rifamycin-sv and Arthritis--Rheumatoid

This study was aimed to evaluate the usefulness of rifamycin SV as an agent for local treatment of rheumatoid synovitis. Rifamycin SV was compared with triamcinolone acetonide in a randomized controlled trial on 87 patients with rheumatoid arthritis and with persistent knee synovitis. The treatment with rifamycin consisted of several weekly intra-articular injections, whereas triamcinolone was given as a single intra-articular injection. At the end of the therapy, 27 (61.4%) of the 44 rifamycin patients and 39 (91%) of the 43 steroid patients responded well to the treatment, and this difference was significant (p < 0.01). Rifamycin SV was responsible for unpleasant local side effects in all cases. In both groups, after 1 year of follow-up the synovitis had relapsed in about 42% of cases. We conclude that rifamycin SV is less useful than triamcinolone acetonide in the local treatment of rheumatoid synovitis.

Topics: Adult; Arthritis, Rheumatoid; Female; Humans; Injections, Intra-Articular; Male; Rifamycins; Synovitis; Triamcinolone

In a randomized, prospective study the efficacy and tolerability of extensive multiple intra-articular administrations of two antibiotics, rifamycin SV and pefloxacin, were evaluated in 40 patients with classical or definite rheumatoid arthritis. Total weekly doses of 525 mg rifamycin or 560 mg pefloxacin were given for 10 weeks, and 12 months after treatment all clinical indices, erythrocyte sedimentation rate and C-reactive protein improved significantly in the rifamycin group. Some of the treatment indices (morning stiffness, severity of pain by visual analogue scale, grip strength and Ritchie's index) were already improved when the treatment ended, whereas others (erythrocyte sedimentation rate, C-reactive protein, number of painful and swollen joints) improved progressively during the follow-up. In the pefloxacin treatment group all indices except C-reactive protein and severity of pain determined using a visual analogue scale were significantly improved 12 months after treatment. Comparison of the two treatments showed a significant difference in erythrocyte sedimentation rate (P less than 0.047), Ritchie's index (P less than 0.036) and C-reactive protein (P less than 0.028) in favour of rifamycin.

Topics: Aged; Arthritis, Rheumatoid; Blood Sedimentation; C-Reactive Protein; Humans; Injections, Intra-Articular; Middle Aged; Pain; Pefloxacin; Prospective Studies; Rifamycins

In a prospective, randomized, single-blind study of 116 patients with early rheumatoid arthritis (mean disease duration 7 months), therapeutic activity of intra-articular rifamycin SV (525 mg/week) infiltration into each peripheral joint over 10 weeks was compared with that of 3 mg auranofin given orally twice daily. The incidence of side-effects was lower in rifamycin-treated patients. At the end of follow-up, the clinical variables and erythrocyte sedimentation rate showed a significant and persistent improvement both in 16 patients who continued the auranofin treatment regularly and in 55 treated with rifamycin who had completed the therapeutic cycle 62.5 months before; the latex test decreased only in the rifamycin group. In patients treated with auranofin or who changed to other commonly used antirheumatic agents, 57% of those with an initially negative radiological picture developed new radiological lesions in at least one of the small joints compared with 9% in the rifamycin group. Although the number of patients treated with rifamycin was small and the follow-up relatively short, the results of the study indicated that treatment with intra-articular rifamycin SV may prevent the appearance of radiological lesions in patients with early rheumatoid arthritis and normal radiographs initially.

Topics: Administration, Oral; Adult; Aged; Arthritis, Rheumatoid; Auranofin; Female; Humans; Injections, Intra-Articular; Male; Middle Aged; Prospective Studies; Radiography; Rifamycins

Thirty rheumatoid patients with persistent knee effusion were treated intra-articularly with rifamycin SV, 500 mg weekly, or with saline solution, 10 ml, in a double-blind study. A complete disappearance of effusion and an impressive clinical improvement was observed in the patients on rifamycin. The synovial fluid and membrane underwent some changes. In 2 patients the rifamycin caused a painful local reaction. After a follow-up of 5 years only one patient has experienced effusion relapse, 5 months after the termination of rifamycin SV treatment. The patients on saline showed no significant change. On the basis of the results obtained from the monoarthritis experimental model and from clinical trials it is tempting to consider that rifamycin has an antimitotic effect, impeding the synthesis of RNA and DNA polymerases in immunocompetent cells.

Topics: Arthritis, Rheumatoid; Clinical Trials as Topic; Humans; Injections, Intra-Articular; Knee Joint; Rifamycins; Synovial Fluid; Synovial Membrane; Synovitis

The chemotaxis, phagocytic capacity and reducing activity of neutrophils derived from peripheral blood of patients with rheumatoid arthritis (RA) did not differ from those of control. However, some significant differences between neutrophils from rheumatic and healthy subjects emerged in the presence of rifamycin SV. The chemotactic response of neutrophils from patients with RA was activated by rifamycin SV, whereas cells from controls did not orient their locomotion towards the drug. Moreover, incubation of RA patient's cells with rifamycin SV in vitro depressed phagocytic and reducing activities; the same treatment on normal cells failed to alter these functions. A correlation between improvement of clinical symptoms after treatment of RA by local infiltration with rifamycin SV, observed by others, and the impairment of phagocytosis and NBT reduction, here described, was suggested.

Topics: Arthritis, Rheumatoid; Chemotaxis, Leukocyte; Dose-Response Relationship, Drug; Humans; Kinetics; Neutrophils; Phagocytosis; Rifamycins

The antibiotic rifamycin SV (RSV) has been successfully used by others on the local treatment of rheumatoid arthritis (R.A.). Since polymorphonuclear leukocytes (PMNL) are involved in the synovial inflammatory process we tested the 'in vitro' effect of RSV on PMNL functions, such as locomotion and phagocytosis. PMNL locomotion was evaluated by using modified Boyden Chamber and phagocytosis was tested by the number of yeast particles ingested and by NBT reduction. The, the functions of PMNL derived from 7 R.A. patients in therapy only with non steroidal anti-inflammatory drugs were compared with those of PMNL from 14 patients with non inflammatory disease (osteoporosis and osteoarthrosis) in the same therapy and with neutrophils from healthy subjects. It was demonstrated that PMNL derived from patients with both R.A. and non inflammatory disease activated their directional locomotion towards RSV, on the contrary, cells from healthy subjects were unresponsive. Moreover, only patients with R.A. showed a defective phagocytic capacity and a depression in NBT reducing activity, when PMNL were treated with RSV. This phenomenon might be correlated with beneficial effect observed after local treatment of R.A. with RSV.

Topics: Arthritis, Rheumatoid; Cell Movement; Humans; Leukocyte Count; Neutrophils; Nitroblue Tetrazolium; Phagocytosis; Rifamycins