For Creaky Joints

For the estimated 7,000,000 Americans who suffer from aching, creaky, inflamed or stiffened joints there were two important pieces of news at last week's meeting of the American Rheumatism Association in Chicago. Not so good was the experts' consensus on hydrocortisone (Compound F), which some Philadelphia doctors had praised to the skies for thawing out joints frozen by arthritis: its usefulness is limited and it is far too expensive. The good news was that a cheap drug (one-third the price of cortisone) has been found which relieves pain in most cases of arthritis and also in gout.

As often happens, the new pain reliever was discovered by accident. The venerable (est. 1764) Swiss pharmaceutical house of Geigy Co. was trying to find a solvent for the almost insoluble painkiller, Pyramidon. Geigy chemists hit upon phenylbutazone, which worked well as a solvent and then paid a big bonus: it turned out to have remarkable painkilling qualities of its own. Geigy started churning out phenylbutazone (from coal tar) for research.

Unlike cortisone, phenylbutazone is not a hormone, and it does not seem to arrest the disease process in arthritis. But it has one huge advantage over ACTH and cortisone: its benefits are not limited to the 10% of arthritis sufferers who have the rheumatoid form of the disease. Instead, it seems to work equally well in the far commoner osteoarthritis (also called degenerative arthritis), which usually comes with old age, and in the crippling arthritis of the spine.

In a vast majority of more than 600 patients studied in Manhattan and San Francisco, doctors found that phenylbutazone gave these results:

P: Marked relief from pain within three days.

P: Great improvement in mobility of joints.

P: Reduction of local inflammation.

However, phenylbutazone's effects (like cortisone's) do not last long after the drug is withdrawn. The dosage, usually three or four tablets daily, at a cost of 50^-c- to 75-c-, must be continuous for long-lasting benefit. And phenylbutazone also has some annoying side effects: one patient out of four has suffered nausea, hives or water retention. As a result, one out of twelve has had to discontinue the drug; the rest have been able to go on with it, taking antihistamine or alkalis to control the side effects. In any case, say the doctors, phenylbutazone must be given only under close supervision.

In gouty arthritis, said Manhattan's Dr. Estes C. Kidd,. phenylbutazone has shown "remarkable effects," and appears to combine the virtues of colchicine and Benemid, the two best drugs up to now. For the whole range of joint disorders, said Dr. Cornelius Traeger, it is "the most potent non-narcotic analgesic we have."

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