Læknablaðið : fylgirit - 01.07.1978, Page 90

Buchanan and Dick 1974) clinical rheumato-
logists are still unaware of the social
needs of arthritic sufferers.
In Great Britain there has been much
debate on rehabilitation, and two reports
have been issued, one Scottish (Mair 1972)
and the other English (Turnbridge, 1972).
Needless to say the former report is much
more lucid and informative! The value of
retraining centres, such as Garston Manor
in London (Mattingly, 1968) in rehabilitating
a patient with rheumatoid arthritis has not
been established.
Drugs.
Aspirin is still recognised by writers of
textbooks as the rheumatologist's Excalibur ,x)
However, both patients and their family
doctors in Glasgow do not agree. For
only 40 per cent of patients are prescribed
aspirin by their family doctors as their
first choice to treat their arthritis (Lee
et al, 1974b). Side effects from aspirin
are common and in a recent study in our
unit approximately 80 per cent of patients
had to discontinue the drug within one year
of beginning therapy. We still do not know
how many, if indeed any, patients develop
acute gastrointestinal haemorrhage while
on aspirin, but the number reported to
the Committee on Safety of Medicines in
Great Britain is not inconsiderable
(Girwood, 1974), and probably under-
reported (Burns et al, 1977). No one as
yet knows which of the non-steroidal anti-
inflammatory drugs should be first
prescribed, but certainly it should not be
phenylbutazone or oxyphenbutazone. From
our experience it matters little whether
aspirin is prescribed as plain, enteric-
coated, so-called buffered (there is only
one truly buffered preparation, Alka-
Seltzer), soluble or glycinated, in term
of dyspepsia. Chronic gastrointestinal
blood loss is seldom severe (Baragar and
Duthie, 1960), and only rarely gives rise
to anaemia (Alvarez and Summerskill,
1958). The amount of blood loss in the
faeces does not appear to be related to
dyspepsia, previous history of peptic
ulceration, or even previous gastro-
intestinal haemorrhage (Tainter and Ferris,
1969). This suggests that acute bleeding
is perhaps an idiosyncratic response, and
in support of this Parry and Wood (1967)
noted that patients who had had a previous
acute haemcrrhage had no more occult
blood loss tlian do controls taking aspirin.
The correct dose of aspirin in a patient
with rheumatoid arthritis is the maximum
that can be tolerated without side effects.
Ansell (1969) suggested that the adult dose
lay between 4 and 10 g per day, but in
our experience only a very few tolerate
more than 5 g per day. The dose in
adults which is required to have an anti-
flammatory effect is 3 g per day
(Boardman and Hart, 1967).
Newer Salicylate Preparations.
Aloxiprin (Palaprin Forte) is a polymeric
condensation compound of aluminium oxide
and aspirin. This drug has been shown
to be undoubtedly effective and to cause
slightly less dyspepsia (Geller, 1968).
Sustained -release aspirin (Levius) is
in the form of microgranules, each
microgranule being coated with a thin
film of methylcellulose. There is some
evidence that there is reduction in
dyspepsia (Rotstein et al, 1967), but the
preparation has not proved too popular in
the United Kingdom because of its high
cost.
Safapryn consists of enteric-coated
aspirin surrounded by an outer coating of
paracetamol. The preparation causes
less dyspepsia than ordinary aspirin
(Maneksha, 1973) but it is not any more
effective (Lee et al, 1976).
Benorylate (Benoral) is a paracetamol
ester of acetylsalicylic acid. The drug
is absorbed intact from the gastrointestinal
tract and then rapidly metabilised into its
component metabolites (Robertson et al,
1972). There is no doubt from published
trials that the drug is effective, and that
is acceptable to patients in either liquid
or tablet form. In a study by Lee et al
(1976) 8g of benorylate per day was slightly
more effective than 3. 9g of enteric coated
aspirin, although the differences were not
marked. In our experience benorylate is
well tolerated by patients, and its only
drawback is that it is slightly more
expensive than simple salicylate prepara-
tions.
x) The name of the sword of the legendary
Welsh hero, King Arthur (Barber, 1973).
88