Topical diclofenac sodium gel was generally well tolerated and effective in primary hand OA. (NCT ID: NCT00171665).

Therapy with cevimeline, 30 mg 3 times daily, seems to be well tolerated and to provide substantive relief of xerostomia symptoms. Although both dosages of cevimeline provided symptomatic improvement, 60 mg 3 times daily was associated with an increase in the occurrence of adverse events, particularly gastrointestinal tract disorders. Use of 30 mg of cevimeline provides a new option for the treatment of xerostomia in Sjögren syndrome.

Interleukin-11 (IL-11) is a pleiotropic cytokine that regulates the growth and development of hematopoietic stem cells and decreases the proinflammatory mediators of cytokine and nitric oxide production. In animal models of arthritis, treatment with recombinant human IL-11 (rhIL-11) reduces both the level of synovitis and the histologic lesion scores in the joints. The goal of this phase-I/II study in adults with rheumatoid arthritis (RA) was to evaluate the safety and clinical activity of different doses and schedules of rhIL-11 in patients with active RA for whom treatment with at least one disease-modifying antirheumatic drug had failed. This was a multicenter, randomized, placebo-controlled trial that evaluated the safety and tolerability of rhIL-11 in 91 patients with active RA. rhIL-11 was administered subcutaneously; patients were randomized into one of five treatment groups (ratio of rhIL-11to placebo, 4:1). Patients were treated for 12 weeks with either 2.5 or 7.5 µg/kg of rhIL-11 or placebo twice per week or 5 or 15 µg/kg of rhIL-11 or placebo once per week. The status of each subject's disease activity in accordance with the American College of Rheumatology (ACR) criteria was assessed before, during, and after completion of administration of the study drug. Administration of rhIL-11 was well tolerated at all doses and schedules. The most frequent adverse event was a reaction at the injection site. The data suggest a statistically significant reduction in the number of tender joints (P < 0.008) at the 15 µg/kg once-weekly dose schedule but showed no overall significant benefit at the ACR criterion of a 20% response. The trial showed rhIL-11 to be safe and well tolerated at a variety of doses and schedules over a 12-week treatment period in patients with active RA. The only adverse event clearly associated with rhIL-11 administration was reaction at the injection site.

The ability of quantitative sacro-iliac scintigraphy (QSS) to detect sacro-iliac joint (SIJ) disease was compared to that of standard radiographs in a prospective study of 26 patients with low back pain suggestive of spondylitis. Of 52 SIJs studied, QSS was abnormal in 21 (40%) and radiographs positive in 23 (44%) (p = 0.47). QSS was abnormal in only 11 of the 23 (48%) radiographically abnormal SIJs. Conversely, 29 radiographically equivocal or negative SIJs yielded positive scintigraphs in ten (34%). Although QSS in general is no more sensitive than standard radiographs, it may allow detection of radiographically inapparent sacro-iliitis in carefully selected patients.

In 1969, a 45-year-old man developed typical psoriasis en plaque affecting the anterior surfaces of the legs and the lumbar area. Adequate control of skin lesions was achieved with the topical application of hydrocortisone cream (1%) three times daily until 1975, when the process spread to the extensor surfaces of the elbows, thighs, and buttocks. Coincident with the extension of skin disease, diffuse arthralgia appeared and evolved within the following year into a frank arthritis, affecting the distal interphalangeal joints of the hands, both shoulders, and the left great toe. Attempts at controlling joint symptoms with various nonsteroidal, antiinflammatory drugs, including acetylsalicylic acid, ibuprofen, and tolmetin were only partially successful. In 1976, the patient was first aware of muscle weakness, which involved the lower extremities more than the upper extremities and resulted in a progressive inability to negotiate stairs, rise from a sitting position, dress, or ambulate. The patient was admitted to the David Grant Medical Center in 1977 for evaluation of his muscle weakness.Physical examination disclosed a well-developed man with profound weakness in the major muscle groups of the upper and lower extremities. The proximal muscles of the lower extremity were the most obviously affected. There was severe quadriceps atrophy, and the patient was unable to rise from a sitting position without assistance. Psoriatic plaques were present over the extensor surfaces of the upper and lower extremities and in the lumbar region. There was also mild scaling of the eyelids and bilateral conjunctivitis. Synovitis of the proximal interphalangeal and distal interphalangeal joints of the third and fourth digits of the left hand and the third digit of the right hand was present. The left great toe was diffusely swollen. There was crepitus on motion of both shoulders with mild limitation of abduction bilaterally. Other joints were unremarkable and the axial skeleton was entirely normal.The following laboratory tests were normal or negative: white blood cell count; platelet count; urinalysis; electrolyte levels; serologic test for syphilis; fluorescent antinuclear antibody test; rheumatoid factor test; aldolase, lactic dehydrogenase and creatine kinase levels; uric acid level; serum protein electrophoretic pattern; thyroid function studies; 2-day dexamethasone suppression test; and posteroanterior radio-The opinions expressed are those of the authors and do not necessarily reflect the views of the United States Air Eorce or the Department of Defense.graph of the chest. The erythrocyte sedimentation rate was elevated by the Westergren method (55-mm/hr), and the hemoglobin level was decreased (11.6 gm %). Radiographs of both hands were remarkable for juxtaarticular erosions, reactive periostitis, and joint space narrowing of the proximal and distal interphalangeal joints of the left third and fourth digits and the right third digit. Radiographs of the cervical, dorsal, and lumbar spine disclosed no evidence of spondylitis....