Three patients receiving gold salt treatment for rheumatoid arthritis developed severe aplastic anemia. All three patients experienced remission of their disease at the time of the occurrence of marrow aplasia. Reviewing data on these patients and recent literature indicate that fatal marrow aplasia seems to occur more frequently in sero-negative women who respond well to therapy with gold salts. Frequent blood monitoring in search for any pronounced or sustained drop in red, white or platelet count, even within normal range could serve as a warning sign for myelotoxicity. Despite intensive supportive measures and specific therapeutic attempts, all three patients eventually died of septic shock.
A double-blind trial was carried out to weigh the effectiveness and tolerance of intraarticular injections of bufexamac (20 mg) against methylprednisolone (40 mg) in 40 patients with an acute bout of inflammatory arthritis. Leucocyte and polymorphonuclear counts and viscosity measurement of the synovial fluid were performed before and 14 days after injection, which showed methylprednisolone to be significantly superior to bufexamac in suppressing inflammation. In both groups a statistically significant improvement of pain on mobilisation and pain index was noted, but the number of clinical remissions was significantly higher in the methylprednisolone group. The blind investigator found a statistically significantly greater improvement with methylprednisolone than with bufexamac, and patients' opinion on effectiveness did not differ significantly. Important local or general side-effects were not observed. It was concluded that, although both drugs appeared to exert a considerable anti-inflammatory effect in inflammatory arthritis, methylprednisolone was more effective.
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