sodium-morrhuate and Arthritis--Rheumatoid

Local invasive procedures represent possibilities for the treatment of arthritic swollen joints without surgical interventions, when general measures alone are not successful and intra-articular injections are of utmost importance in this context. The differences between degenerative and rheumatologic diseases must be considered as well as possible specific adverse reactions, side effects and contraindications. The technical intervention is performed according to the guidelines of scientific societies such as the Scientific Medical Profession Society (AWMF). Cortisone and radiosynoviorthesis/chemosynoviorthesis are suitable for activated rheumatic and degenerative joints, low-grade radiation therapy or infiltration of hyaluronic acid is recommended for relief in cases of arthritic inflammation. The combination of arthroscopic synovectomy and subsequent radiosynoviorthesis in the early stages of rheumatically swollen joints show the best results with respect to regression prophylaxis and slowing the process of rapidly progressing destruction of chondral surfaces and distension of the capsules and ligaments.

Topics: Arthritis, Infectious; Arthritis, Rheumatoid; Arthroscopy; Brachytherapy; Cortisone; Diagnosis, Differential; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osmium Compounds; Osteoarthritis; Practice Guidelines as Topic; Radioisotopes; Sclerosing Solutions; Sodium Morrhuate; Synovectomy; Synovitis

Thirty-one patients with knee effusions associated with rheumatoid arthritis (RA) have been treated with two intraarticular (i.a.) injections of each 330 mg sodium morrhuate (SM) used for synoviorthesis versus a single injection of 20 mg triamcinolone hexacetonide (TA). During an observation period of one year, five articular parameters as well as patient's and doctor's global assessments were evaluated. TA showed an earlier onset and a longer duration of therapeutic effects with high statistical significance. The maximum improvement was significantly more pronounced with TA than with SM. Finally after one year improvement measured by a remission index was observed in 81% versus 33% resp. of all joints injected. Due to ineffectiveness of the primary treatment nine patients (60%) out of the SM group, but not patient out of the TA group had to be crossed over to the other treatment. SM usually caused a reactive effusion within hours after injection requiring arthrocentesis. In conclusion efficacy and tolerability are clearly better for TA than for SM.

Topics: Adult; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Humans; Injections, Intra-Articular; Knee Joint; Middle Aged; Prospective Studies; Remission Induction; Sodium Morrhuate; Synovitis; Treatment Outcome; Triamcinolone Acetonide

The aim of this study was to assess the efficacy and safety of intra-articular sodium morrhuate injections in the treatment of recurrent knee joint effusions. Ninety-eight knees of 92 patients (f = 59, m = 33) with knee arthritis of heterogeneous etiology were treated with chemical synovectomy (CSO). Of those, 39 patients suffered from rheumatoid arthritis (RA). The mean follow-up was 29.8 months. Clinical outcome was evaluated by analyzing subjective patient satisfaction, activity level, pain severity on the basis of the Visual Analogue Pain Scale (VAS), Lysholm and Gillquist score, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Fifty-seven percent of all patients and 67% of patients diagnosed with RA were satisfied with CSO. No significant effects on patient satisfaction by CSO were noted in patients older than 40 years. Overall, VAS, Lysholm and Gillquist score, and KOOS improved significantly at final review. The intra-articular application of sodium morrhuate is an effective and safe measure in the treatment of recurrent symptomatic knee joint effusions in young patients suffering from recurrent knee joint effusions.

Topics: Adolescent; Adult; Aged; Arthralgia; Arthritis; Arthritis, Rheumatoid; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Pain Measurement; Patient Satisfaction; Recovery of Function; Recurrence; Retrospective Studies; Sodium Morrhuate; Surveys and Questionnaires; Synovial Membrane; Synovitis; Time Factors; Treatment Outcome; Young Adult

Topics: Arthritis, Infectious; Arthritis, Rheumatoid; Arthroscopy; Brachytherapy; Cortisone; Diagnosis, Differential; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osmium Compounds; Osteoarthritis; Practice Guidelines as Topic; Radioisotopes; Sclerosing Solutions; Sodium Morrhuate; Synovectomy

The only early surgical therapy of rheumatoid arthritis is synovectomy. But even an arthroscopic synovectomy is restricted to more or less big joints. It has been shown recently that for smaller joints a laser synovectomy is possible but more time-consuming than with mechanical instruments. An alternative method may be photodynamic therapy.. In this study, possible photodynamic effects of Chloroquine, Methotrexate, Piroxicam, and Sodium Morrhuate were examined using a cell culture model of human synovial fibroblasts from patients having rheumatoid arthritis.. Incubation with Chloroquine or Methotrexate and subsequent laser irradiation at a wavelength of 351 nm resulted in an at least twenty-fold enhanced cytotoxicity.. Both substances therefore may serve for a photodynamic therapy of rheumatoid arthritis.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Arthritis, Rheumatoid; Cells, Cultured; Chi-Square Distribution; Chloroquine; Fibroblasts; Humans; Laser Therapy; Methotrexate; Photochemotherapy; Piroxicam; Sclerosing Solutions; Sodium Morrhuate

Varicoid was administered to 170 patients with rheumatoid arthritis, to 11 patients with a diagnostically uncertain monarthritis, to 12 patients with exudative gonarthrosis and also to 4 patients with lupus erythematodes visceralis. A total of 262 joints were treated. The short-term results, which were evaluated 4 weeks after the administration of Varicocid, revealed improvement is 95% of the patients. After 12 months, 46% of the patients were found to be free from symptoms within the area of the treated joint, and 33% of the patients showed a considerable improvement. An objectively evident improvement was found in 35 out of 40 patients with rheumatoid arthritis followed up over a period of 3 years. Comparable results after treatment with Varicocid were also obtained in patients suffering from any one of the above-mentioned rheumatic diseases. A new inflammation activity/function index for the evaluation of the local joint therapy has been used. The first investigations both of function and of morphology of the synovial membrane treated with Varicocid are reported. In our opinion, chemical synovectomy with Varicocid fills a gap in the therapy of the rheumatoid arthritis. The essential value of this type of therapy is the absence of toxicity, a temporary increase in local reactions only, and also a continuous improvement, especially in early cases.

Topics: Arthritis; Arthritis, Rheumatoid; Drug Evaluation; Fatty Acids; Humans; Injections, Intra-Articular; Lupus Erythematosus, Systemic; Sodium Morrhuate; Time Factors