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Treatment with oral enzymes in painful osteoarthritis of the knee and periarthritis of the shoulder

Kullich W.*, Klein G.**. Treatment with oral enzymes in painful osteoarthritis of the knee and periarthritis of the shoulder. Reumatologia 1998, Suppl Vol. XXXVI, Warsaw 1998, Lectures No. 213, pp 111-114. ISSN 0034-6233. 619 KA (19-09-2)
* Ludwig Boltzmann Institute for Rehabilitation of Internal Diseases, Saalfelden, Austria. ** Rehabilitation Centre for Rheumatic and Cardiovascular Diseases, Saalfelden, Austria. 2nd Central European Congress of Rheumatology, 13-16 May, 1998, Warsaw, Poland



40 patients with periarthropathia tendopathica simplex, aged between 38 and 68 years, were observed. The patients took double-blind randomized the non-steroidal antiinflammatory drug diclofenac in a dosage of 2 x 50 mg daily or oral enzymes (Phlogenzym®; Mucos Pharma GesmbH., Germany) in a dosage of 3 x 2 enteric coated tablets daily, consisting of 90 mg bromelain, 48 mg trypsin and 100 mg of the flavonoid rutosid which normalizes pathologically increased vessel permeability without inhibiting the endogenous defensive power.
The randomization resulted in a patients' group with enzyme treatment of 12 men and 8 women with an average age of 54.5 years and a group with diclofenac treatment of 12 men and 8 women with an average age of 51.9 years.
Examinations were made at the beginning and after 1, 2 and 3 weeks of therapy.
For judgement of efficacy, a sum score of four different types of pain (pain on rest, pain on motion, pain on pressure, night pain) and functional impairment was compared.
In our second study 73 patients (36 male, 37 female; 52,0 + 9,1 years of age) with symptomatic OA of the knee and radiographic evidence of joint space narrowing and osteophyte were recruited. A patients sum score of the Lequesne's index > 10 was demanded.
The study was performed double-blind randomized with a three weeks medication.
Due to the "double blind" method, 37 patients were treated with 50 mg diclofenac sodium 3 times daily.
(TID) during the first week, followed by a dosage of 50 mg diclofenac sodium twice a day (BID) during week 2 and 3, in order to improve the gastroduodenal tolerance. Those patients additionally got "enzyme placebo" tablets. 36 patients were treated with 2 enzyme tablets TID during the whole period. These tablets were an enteric coated enzyme preparation as mentioned in the former presented study of . The "double blind" method required an additional application of "diclofenac placebo" in this group. In both groups the therapy was continued with 2 enzyme tablets TID during the weeks 4-7.

 [See Summary of Study Report]