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Pro-Banthine for Hypertrophic Osteoarthropathy.

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LETTERS
1588
Corticosteroids in Cogan’s syndrome
To the Editor:
Although our paper on Cogan’s syndrome (1)
did not directly address itself to the problem of deafness, total deafness was the end result in both of our
reported cases despite liberal use of prednisone, 60 to
80 mg every day for 2 weeks, in each case. This finding
is at variance with that reported by Haynes et al in the
March 1981 issue of Arthritis and Rheumutism ( 2 ) .
One of our patients did respond to 60 mg
prednisone given daily beginning 18 hours after deafness occurred. However, on a subsequent occasion,
she remained totally deaf despite institution of the
same therapy 8 hours after onset.
Our other patient became totally deaf and remained so despite 80 mg prednisone daily for 2 weeks
begun 24 hours after onset.
I think we can agree that the therapy may be
beneficial, but very cautious optimism should be exerted. We agree with the caution expressed by Haynes
and his colleagues.
THOMAS
G . KANTOR,MD
New York University School ojMedicine
New York, N Y
1 . Gelfand ML, Kantor TG, Gorstein F: Cogan’s syndrome
with cardiovascular involvement: aortic insufficiency.
Bull NY Acad Med 48:647-660, 1972
2. Haynes BF, Pikus A, Kaiser-Kupfer M, Fauci A: Successful treatment of sudden hearing loss in Cogan’s
syndrome with corticosteroids. Arthritis Rheum 24501503. 1981
Pro-Banthine for hypertrophic
osteoarthropathy
To the Editor:
In the July 1980 issue of Arthritis and Rheumutism, Lopez-Enriquez et a1 (Lopez-Enriquez E, Morales AR, Robet F: Effect of atropine sulfate in pulmonary hypertrophic osteoarthropathy. Arthritis Rheum
23:822-824, 1980) described the use of atropine sulfate
in pulmonary hypertrophic osteoarthropathy ( 1). Their
patient had subjective improvement of joint symptoms
with the use of subcutaneous atropine, and he was
then switched to oral Pro-Banthine (propantheline
bromide). This is a preliminary report of the successful
use of Pro-Banthine by itself for symptomatic treatment of hypertrophic osteoarthropathy .
My patient is a 37-year-old man who has had
inflammatory bowel disease since 1973. lnitial treatment with high-dose corticosteroids was quite effective. Steroids were ultimately discontinued, and his
bowel disease has been only mildly active recently. In
addition, the patient has had chronic, active hepatitis
with cirrhosis and he has had three episodes of hepatic
encephalopath y .
In 1977, finger clubbing was noted and periosteal thickening of long bones was seen on roentgenogram. He was asymptomatic at that time and no
therapy was administered for this condition. In February 1980, he began to notice stiffness and aching in his
knees, and by April 1980, he had become markedly
disabled because of pain and swelling in the knees,
ankles, toes, wrists, and hands.
Initial treatment with Tylenol and Darvon was
not very successful. Treatment with antiinflammatory
agents was considered somewhat risky because of his
cirrhosis and the fear that even small amounts of
gastrointestinal bleeding might result in hepatic coma.
On October 6, 1980, he was started on Pro-Banthine 40
mg four times a day, and he described rather striking
results over the next 3 to 4 days. In mid-November,
Pro-Banthine was discontinued on a trial basis, and
after 2 days, the number of painful joints had increased, so Pro-Banthine was restarted. When seen on
December 19, 1980, he continued to have swelling of
knees and ankles, but grip strength had improved and
there was no active synovitis of small finger joints. His
only side effect has been slight dryness of his mouth.
He has continued to be symptomatically improved and
is able to work fulltime.
In many patients with hypertrophic osteoarthropathy, the underlying cause cannot be corrected and
symptomatic treatment becomes necessary. Therapeutic approaches that have been reported to be
successful in relieving symptoms include vagotomy,
adrenergic blockade, atropine, and nonsteroidal antiinflammatory drugs. This case documents the positive results with the use of Pro-Banthine, an oral
parasympathetic blocking agent.
HARVEYA. SCHWARTZ,
MD, FACP
Assistant Clinicul Professor of Medicine
Georgetown University
Washington, DC
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