Nimesil treatment of gouty arthritis

AIM: To evaluate efficacy and safety of nimesil, a selective inhibitor of cyclooxigenase-2, in gouty arthritis (GA). MATERIAL AND METHODS: Nimesil was given to 20 male patients with GA (mean age 53.8 years, mean duration of the disease 8.1 years) in a dose 100 mg twice a day for 14 or 21 days depending on positive clinical changes (13 and 6 patients, respectively). The articular swelling index, supraarticular skin hyperemia, the articular index, pain in rest and movement were estimated on the treatment day 1, 5, 14 and 21. Arterial pressure was controlled in all the patients. ESR, uric acid, seromucoid, ALT, AST, gamma-GTP, glucose levels were measured before and after the treatment. RESULTS: Nimesil relieved pain and inflammation (ESR and seromucoid level lowered significantly). Effects on the other estimates were not registered. One patient developed generalized urticaria on the treatment day 5. The drug was discontinued in him. CONCLUSION: Nimesil can be used as monotherapy of an acute attack of gout. In a dose 200 mg/day nimesil provides an effective and fast treatment of gout, is well tolerated and safe.     

Garlic effectiveness in rheumatoid arthritis]

AIM: To perform of clinical trial of alisate--a garlic preparation produced in Russia. MATERIALS AND METHODS: An open controlled trial of alisate enrolled 30 patients with rheumatoid arthritis (RA). 15 patients with RA of varying clinical form, stage and activity were given alisate in a dose 300 mg (1 tablet) twice a day for 4-6 weeks. 15 control RA patients received conventional antirheumatic therapy. RESULTS: The alisate group achieved a good and partial response in 86.5% of cases. The drug was well tolerated and had no side effects. In control group, some parameters changed for the worse. CONCLUSION: Alisate can be recommended for treatment of RA patients in combined and monotherapy.     

Comparative effectiveness of chrysanol and auranofin in rheumatoid arthritis

A randomized study of 46 patients with classic and definite rheumatoid arthritis on chrysotherapy (25 patients--auranofin orally and 21--allochrysine intramuscularly) showed a therapeutic effect of both drugs. Allochrysine turned out more effective, it was not abandoned in any patients as a result of its inefficacy. However as compared to allochrysine auranofin was slightly better tolerated.     

矿泉中药浴治疗类风湿性关节炎临床疗效评价

目的　比较在改变病情药物 (DMARDs)基础上用矿泉中药浴和非甾体类抗炎药 (NSAIDs)治疗类风湿性关节炎 (RA)的疗效。方法　RA患者 1 1 4例 ,随机分为实验组和对照组。实验组施以矿泉中药浴 ;对照组口服NSAIDs;两组同时予以甲氨喋呤 (MTX) 3～ 8粒 /周及雷公藤多甙 1～ 2片 ,每日 2次 ,口服 ,疗程 1 2周。结果　实验组总有效率为 87.0 % ,对照组总有效率为 92 .6% ,差异无显著性 ,(P >0 .0 5) ;副反应发生率分别为 2 2 .8%和 4 2 .1 % ,差异显著 ( P <0 .0 5)。病人自我评价总有效率分别为 85.2 %和 90 .7% ,差异无显著性 ( P >0 .0 5)。结论　矿泉中药浴治疗RA病人 3个月 ,在使用DMARDs基础上 ,其疗效可与NSAIDs相匹敌 (P >0 .0 5) ,且副反应发生率低 (P <0 .0 5)。     

The effectiveness of nurse-led care in people with rheumatoid arthritis: a systematic review

Objectives

The objective of this systematic review was to determine the effectiveness of nurse-led care in rheumatoid arthritis.

Design

Systematic review of effectiveness.

Data sources

Electronic databases (AMED, CENTRAL, CINAHL, EMBASE, HMIC, HTA, MEDLINE, NHEED, Ovid Nursing and PsycINFO) were searched from 1988 to January 2010 with no language restrictions. Inclusion criteria were: randomised controlled trials, nurse-led care being part of the intervention and including patients with RA.

Review methods

Data were extracted by one reviewer and checked by a second reviewer. Quality assessment was conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Tool. For each outcome measure, the effect size was assessed using risk ratio or ratio of means (RoM) with corresponding 95% confidence intervals (CI) as appropriate. Where possible, data from similar outcomes were pooled in a meta-analysis.

Results

Seven records representing 4 RCTs with an overall low risk of bias (good quality) were included in the review. They included 431 patients and the interventions (nurse-led care vs usual care) lasted for 1-2 years. Most effect sizes of disease activity measures were inconclusive (DAS28 RoM = 0.96, 95%CI [0.90-1.02], P = 0.16; plasma viscosity RoM = 1 95%CI [0.8-1.26], p = 0.99) except the Ritchie Articular Index (RoM = 0.89, 95%CI [0.84-0.95], P < 0.001) which favoured nurse-led care. Results from some secondary outcomes (functional status, stiffness and coping with arthritis) were also inconclusive. Other outcomes (satisfaction and pain) displayed mixed results when assessed using different tools making them also inconclusive. Significant effects of nurse-led care were seen in quality of life (RAQoL RoM = 0.83, 95%CI [0.75-0.92], P < 0.001), patient knowledge (PKQ RoM = 4.39, 95%CI [3.35-5.72], P < 0.001) and fatigue (median difference = −330, P = 0.02).

Conclusions

The estimates of the primary outcome and most secondary outcomes showed no significant difference between nurse-led care and the usual care. While few outcomes favoured nurse-led care, there is insufficient evidence to conclude whether this is the case. More good quality RCTs of nurse-led care effectiveness in rheumatoid arthritis are required.     

Cytokines in rheumatoid arthritis

Joints with rheumatoid arthritis are a site for chronic inflammation involving T cells, B cells, macrophages and dendritic cells. When these cells interact cytokines are likely to be produced. The presence of different cytokines in the synovial fluid of patients with rheumatoid arthritis has been studied and the macrophage derived cytokines such as IL-1, IL-6, TNF-alpha, TGF-beta and PDGF have usually been detected in large quantities, whereas T cell produced cytokines (IL-2, IL-4, IFN-gamma) are absent or present in small quantities. IL-1, IL-6 and TNF-alpha have several functions which suggest that they participate in the chronic disease process of rheumatoid arthritis, such as increasing production of eicosanoid, collagenase and prostaglandin E2. Many synovial B cells are activated and produce large amounts of immunoglobulins. We searched for a B cell stimulatory activity in rheumatoid synovial fluid and found a B cell differentiation and helper activity. Cytokines in the joints of patients with rheumatoid arthritis seem central for the propagation of the disease process. Specific intervention in cytokine production or in its effects might help to relieve symptoms in rheumatoid patients.     

Emergencies in rheumatoid arthritis

Musculoskeletal emergencies include tendon rupture, carpal tunnel syndrome, rupture of synovial cyst (" pseudothrombophlebitis " syndrome), subluxations in the cervical spine, cricoarytenoid arthritis and septic arthritis. Ocular complications can be serious emergencies, as can vasculitis and rheumatoid nodules. Drug reactions represent an additional group of urgent problems. While rheumatoid arthritis is characteristically an indolent disease, failure to recognize its urgent complications can cause significant morbidity and mortality.     

HLA-DR in rheumatoid arthritis

The authors describe the results of HLA-DR typing of 80 patients with rheumatoid arthritis (RA). The patients showed accumulation of HIA-DR (51.25% versus 28.9% in the control), with the relative risk being 2.58. The interrelationship is demonstrated between the clinical picture of RA and HIA-DR antigens: a statistically significant accumulation of HIA-DR4 in the seropositive patterns according to the RF of RA as compared with the seronegative pattern and primary demonstration of HIA-DR3 in RA with the systemic manifestations as compared with the articular pattern.     

Leukocytapheresis in rheumatoid arthritis

In this article, we discussed leukocytapheresis (LCAP) for rheumatoid arthritis (RA). Recently, a simple and practical on-line continuous LACP system has been developed. It is equipped with a direct hemoperfusion column (Cellsorba^®, Asahikasei Medical Co., Ltd.) packed with fine-diameter polyester fibers, which are commonly used to adsorb white blood cells to prevent a graft-versus-host reaction during blood transfusion. Clinical trials revealed that LCAP is a effective and safe therapy for patients with drug-resistant RA or RA complicated with vasculitis. Because the procedure is simple and requires no plasma substitutes and the volume needed for extracorporeal circulation is less than that for other plasmapheresis, LCAP might be accepted as an optional therapeutic modality for active RA that was refractory to conventional drug therapy including biological agents. The mechanism of the efficiency of LCAP on RA is unclear. LCAP may cause a reduction of activated T cells from affected joints, down-regulation of Pgp on helper T cells and restoration of Treg function, and that may modify the abnormal cytokine balance. These findings may explain some of the mechanisms by which the articular symptoms are improved by LCAP.     

Interferon in rheumatoid arthritis

The paper is concerned with the role played by interferon (IF) in rheumatoid arthritis (RA). The content of IF was measured in the patients' blood serum and the possibility of the use of the preparations of exogenous interferon for the treatment of RA patients was demonstrated. Assay of serum IF in RA patients showed that its content did not exceed normal. The results of the treatment with IF preparations has demonstrated their beneficial effect on certain parameters. Further study of the role played by IF in the management of rheumatic diseases is required in order to develop the drug doses and schedules for the treatment.