[Löfgren syndrome].

A short review on incidence, prevalence, possible causes and pathologic findings in sarcoidosis is given. Especially the symptomatology, differential diagnosis and therapy will be described. Finally some data on 10 patients with this syndrome will be presented.

[Function of cytokines in cartilage degradation].

Growth-hormones like Insulin-Like-Growth-Hormone-1 (IGF-1) and Tissue-Growth-Factor-beta (TGF-beta) and Cytokines IL-1, IL-6 and TGF-alpha play an important part in the homeostasis and also degradation of the articular cartilage. IL-1 stimulates the production of proteolytic enzymes and inhibits the synthesis of aggrecan and leads therefore to a degradation of the cartilage. TNF-alpha acts in a similar way, whereas the significance of IL-6 for chondrocytes is not yet fully understood.

[Drug therapy of arthrosis].

The drug therapy of osteoarthritis and mainly of the large joints consists in less severe cases in analgesic drugs. Nonsteroidal antirtheumatic drugs with their analgesic and antiinflammatory action are used in more severe cases. In elderly persons their side effects are more serious, therefore strict controls are important.

Bronchoalveolar lavage in rheumatoid arthritis.

Bronchoalveolar lavage (BAL) was performed on 70 RA patients, 28 without extra-articular manifestations, nine with pulmonary involvement, 13 with sicca-syndrome, 20 with other extra-articular manifestations such as renal involvement, cutaneous vasculitis and rheumatoid nodules. Fifteen patients without rheumatic or pulmonary disease served as the control group. Compared with the control group RA patients showed a statistically significant increase of lymphocytes, especially of activated (DR+)T(CD3+)-helper (CD4+) cells, resulting in a significantly diminished percentage of alveolar macrophages, B(CD21+)-lymphocytes, T-suppressor (CD8+) cells and an increased CD4/CD8 ratio.

[Helicobacter pylori and nonsteroidal antirheumatics].

The frequency of occurrence of Helicobacter pylori in the antral mucosa was investigated prospectively in a group of 66 patients (17 men, 49 women, mean age 58 +/- 8.4 years) who had been treated with nonsteroidal anti-rheumatic drugs and 33 controls (14 men, 19 women, mean age 60.7 +/- 6.

Demonstration of a new antinuclear antibody (anti-RA33) that is highly specific for rheumatoid arthritis.

Using immunoblot analysis with soluble nuclear extracts from HeLa cells, we identified autoantibodies to an antigen with a molecular weight of approximately 33,000 in 36% of 95 sera from rheumatoid arthritis patients, but in only 1 of 170 controls. The antigen, termed RA33, was resistant to DNase and RNase digestion but sensitive to proteinase K treatment. There was no discernible relation to other autoantibodies.

[Clinical effectiveness and tolerance of auranofin in patients with chronic polyarthritis. Results of a multicenter long-term study].

In an open multicenter trial, 90 patients with rheumatoid arthritis were treated with a daily dose of 6 mg auranofin. The duration of the treatment was 12 months. A significant improvement in the following parameters was observed: grip strength, number of swollen and painful joints after the 4th month, blood erythrocyte sedimentation rate decreased significantly after the 2nd month.

[Chronic polyarthritis in advanced age].

Approximately a quarter of polyarthritis in the elderly is beginning with a single- or oligo-articular attack of big joints. The first attack of the shoulder joints is noticed especially in men. Most of the patients with rheumatoid arthritis in the elderly have a gradually progressive course.

The efficacy and safety of fentiazac and diclofenac sodium in peri-arthritis of the shoulder: a multi-centre, double-blind comparison.

In a double-blind parallel group comparison of efficacy and safety, 19 patients with peri-arthritis of the shoulder received 200 mg fentiazac twice daily and 19 received 50 mg diclofenac sodium twice daily, with both drugs given orally for 3 weeks. In both groups, observers' verbal rating scales of pain severity at rest and on movement showed decreases that were significant by week 1. Both groups also had significant improvement in abduction, external rotation, retroversion and anteversion.

[Differential diagnostic value of nephelometrically determined protein fractions in the synovial fluid].

Synovial fluids of patients suffering from rheumatoid arthritis and osteoarthritis with effusions of the knees were examined. Different parameters were evaluated out of the synovial fluid (immunglobulins, Complement-1Q,-3,-4, haptoglobins, alpha-1-anti-trypsin, alpha-2-macroglobulin, transferrin, ceruloplasmin, rheumatoid factors, total count of cells, and ragocytes) and out of the plasma (blood sedimentation rate). The proteins were analysed by a nephelometricturbidimetric automatic centrifugal analyser.

[Clinical diagnostic strategy in rheumatology].

The diagnosis of rheumatic diseases should follow a pattern of stages, the first comprising family case history, the case history of the patient and basic physical examinations. The second stage should include X-ray examination and basic or, if necessary, more extensive laboratory tests and simple synovia analysis. The third stage would then incorporate articular biopsy, arthroscopy, different biopsies outside the joint, isotope examination, electromyography, thermography, arthrosonography, computed tomography etc.

[Local and systemic parameters in the synovial milieu].

Our own results as well as recent data from the literature confirm the already long known fact, that synovial fluid analysis allows only in very few diseases as for example a crystal synovitis a definite diagnosis in the individual case. In the majority of the patients this technique permits only to differentiate between inflammatory and non-inflammatory joint disease as well as an estimation of the local inflammatory activity of joint. The simultaneous histologic examination of synovial membrane according to our experience seems to bring no major additional information which exceeds the information given by each technique alone.

HLA antigens and toxicity to gold and penicillamine in rheumatoid arthritis.

One hundred sixty-eight patients with rheumatoid arthritis treated with chloroquine (n = 87), gold salts (n = 133) and/or penicillamine (n = 77) were investigated for possible associations between HLA antigens and toxic reactions. Patients with 2 or more side effects to gold and/or penicillamine had a significantly increased frequency of antigens HLA-B8 and DR3 compared to patients with one or without adverse reactions. Proteinuria to gold or penicillamine was significantly associated with HLA-B8 (relative risk [RR] 4.

Concentrations of lonazolac in serum and synovial fluid of patients with inflammatory or degenerate joint disease.

In 15 patients with inflammatory and degenerative joint disease the concentrations of lonazolac were measured in serum and synovial fluid at steady state conditions. The mean concentration in the synovial fluid in 14 patients was 0.275 microgram/ml, which was 48% of that in the serum.

[Comparison of oral and parenteral gold therapy--review of the literature].

Numerous open and placebo-controlled trials have shown Auranofin, an oral gold salt, to be effective in the base-line treatment of rheumatoid arthritis. In comparative trials the drug was found to be somewhat less potent than sodium aurothiomalate. Whether it is equal or superior to other base-line antirheumatoids like D-penicillamine or antimalarials, can as yet not be established because of the small patient groups involved in the published trials.

Double-blind, multi-centre trial to compare a once-daily combination of trimethoprim and sulfamethopyrazine with ampicillin 4-times daily in patients with urinary infections.

Sixty-eight patients with urinary infection were allocated at random to receive treatment with either 500 mg ampicillin 4-times daily or a trimethoprim (250 mg)/sulfamethopyrazine (200 mg) combination given once daily after a double, loading dose on the first day. All patients complained of urinary symptoms and showed significant bacteriuria, E. coli being the pathogen most frequently recovered.

[Mechanism of action of non-steroidal antirheumatic agents].

Non-steroidal antirheumatic drugs permit a nonspecific, symptomatic therapy of inflammatory rheumatic processes and may also be given for a limited period of time in patients with so-called activated osteoarthrosis. Their mode of action is a complex one. More recent knowledge on mediators in inflammation such as prostaglandins, leukotriens and oxygen radicals have brought new insights on the mode of action of non-steroidal antirheumatic drugs.

The use of questionnaires in the evaluation of the functional capacity in rheumatoid arthritis.

The functional capacity of 46 patients with rheumatoid arthritis was assessed by means of two systems of investigation. Three different questionnaires were used. One set of each was filled out by the patient himself; the other with the help of the occupational therapist.

Oral gold therapy with auranofin (SK&F 39162). A multicenter open study in patients with rheumatoid arthritis.

One hundred and fifty patients with rheumatoid arthritis received 6 mg of auranofin daily for 2-24 months. Thirty patients were withdrawn from the study, and 82 patients were observed for 12 months. Statistical evaluation was available for 74 patients at weeks 24, 38, and 48, respectively.

The use of thermography in the evaluation of the anti-inflammatory activity of feprazone on rheumatoid arthritis.

By means of the exploration of patients suffering from an active, unequivocal rheumatoid arthritis it was possible to show the unequivocal, and antiinflammatory effect of 4-phenyl-1,2-diphenyl-3,5-pyrazolidinedione (feprazone, Zepelin). Moreover, it was documented that thermography is a very suitable medium to furnish proof of this effect and can be used to the advantage of the patients in clinical routine. The physiological processes of the production and distribution of heat must be taken into account to avoid false interpretation of thermograms.