A double blind, randomised, multicentre comparison of two doses of intravenous iloprost in the treatment of Raynaud's phenomenon secondary to connective tissue diseases

Article Abstract:

Raynaud's phenomenon is characterized by whitening and then cyanosis (bluish discoloration) of the hands during exposure to cold. The cyanosis may be followed by whitening. Transient vasoconstriction (narrowing of blood vessels) seems to underlie this disorder, which is often associated with diseases of connective tissue (skin, bone, and cartilage). This secondary Raynaud's phenomenon is often difficult to treat, as unpleasant side effects can accompany vasodilator drugs and responses to the drugs may be inconsistent. Prostacyclin is a naturally-occurring vasodilator that can improve symptoms of Raynaud's phenomenon, but is unstable and can cause adverse effects associated with vasodilation. Iloprost, a derivative of prostacyclin, has been shown to be helpful in treating Raynaud's phenomenon, although the specific mechanism is unclear and undesirable side effects such as nausea, headache, and flushing may occur with maximum doses. To determine whether lower doses of iloprost are equally effective and whether effectiveness is dependent on vasodilator effects, 55 patients who received a low or standard dose of iloprost were assessed. Of these patients, 51 completed the study. The frequency, severity, and duration of Raynaud's attacks decreased similarly in both treatment groups. Both the frequency and severity of attacks were significantly lower during the last half of the eight-week study period. Eighteen patients had ulcers on their fingers before or during the treatment period. Ulcers healed similarly in both groups, and the low-dose group developed slightly more new ulcers. Significantly fewer patients receiving the low dose of iloprost reported side effects. Dose reduction was required in one patient in this group and in 16 of the 27 patients in the high-dose group. Treatment with either dose resulted in significant increases in levels of platelets and white blood cells. The results indicate that low-dose iloprost therapy effectively treats Raynaud's phenomenon and that vasodilation may be only part of the cause for improvement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Raynaud's disease

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Randomised, double blind, placebo controlled trial of inosine pranobex in rheumatoid arthritis

Article Abstract:

The synthetic drug inosine pranobex is capable of modulating the immune system, and has been used to treat various viral diseases, including herpes simplex infections. Inosine pranobex has been shown to improve some symptoms of rheumatoid arthritis, such as morning stiffness, and is well-tolerated by patients, but may increase blood levels of urate. Rheumatoid arthritis (RA) is a joint disease characterized by inflammation of the joints, stiffness, swelling, overgrowth of cartilage tissue, and pain. The effectiveness of inosine pranobex in treating RA was assessed in 24 patients with RA who were given this drug for 24 weeks; 26 patients were given a placebo, a substance with no known therapeutic effect for the same time period. Various indicators of RA, such as morning stiffness, articular index, grip strength, pain score, erythrocyte sedimentation rate, C reactive protein, levels of immunoglobulins G and M, and blood urate levels were measured at the start of the study, and at 12 and 24 weeks thereafter. Before the study, all indicators of RA were similar for both the treated and untreated groups, with the exception of C reactive protein, which was greater in the placebo group than in patients treated with inosine pranobex. C reactive protein is an abnormal protein present in the blood during active disease activity. Inosine pranobex did not improve any of the symptoms of RA, but did increase blood levels of urate. The results show that inosine pranobex is ineffective in treating RA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Joint diseases, Isoprinosine

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Serum concentrations of soluble interleukin 2 receptor in patients with rheumatoid arthritis: effect of second line drugs

Article Abstract:

Measuring blood levels of soluble interleukin 2 receptor (sIL-2R) may not be effective method for monitoring the condition of patients suffering from rheumatoid arthritis. Rheumatoid arthritis is an inflammatory disorder that affects the joints. Among 79 patients between 46 and 64 years old suffering from rheumatoid arthritis whose blood levels of sIL-2R were measured, 41 were treated with sodium aurothiomalate, 18 were treated with auranofin and 20 were treated with sulphasalazine. No significant association was found between blood levels of sIL-2R and different clinical indications of disease severity. None of the drugs affected blood levels of sIL-2R significantly despite clinical improvement among patients in all three treatment groups. Blood levels of sIL-2R have been used to monitor the condition of patients suffering from other disorders involving the immune system.

Interleukin-2, Drug receptors, Sulfasalazine

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