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AB0064 Comparative evalution of oral enzymes versus standard therapy in aspect to efficacy and tolerability in treatment of rheumatoid arthritis and juvenile idiophatic arthritis
  1. M Zeibarts1,
  2. I Purvinsh1,
  3. H Mikazhane2,
  4. R Shantere3,
  5. V Stanevicha3,
  6. A Scegolevs3
  1. 1Department of Pharmacology, University Children Hospital
  2. 2Centre of Rheumatology
  3. 3Department of Rheumatology, University Children Hospital, Riga, Latvia


Background Tolerability and side effects of standard therapy used in rheumatology are the most serious problem, especially if treatment must be started in early age. Gastrointestinal endoscopies allow to detect injury of gastrointestinal mucosa in up to 75% patients, who are using NSAIDs over longer period. Adjuvant treatment with omeprazol or nizoprostol raises the cost of treatment. For this purpose oral enzymes (OE) can be used in treatment of joint diseases, as they possess the properties of both basic medications and antiinflammatory drugs. Oral enzymes – Phlogenzym allow to refuse from NSAIDs or to shorten the course of NSAIDs.

Objectives The goal of the present evaluation was to assess the efficacy and tolerability of Phlogenzym in treatment of joint diseases;1) versus NSAIDs, 2) versus DMARDs.

Methods We evaluated total 86 patients of both genders with first time diagnosed illness. 40 RA patients aged between 20 – 62 years: 20 patients got DMARDs and Phlogenzym,20 patients got DMARDs and NSAIDs. 46 JIA patients aged between 7 – 17 years: 23 patients got Phlogenzym and shorter course of NSAIDs, 23 patients got standard therapy DMARDs and shorter course of NSAIDs.


  1. after the RA patients treatment during 4 months the efficacy of combined treatment with DMARDs and OE was estimated as superior 84% versus DMARDs and NSAIDs as 75%. Integrative tolerability rate was in RA treatment as 3,8 vs. 3,6.

  2. after the JIA patients treatment during 3 months the efficacy of combined treatment with OE and NSAIDs was estimated as superior 70% versus DMARDs and NSAIDs as 53%. Integrative tolerability rate was in JIA treatment identical.

ResultsOtherwise we obtained elimination of Helicobater pylori after adequate treatment in all 7 Helicobacter pylori (+) cases in JIA patients treated with OE, healing of duodenal ulcer in 1 patients and healing of erosive gastritis in 3 patients. Among 5 Helicobacter pylori (+) patients treated with DMARDs and NSAIDs only 1 became Helicobacter pylori (-) after same “Tripl” therapy (Amoxicillinum, Metronidazolum, Ranitidinum/Omeprazolum).

Conclusion Our evaluation corresponding to the judgements given by the doctors concerning efficacy and tolerability to tested drugs shows that treatment with Phlogenzym was safe and more effective.

According to these results it can be stated that OE is the group of medicines, which may be used for substitution of DMARDs or NSAIDs considering to course of disease and concomitant pathologies.

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