Studies on the superoxide generating system, superoxide dismutase and lipoperoxide in rheumatoid arthritis Part Ⅱ Trial of Cepharanthin (biscoclaurine alkaloid) -intraarticular injection in the treatment of rheumatoid arthritis -including influence of Cepharanthin (biscoclaurine alkaloid) on lipoperoxide level, synovial fluid superoxide dismutase activity and synovial fluid leucocyte superoxide dismutase activity-

Cepharanthin was administered intraarticularly to rheumatoid arthritis (RA) patients who showed no beneficial response to intraarticular RA treatment. Joint symptoms, volume, leucocyte counts, relative viscosity, lysosomal enzyme activity, C-reactive protein concentration, lipoperoxide level, superoxide dismutase (SOD) activity of synovial fluid and SOD activity of synovial fluid leucocytes were tested before and after intraarticular injection of Cepharanthin. Furthermore the therapeutic effects on hydroarthrosis were investigated. I divided these RA patients into three groups. Group 1 consisted of patients who received only Cepharanthin-intraarticular injection. Group 2 consisted of patients who received Cepharanthin-intraarticular injection and corticosteroid-intraarticular injection about one week later. Group 3 consisted of patients who received simultaneous intraarticular injection of both Cepharanthin and corticosteroid. The results are summarized as follows: 1) The decrease of knee puncture frequency and the reduction of synovial fluid volume were prominent in 5 out of 9 (55.5% ) cases in Group 1, 5 out of 5 (100% ) cases in Group 2, and 4 out of 4 (100% ) cases in Group 3. 2) Cepharanthin had no effect on leucocyte counts, relative viscosity, lysosomal enzyme activity or C-reactive protein concentration. 3) Cepharanthin had no effect on lipoperoxide level, synovial fluid SOD activity or synovial fluid leucocytes SOD activity. 4) All four cases who had Cepharanthin of 20mg or 30mg injection experienced a post-injection flare up-like phenomenon. Three out of 14 (21.4% ) cases who had Cepharanthin 10mg experienced a slight postinjection flare up-phenomenon. Postinjection flare up-like phenomena did not appear in Group 3. 5) Simultaneous intraarticular injection of both Cepharanthin of 10mg and corticosteroid was the most effective method. It was considered that simultaneous intraarticular injection of both Cepharanthin 10mg and corticosteroid was a useful measure for treatment of the so-called wet type of RA.