Ralph W. Schaffarzick

Evaluation of medical-technology strategies: effects of coverage and reimbursement (first of two parts).

Rationale The current federal policy is to reduce the governments responsibility for health care and its evaluation, substituting market mechanisms whenever possible, and to vest residual control ...

Phenylbutazone (butazolidin) in gout

Abstract 1.1. The therapeutic efficacy of phenylbutazone was evaluated in 200 patients with acute gout or chronic gouty arthritis. Major improvement or complete remission was achieved in 84 per cent of these patients. Males responded more favorably than did females. Acute gout was more amenable to phenylbutazone therapy than was chronic gouty arthritis. 2.2. Among 408 patients with painful musculoskeletal disorders other than gout, the beneficial effect of phenylbutazone was appreciably less in those patients who had elevated serum uric acid than in those with normal uric acid levels. This suggests that the characteristic diminution of serum uric acid promoted by phenylbutazone may not be the most important pharmacologic action of the drug. 3.3. It is our impression that intramuscular administration effects a more rapid remission of acute gout than does oral phenylbutazone. 4.4. Maintenance therapy in chronic gouty arthritis with phenylbutazone, 100 to 600 mg. daily, greatly reduced the attack rate, severity and duration of acute exacerbations. This control was exerted even in the presence of serum uric acid levels which had again risen to pretreatment magnitude. In no case were tophi observed to increase or decrease in size. 5.5. Seventy-one toxic side effects occurred in fifty-two (26 per cent) of the 200 gouty patients. In fourteen patients (7 per cent) toxicity was severe enough to warrant discontinuance of the drug. The most common untoward actions were edema and nausea. There was no case of agranulocytosis or activation of peptic ulcer among these patients. The age of the patient did not appear to influence the incidence of toxicity. Undesirable effects were less severe in gout than in other painful musculoskeletal disorders and usually occurred early in the course of treatment. 6.6. In homogenates of rat liver and intestine, phenylbutazone did not inactivate xanthine oxidase or adenosine deaminase. The drug was found to inhibit the growth of yeast.

Evaluation of Medical-Technology Strategies

Rationale The current federal policy is to reduce the governments responsibility for health care and its evaluation, substituting market mechanisms whenever possible, and to vest residual control ...