Non-ulcer dyspepsia associated with NSAID intake: possibility of antacid drugs application

Objective. To investigate the comparative efficacy of Magalphil 800 in NSAID-associated dyspepsia. Patients and methods. 30 pts with rheumatic diseases (RD) receiving NSAIDs and having dyspeptic symptoms were included. Pts were divided into 2 groups: group 1 (n=20, 2 males, 18 females, mean age 51,7+12,3 yTs, 7 pts had single erosion of stomach, 1 - multiple erosions, 1 - ulcer of stomach); group 2 (n=10, 1 male. 9 females, mean age 46,2±14,6 yrs, 2 pts had single erosion of stomach). Concomitant therapies (corticosteroids, cytotoxics) were approximately the same in both groups. Pts in Group 1 received one tablet of Magalphil 800 four times a day; pts in Group 2 were treated by ranitidine 150 mg bid. Therapy of RD was not changed during the study. Subjective complains were controlled after 2 weeks. Results. Complains related to dyspepsia disappeared in all pts of Group 1 and in 8 pts of Group 2 after 5,2±2,4 and 7,3±3,8 days of treatment respectively (p>0,05). Healing of ulcer in 1 and healing of erosions in 5 pnts was observed in Group 1. Conclusions. Magalphil 800 is effective in NSAID-associated dyspepsia and can be used for treatment of NSAID-induced gastropathy

Gastroduodenal safety of Nimesulid (Nimesil, Berlin Chemie) in rheumatic patients with history of ulcer

Objective. To assess safety of nimesulid in rheumatic pts with history of ulcer or multiple erosions (ME) of stomach and/or duodenal mucosa. Methods. 42 pts with rheumatic diseases aged 22-73 years were included. AH had gastric or duodenal ulcers or ME (n>10) connected with NSAID treatment and confirmed by endoscopy no more than 6 months before the beginning of the study. Pts were included after healing of ulcers and erosions. The pts were randomized to receive Nimesulid 200 mg/day (group 1) or Diclofenac suppositoria 100 mg/day + ranitidine 150 mg/day (group 2). Esophagogastroduodenoscopy was performed before and 12 weeks after the beginning of treatment. Results. Relapse of stomach ulcer was observed in I pts of group 1 (5,6%). Relapse of NSAID-induced ulcers and ME was noted in 6 pts of group 2 (33,3%): in 4 cases stomach ulcers, in 1 case stomach ME, in 1 case duodenal ulcer (p=0,0424). Presence of gastralgias and dyspepsia was noted in 36,8% pts of group 1 and in 20% pts of group 2 (p=0,0539). In 1 pts of group 2 gastralgias were the reason for premature endoscopy. Conclusion. Nimesil (Nimesulid) can be considered as a more safe drug than classical NSAIDs with smaller risk of serious gastroduodenal complications development in rheumatic pts with ulcer history. The results of the study allow to recommend Nimesulid as a drug of choice for treatment of pts with history of NSAID-induced gastropathy

New approaches to the assessment of rheumatoid arthritis activity: Simplified Disease Activity Index (SDAI) TOC \o "1-5" \h \z in early arthritis

Objective. To assess significance of Simplified Disease Activity Index (SDAI) in early arthritis. Material and methods . 76 pts with suspicion of rheumatoid arthritis (RA), duration of the disease less than 6 months (3,6±1,7 months), meanage48,5±14years(17-76years)and male/female ratio 1/5 were examined. DAS 28 and SDAI were calculated for complex assessment of arthritis activity. Results. Mean SDAI value was 28,9±14,9 (1,37-67,64). In 40 (52,1%) of pts it corresponded to moderate, in 20 (26,6%) - to low and in 16 (21,3%) - to high activity of RA. Mean DAS 28 value was 4,86+1,23 (2,31-6,92). 12,5% of pts had low, 40,3% - moderate and 47,2% - high activity. SDAI significantly correlated with DAS 28 (p<0,0001). Functional status examination showed mean HAQ value 0,82±0,62(0-2,5). HAQ correlated with SDAI and DAS 28 (p<0,005). In 37 from 76 pts (48,7%) RA was diagnosed according to ACR 1987 criteria. In 39 (51,3%) of pts the diagnosis was not verified and they were considered as having undifferentiated arthritis (UDA). SDAI values in RA were significantly higher than in UDA (33,1±I5,9 and 24,5+12,3 respectively, p<0,05). Similar differences were shown for DAS 28 (4,72±1,1 in RAand 2,9±0,7 in UDA, p<0,05. 30,8% of RA pts had low, 48,7% - moderate and 20,5% - high inflammatory activity according to SDAI. In UDA low and moderate activity were more frequent (59,5% and 32,4% respectively) than in RA. DAS 28 and SDAI activity stages completely coincided neither in RA nor in UDA pts. Conclusion. SDAI is a sensitive method of activity assessment and correlates with DAS and HAQ not only in definite long standing RA that was shown at validation of this index but also in early arthritis

Possibilities of gastroprotective therapy in NSA1Dinduced gastropathies with De-Nol

Objective. To assess efficacy of De-Nol in NSAID-induced gastropathies. Material and Methods. 45 pts with rheumatic diseases taking NSAID with gastric and/or duodenal ulcer up to 1 cm of size or multiple (>10) gastric erosions (MGE) confirmed with endoscopy were included. They were randomized to receive De-Nol 240 mg twice a day with amoxicillin 2 g/day and furosolidon 400 mg/day (subgroup la) or De-Nol 240 mg twice a day as monotherapy (subgroup lb). Group 2 patients were treated with ranitidin 150 mg twice a day. Demographic parameters, nosological structure, treatment of the main disease and gastrointestinal changes stmcture in these groups did not significantly differ. Elderly women with rheumatoid arthritis and gastric ulcer were prevalent. HP was revealed in 73,3% and 90% of pts. Dyspepsia and heartburn were present in 90% and 93,3% respectively. Therapy efficacy was assessed after 4 weeks. Preventive effect was assessed in 2 months after the successful treatment course. Preventive doses of the drugs were equivalent to ? of treatment doses. Results. 3 pts from group 1 and 1 pt from group 2 were lost to follow up. I pt from group I stopped De-Nol prematurely because of adverse event (diarrhea). Ulcer and erosion healing was achieved in 22 from 26 pts of group I (86.6%) and from 7 from 14 pts of group 2 (50%), p=0.036. After the course of therapy remained in in 4 pts of group 1 (15,4%) and 9 pts of group 2 (64,3%), p=0.003. 3 pts receiving De-Nol had adverse events (2 - diarrhea, 1 - wind). Antihelicobacter effect was assessed in 7 pts of subgroup la. Eradication was achieved only in 3. Antiulcer effect in subgroup la and lb did not differ (88,8% and 82,4% respectively, p=0,732. HP was present in 12 from 20 pts (60%) of subgroup lb. Antiulcer therapy was effective in 6 from 7 of HP-negative (85,7%) and in 8 from 10 of HP positive (80%) pts, p=0,S4l. Preventive effect was assessed in 15 pts of group I and 5 pts of group 2. Relapse frequency was 13,3% and 20% respectively. Conclusion. De-Nol is effective in NSAID-induced gastropathies and its effect does not depend on HP