Systemic lupus erythematosus presenting as polymyalgia rheumatica.

weeks. All patients were given intra-articular injections of saline or 1% procaine solution, or both, for control observations, before receiving phenylbutazone. Of the 11 patients with osteoarthritis who received 34 intra-articular injections, one derived major improvement, seven derived slight to moderate improvement, and three failed to benefit. Of 18 patients with rheumatoid arthritis, given 45 intra-articular injections, seven obtained major benefit, seven slight to moderate improvement, and four failed to respond. The only adverse effect was transient local discomfort described as a 'burning' sensation that occurred during and after the injection in approximately half of the patients. Synovial fluid showed a significant decrease in the white blood cell count in five of 10 fluids examined one to two weeks after injection. When synovial fluid was removed shortly after the phenylbutazone injection, however, examination disclosed severe disintegration of the white cells, making a differential count impossible. To summarise, although intra-articular injections of phenylbutazone may produce a beneficial response, the drug causes local irritation and offers no therapeutic advantage compared with corticosteroids. Incidentally, if the authors had recommended a strict postinjection rest regimen, the use of this technique might have facilitated a beneficial response, especially in some of their patients reportedly unresponsive to conventional steroid joint injections)