Jacques R. Caldwell

Sucralfate treatment of nonsteroidal anti-inflammatory drug-induced gastrointestinal symptoms and mucosal damage

In a randomized, double-blind trial, sucralfate therapy, 1 g four times daily, was compared with placebo in 143 symptomatic patients to assess the treatment of gastrointestinal symptoms and gastric mucosal damage associated with nonsteroidal anti-inflammatory drugs (NSAIDs). All patients followed a fixed regimen of NSAIDs, were assigned to one of two groups based on the presence or absence of gastric erosions at baseline endoscopy, and were then assigned randomly to receive sucralfate or placebo for four weeks. Patients were then followed for up to six months while receiving open-label sucralfate 1 g twice daily to up to 1 g four times daily. After four weeks of double-blind therapy, patients taking either nonsalicylate NSAIDs or long half-life NSAIDs and who were treated with sucralfate experienced a significant reduction in both peptic symptom frequency and intensity (p less than 0.03) as compared with patients receiving placebo. Sucralfate-treated patients with baseline endoscopic lesions showed a significant reduction in lesion scores (p less than 0.005) at four weeks as compared with baseline, whereas no improvement was observed in gastric mucosal lesions of patients given placebo. Long-term sucralfate therapy resulted in continued improvement in gastrointestinal symptoms and gastric lesion scores in patients receiving all types of NSAIDs. The results indicate that sucralfate used in conjunction with NSAIDs may allow patients to continue therapy by relieving gastrointestinal symptoms and mucosal damage associated with NSAID therapy.

Paraneoplastic vasculitis. Unique syndrome of cutaneous angiitis and arthritis associated with myeloproliferative disorders

Six patients are described whose myeloproliferative disorders were complicated by inflammation in small, predominantly cutaneous blood vessels. The clinical manifestations of the vasculitis included palpable purpura, urticaria, maculopapular lesions, and erythema multiforme. Vascular inflammation was confirmed by skin biopsy. Two patients experienced fleeting, asymmetrical nondestructive arthritis. Transient proteinuria complicated one case and was the only suggestion of visceral vasculitis. The clinical features of cutaneous vasculitis antedated bone marrow deterioration in four patients and diminished as bone marrow function worsened in all patients. Oral corticosteroids or chemotherapy for the underlying disorder inconsistently affected the clinical course of the cutaneous vasculitis. Myeloproliferative disorders should be considered among disorders that are complicated by inflammation in small blood vessels.

Weber–christian Disease: Analysis Of 15 Cases And Review Of The Literature

We report 15 patients encountered over 13 years who presented with inflammation of subcutaneous fat and were given clinical and pathologic diagnoses of Weber--Christian disease (WCD). Prominent clinical features included female predominance, lower extremity nodules, fevers, arthritis/arthralgias, and myalgias. Notable laboratory features were elevated erythrocyte sedimentation rate, anemia, leukopenia, and hypocomplementemia, frequently with circulating 7S IgM or immune complexes at times of active symptoms. Histologic findings were lobular--together with frequent septal--panniculitis, fat-laden macrophages, variable cellular infiltrates, necrosis, and occasional vasculitis. Follow-up revealed the death of 2 patients and disease stabilization or improvement in 13 patients. Six patients developed features of other diseases (factitial disease, erythema nodosum, acute myelogenous leukemia, rheumatoid arthritis, systemic lupus erythematosus, and sarcoid) and a seventh may have had erythema induratum. We suggest that classic WCD, as originally described, reflects an increasingly recognized spectrum of panniculitides. These are syndromes of diverse etiology that share many clinical, inflammatory, and immunologic features.

Efficacy and safety of diclofenac sodium in rheumatoid arthritis experience in the United States

Diclofenac sodium is a nonsteroidal, anti-inflammatory drug that has been studied in the United States for the treatment of rheumatoid arthritis in 681 patients, 468 of whom were enrolled in five multicenter, double-blind parallel controlled investigations. Results of these trials indicate that 150 mg daily of diclofenac is more effective than placebo and as effective as 2.4 g daily of ibuprofen or 3.6 g daily of aspirin. Moreover, the safety profile of diclofenac proved to be better than that of aspirin and similar to that of ibuprofen.

Trace elements in the treatment of rheumatic conditions.

The role of trace metallic elements (copper, selenium, zinc, gold) in chronic inflammatory states is of great interest because many of them are co-factors in metabolic processes involving articular tissues and immune system function. Deficiencies of several of these have been documented in patients with rheumatoid arthritis. Other than for the clinically approved gold compounds, there exists only inconsistent evidence for a therapeutic role of trace metallic elements in the management of rheumatoid arthritis.

Venoms, copper, and zinc in the treatment of arthritis

This article discusses the use of venoms, copper, and zinc in the treatment of arthritis. The author examines the history and effectiveness of viper, bee, and ant venoms in order to determine whether these natural ingredients in anti-inflammatory medications help relieve a patients symptoms. Copper and zinc studies may offer therapeutic benefits, but there is still no solid consensus on the potential role of these elements in treating arthritis.

Treatment of ankylosing spondylitis with oxaprozin: A comparison with indomethacin

Ninety-seven patients with ankylosing spondylitis entered a 6-month multicenter, double-blind study that compared the efficacy and safety of Oxaprozin with those of indomethacin. Fifty-five patients received Oxaprozin (1,200 to 1,800 mg once daily) and 42 received indomethacin (50 to 200 mg in two divided daily doses). Significant ( P P P P P P

Summary profile of oxaprozin: Comparison with other nonsteroidal antiinflammatory drugs

Oxaprozin (4,5-diphenyl-2-oxazole propionic acid), a new nonsteroidal antiinflammatory drug (NSAIO) developed by Wyeth Laboratories, has a number of advantages relative to currently available drugs of this class. The clinical efficacy of Oxaprozin has been demonstrated in rheumatoid arthritis (RA), osteoarthritis (OA), acute gout, ankylosing spondylitis, juvenile RA, and tendinitis/bursitis. The long half-life (about 50 hours) of Oxaprozin permits a once-daily dosage schedule that may lead to enhanced patient compliance with therapy. It is effective when given on an every-other-day basis for maintenance therapy in OA and thus may offer cost benefits over existing drugs. It has been hypothesized that the dual metabolism of Oxaprozin, involving both glucuronidation and oxidation, may provide an added safety factor in patients in which one of the two metabolic pathways is impaired. The pharmacokinetics of Oxaprozin have been studied in elderly persons, patients with renal impairment, patients with hepatic impairment (cirrhosis), and patients with congestive heart failure, as well as in healthy volunteers. Few differences have been shown between the pharmacokinetics of Oxaprozin in each of these special groups and those in normal subjects. Clinical safety also has been demonstrated in elderly patients and in patients with various concomitant diseases.

THE TREATMENT OF RHEUMATOID ARTHRITIS OF THE HAND WITH PULSED ELECTRICAL FIELDS

The safety and effectiveness of stimulation from pulsed electrical fields using the Bionicare® Stimulator System Model BIO-1000TM was investigated for the treatment of rheumatoid arthritis (RA) of the hand. Eighty-nine patients were enrolled in a multi-center, double-blind, placebo device controlled clinical study. All patients met the inclusion and exclusion criteria of the American College of Rheumatology (ACR) for rheumatoid arthritis1 and had active symptomatic synovitis. Background arthritis medications were maintained constant throughout the study. Device was used for 8±2 hours daily for a four week treatment period. The weekly efficacy assessments included the physician’s global evaluation of the treated hand, the patient’s assessments of pain/symptoms and function, joint tenderness and swelling, range of motion, grip strength, morning stiffness and activities of daily living. The active device group demonstrated significant improvement compared to the placebo device group using repeated measures models for the physician’s global evaluation, the patient’s evaluation of pain/symptoms and the patient’s evaluation of function, all of the treated hand. There were no consistently significant trends for the other outcome measures. Transient skin rash, the only type of adverse event reported, was comparable between groups. This study suggests the Bionicare stimulator is safe and effective for treating rheumatoid arthritis of the hand.

The Immunologic Consequences of Infection

Tissue damage instead of host protection is sometimes the outcome of the interaction between antibody and microbial antigen. Poststreptococcal rheumatic fever and glomerulonephritis are consequences of immune response to an infectious agent. Common fungi are associated with allergic lung syndromes. Allergic manifestations often accompany helminthic infections. “Slow virus” infections may cause certain neurologic disorders. Treatment of immunologic events complicating infectious diseases should be directed toward prevention rather than cure of the immunologic injury