In 1946, Aslan published her first research on Novocaine (1). In 1951, she studied the effect of procaine on experimental arthritis (2).

“After the first results with Novocaine injections, I tried this treatment on patients with arthritis and those with a tendency to ankylosis. Because these diseases are chronic, I administered novocaine for each patient with more injections. With great joy, I noticed an improvement in the local symptoms, and even more importantly a great improvement in their overall general condition. Before the treatment, the patients avoided any movement due to pain and now they were willing and wanting to walk, sitting up to read and talking. The biggest reward was noticing an increase in their interest in life and for their family”.

Aslan remembered, too: “On April 15, 1949- an American GI, with arthritis arrived in my clinic. He had terrible pains and his articulations were blocked. I explained to him my ideas about novocaine and after receiving his permission, I gave him an intra-arterial injection with 1-% novocaine. After 10 to 15 minutes, his knee was mobile and he could flex his leg outright. What happiness! I administered his treatment for a further two weeks and he was completely recovered” (3).

Clinical (5,6,7,8,9) and experimental studies (2,10) previously conducted by Aslan et al. have pointed out the effects of Gerovital-H3 ® therapy in arthritis. Concerning the chronic degenerating disease under the effect of the eutrophic Gerovital-H3 ® treatment, an obvious amelioration of the clinical signs was particularly noticed in osteoarticulary diseases (11,12,13). In a study performed in 1982 (4) on 2643 patients, Aslan noticed that it became evident that pains ceased in 62.2% of the patients, and articulary mobility and periarticulary muscular tonus were ameliorated in 51.8% of the cases. Repeated radiological examinations indicated a gradual amelioration of osteoporosis and other dystrophic osteoarticulary modifications.

I conducted a study on 100 elderly patients admitted to the National Institute of Gerontology and Geriatrics (NIGG) in Bucharest. They were aged 60 to 89 and suffering from moderate to severe arthritis involving one or more joints. Two groups of 50 patients were made up being very similar in age, sex and rheumatic diseases.

In both groups, arthritis involved more often the spine than the peripheral joints, in which hip-arthritis was slightly less prevalent than knee-arthritis, the latter being more frequent in women than men did. Patients with severe organ or system pathology were not included. No patient with abarticular rheumatism was included in the groups under study, nor patients with clinical, paraclinical or radiological signs suggesting another type of rheumatism, nor those having a positive test for the rheumatoid arthritis. I noted a significant number of patients suffered from Heberdenosis, which was much more frequent in women than in men.

Two reasons for admission of the patients included pains in the affected joints, limitation of movements, myalgia, joint swelling and declining muscular strength. The patients under study were divided into the following clinical forms who display joint pains persisting at rest; moderate limitation of movements (with 10% to 30% of the normal joint movement capacity; accompanying phenomena which point to ‘warm up’ arthritis processes-rubor, swelling, heat; reduction of joint space and the presence of osteophytes (diagnosed radiologically). Severe forms with marked pains; who display over 30% deficits of joint function; marked joint swelling; a certain degree of invalidity that forced the patient to use an aid such as a stick or frame- for walking.

Radiologically, the patients displayed reduction of joint space and osteophytosis.

The distribution of these two clinical forms was sensibly equal.

As far as associated morbidity of the patients is concerned, the obvious prevalence of cardio-vascular diseases was first followed in order by neuro-psychiatric, respiratory and digestive complaints.

Gerovital-H3 ® treatment was administered to the patients in the first group as follows: one i. m. injection daily in the morning for 18 days, followed by 12 days of Gerovital-H3 ® pills, twice daily: 9:00 A.M. and 4:00 P.M. Similarly, the patients in the second group received Placebo injections and pills. No other drug was given, nor any local therapy applied.

Treatment efficacy was assessed by comparing prior and post-treatment values of the following parameters recorded in all patients of the two groups:

• pain as a subjective parameter and its characteristics;
• joint mobility assessed by goniometry and movements based on tests specific to each joint;
• muscular tone by muscular check-up;
• accompanying phenomena: joint swelling, instability, crepitations;
• overall functional capacity of joints affected by arthritis.

Some parameters reflecting the patients’ general condition such as arterial blood pressure, cyrcadian rhythms and psychic state were also checked in parallel. In the two groups (Gerovital-H3 ® and Placebo) the clinical signs of progress was recorded as the following:

In the Gerovital-H3 ® group the following was recorded:

1. Pain: A remarkable alleviation in 34% of cases, satisfactory alleviation in 54% of cases and no effect in just 12% of the cases;
2. Joint Mobility: Improved in 56% of cases and remaining unchanged in the rest;
3. Muscular Tone: Improved in 41% of cases and no change in the rest.

I didn’t notice any side effects during the treatment with Gerovital-H3 ®.

For the Placebo group:

1. Pain: A satisfactory alleviation in only 11% of cases and no influence upon the remaining ones;
2. Joint Mobility: Improved in only 4% of cases and there was no change for the rest;
3. Muscular Tone: Unchanged in 100% of the patients.

Conclusions

Clinical symptoms dominated by pain and limitation of movements was positively influenced in the case of the first group of patients, (i.e. those under Gerovital-H3 ® treatment). Their psychic condition was obviously improved. The small amount of positive outcomes recorded in the patients from the second group, (i.e. the Placebo group) by the slight alleviation of joint pains can be explained in terms of the patients resting while hospitalized, which is likely to have diminished the degree of pain felt.

Previous studies carried out at the National Institute of Gerontology and Geriatrics in Bucharest have proved that Gerovital-H3 ® exerts a beneficial effect on the vascular, nervous and metabolic components involved in the genesis of degenerative rheumatism (4,6,7,8,10,11,12). The positive properties of Gerovital-H3 ® treatment can be explained as:

1. The antalgo action either controlling or reducing the pain caused by irritation of the nervous network from the spongious or by osteophitic presence;
2. The anti-inflammatory effect exerted through the AMPc, stimulated by the moderate rise in circulating catecholamine levels;
3. Improvement of capillary permeability and the favourable intervention in the bioenzymatic disorders at the level of the joint cartilage considered primum movens in the process of joint degeneration.
4. Gerovital-H3 ® can be the drug of choice in the management of arthritis in Geriatrics, because of its beneficial effects on the distressing, sometimes invalidating clinical phenomena and because of its paucity of side effects.

IAS Comments

Doses, contra-indications and side effects were described in the Gerovital-H3 ® monography of October 1998. Please ask for a copy if you have not received one.

REFERENCES

1. Aslan A., Rosenzweig S.: L’action de la novocaine injectee hans la veine chez l’homme. Bull. Acad. Med. Roumaine, 1946, 7, p. 891-900.
2. Aslan A. et al.: The effects of procaine on experimental arthritis induced in albino rats. Com. Acad. Romainia, 1950. 1, 11-12, p. 1110-1116.
3. Aslan A. et al.: Intra-atrerial treatment with procaine in arthritis. Bull. St. Acad. Bucharest, 1950, II, 7, p. 891.
4. Aslan A. et al.: Peculiarities of chronic degenerative rheumatism in the aged and the efficiency of Gerovital-H3 ® therapy. Romanian J. Geront. & Geriatrics, 1982, 3, 1, 3-13.
5. Aslan A., David C.: Ergebnisse der Novocainbehandlung-Stoff H3- bei dysmetabolischen Arthropathien. Therapie Woche-Karlsruhe, 1957, 8, 19-23.
6. Aslan A.: Longitudinal Study in the National Institute of Gerontology & Geriatrics of Romania. J. Geront. & Geriatrics. 1980, 1, 2, 179-187.
7. Aslan A. et al.: The Parenteral Therapy with Gerovital-H3 ® in the Aged with Degenerative Rheumatism. Romanian J. Geront. & Geriatrics. 1983, 4, 3, 151-158.
8. Barsan M., Rodica P.: Cervical Spondylodiskarthrosis in the Elderly and Gerovital-H3 ® Treatment. Romanian J. Geront. & Geriatrics. 1985, 6, 1, 35-42.
9. Aslan A.: The Therapeutics of Old Age. The Action of Procaine. Congr. of the Intern. Assoc. of Geront., 1960, San Francisco. Medical and Clinical Aspects of Aging. H. T. Blumenthal, Ed., Columbia Univ. Press, New York, USA, 1962, 4, p. 272-292.
10. Matei V.Cet al.: The Effects of Gerovital-H3 ® Treatment on Antigen-Induced Arthritis in Rabbits. Romanian J. Geront. & Geriatrics. 1984, 5, 1, 55-63.
11. Aslan A., David C. et al.: Gerovital-H3 ® Original Product. Ed. Ministry of Chemical Industry. Bucharest, 1977.
12. Aslan A.: Theoretical Bases of Procaine Therapy in the ‘Prophilaxis of Ageing. Romainan J. Geront. Geriatrics. 1980, 1, 1, 5-15.
13. Dumitru M. et al.: Double Blind Study on Gerovital-H3 ® Treatment in the Elderly with Arthritis. Romanian J. Geront. Geriatrics. 1985, 6, 4, 257-263.

P