rifamycin-sv and Synovitis

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

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

Synoviorthesis is the intra-articular injection of chemical or radioactive substances able to produce fibrosis of hypertrophied synovium, which has proved effective in the treatment of chronic haemophilic synovitis. Between September 1999 and October 2001 we treated 28 outpatients (25 with haemophilia A, three with haemophilia B). Our treatment was focused on pain and functional limitation of joints. A schedule was adopted to treat each joint using intra-articular rifamycin once a week, repeated five times. Patients were covered with factor replacement on demand. Oral analgesia was offered as required because of acute but transient painful inflammatory reaction. Their median age was 34 years (range 15-60 years). The indication for synoviorthesis was chronic synovitis characterized by recurrent haemarthroses, persistent pain and limited range of motion (ROM). Thirty-five joints were treated with a total of 169 injections, including six joints (20%) in patients with inhibitors. In five patients two joints were treated in the same session. Thirty procedures were completed: 24 (80%) were considered effective (as excellent or good), while six were considered insufficient (20%). Pain was reduced in 96% of cases and in 70% the ROM was improved. In our experience intra-articular infiltration with rifamycin appears to be effective in reducing joint pain and in improving the ROM. The procedure presents a low risk of bleeding, can be used for patients with inhibitors and multiple joints can be treated without any additional cost.

Topics: Adolescent; Adult; Antirheumatic Agents; Arthralgia; Chronic Disease; Cohort Studies; Drug Administration Schedule; Hemarthrosis; Hemophilia A; Hemophilia B; Humans; Injections, Intra-Articular; Male; Middle Aged; Range of Motion, Articular; Rifamycins; Synovitis; Treatment Outcome

Topics: Fibrosis; Humans; Rifamycins; Synovitis

Intraarticular injections of rifamycin SV were repeated weekly in patients with rheumatic disease with a chronic knee joint effusion. The clinical signs of synovitis were reduced in all, but disappeared in only one. A post injection reaction with transient local pain and effusion appeared at the third or a later injection in all the patients prompting withdrawal of 3. At these later injections local drug retention was shown by parallel determinations of rifamycin SV in synovial fluid and serum. The post treatment synovial fibrosis seen at arthroscopy could possibly explain the drug retention and the post injection inflammatory reaction. Thus, local treatment with rifamycin SV alleviated but rarely abolished synovitis.

Topics: Adolescent; Adult; Aged; Arthroscopy; Drug Evaluation; Female; Humans; Male; Middle Aged; Rifamycins; Synovial Fluid; Synovitis

Topics: Arthritis, Juvenile; Child, Preschool; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Rifamycins; Synovitis