Intra-articular drug therapy in rheumatoid arthritis

Summary Six patients (4 men, 2 women) with moderate/large knee effusions due to rheumatoid arthritis (RA) were studied after receiving indoprofen, 25 mg intra-articularly and then 200 mg orally 1 week later. There was significant improvement in pain (t=3.74, P<0.05), morning stiffness (t=2.91, P<0.05) and range of movement (t=2.52, P<0.05) for at least 1 week following the intra-articular injection. The terminal phase plasma half-life after the 200 mg oral dose was 6.4±0.7 h (mean±SEM) and was significantly longer than the often quoted plasma half-life of 2–3 h from previous studies, but much less than the pharmacodynamic half-life. Synovial fluid concentration were not significantly different from those in plasma in the post-distribution phase. Intra-articular indoprofen may be a useful addition to the treatment of RA.     

Atrioventricular conduction time in rheumatoid arthritis

Summary The atrioventricular conduction time (P-R interval) was determined in 189 women and 90 men with rheumatoid arthritis (RA). Only three women and one man were found to have pathological prolongation of the P-R interval. However, a significant prolongation of the P-R interval, within normal range, was seen in women with RA compared with healthy controls. Apart from the relation to radiographically enlarged heart, prolonged P-R interval showed no association with other signs of RA and had no prognostic implications in the follow-up period (mean 5.4 years). Current chloroquine therapy delayed the atrioventricular conduction while corticosteroids accelerated it.     

Correlation of serologic indicators of inflammation with effectiveness of nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis

Forty-seven patients with rheumatoid arthritis (mean duration 5.7 years) who were receiving neither disease-modifying drugs nor corticosteroids were enrolled in a 12-week, multicenter study of the relationship between clinical and serologic measures of disease activity in patients taking nonsteroidal antiinflammatory drugs. After a 2-week drug washout period, patients received flurbiprofen (200 mg/day) or sustained-release ibuprofen (2,400 mg/day) for a 10-week trial. Clinical response was assessed biweekly using standard clinical parameters, including 50-foot walk time, tender joint score, duration of morning stiffness, and global assessment of disease activity and pain (by both the patient and the physician). Patients were classified as responders if there was greater than or equal to 30% improvement in at least 3 of the 4 clinical measures of disease activity. Thirty patients completed at least 8 weeks of therapy; there were 12 responders and 18 nonresponders. Of the laboratory parameters examined, the responders, but not the nonresponders, demonstrated significant reductions (from postwashout values) in levels of IgM rheumatoid factor and C-reactive protein (CRP), along with significant increases in the number of circulating lymphocytes and decreases in the number of circulating granulocytes (P less than or equal to 0.05). In contrast, the nonresponders demonstrated either no change or worsening of the laboratory correlates of disease activity. The responders also appeared to have more aggressive disease at baseline, with significantly more painful joints, greater 50-foot walk times, elevated CRP values, and elevated erythrocyte sedimentation rates (P less than or equal to 0.05). These data suggest that there is a subset of rheumatoid arthritis patients in whom clinical improvement with nonsteroidal antiinflammatory drug therapy is associated with significant reductions in IgM rheumatoid factor and CRP levels.     

Basic drug therapy of rheumatoid arthritis

At first the term of basic therapeutic preparations is explained. Then the essential representatives of the basic medicaments are described, in which cases the author particularly pays attention to their therapeutic mechanisms, the clinical efficiency and their dosage. Out of the number of the possible basic drugs preparations with guaranteed efficacy are particularly described.     

Causes and investigation of increasing dyspnoea in rheumatoid arthritis.

Fibrosing alveolitis and bronchiolitis obliterans are two of the many pulmonary manifestations of the connective tissue disorders. When shortness of breath is the main complaint, it is often difficult to diagnose the individual causative lesion from the clinical examination, lung function tests, and chest radiographic findings. In such cases high resolution computed tomography, with its increased sensitivity and specificity for analysis of the pulmonary parenchyma, provides an excellent diagnostic tool for determining the presence and type of pulmonary abnormality.     

类风湿关节炎的药物治疗进展

类风湿关节炎的药物治疗进展曾庆馀刘建平类风湿关节炎（ＲＡ）的治疗问题虽未解决，但近年来有长足进展，概述如下。一、ＲＡ治疗的目的和原则ＲＡ的治疗目的在于减轻疼痛，缓解症状，控制病情发展，阻止不可逆的骨改变，尽可能地保护关节及肌肉的功能，改善患者的生活质...     

Pharmacoeconomics of drug therapy for rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease that results in progressive functional limitation, physical disability and premature death. RA extracts a considerable economic toll, particularly in terms of indirect costs related to lost productivity and premature mortality. Given these considerations, any therapy for RA that slows or prevents disability would be expected to confer economic benefit. Determination of drug efficacy does not automatically imply economic benefit, however. Establishment of economic benefit requires a rigorous analysis of both the benefits and the total costs of a given therapy The cost of drug therapy, including treatment of side-effects, currently constitutes only 15% of the total direct cost of RA, so it is important to assess other costs in any economic analysis. Common guidelines with regard to methods, units and data treatment are necessary to permit comparison of the economic benefit of different therapies within and across disease states. Such guidelines are being established for economic evaluations of medical interventions in RA. Application of these guidelines to future pharmacoeconomic studies of RA therapy will permit more accurate assessment of the economic benefit of such treatments. Given the current fiscal constraints on health care, demonstration of economic benefit will become an increasingly important factor for drug acceptance.     

Balancing effectiveness and toxicity of levamisole in the treatment of rheumatoid arthritis

One hundred and forty-four courses of levamisole were given in various dosage schedules for the treatment of rheumatoid arthritis from 1976 to 1980. A placebo-controlled double-blinded study was analyzed traditionally and life table analysis used to describe events during follow-up. Lower dosage was significantly less toxic, but not significantly better than placebo. Toxicity to other slow acting anti-rheumatic drugs did not predispose to levamisole toxicity. Because effective doses are poorly tolerated, and tolerable lower doses are relatively ineffective, levamisole cannot be recommended as standard treatment of rheumatoid arthritis.