Acetaminophen rheumatoid arthritis

Acetaminophen (Tylenol) is an effective antipyretic and analgesic that is well tolerated at therapeutic doses. It has only weak antiinflammatory activity thus, it is not useful in the treatment of rheumatoid arthritis and other inflammatory conditions. The properties of acetaminophen are described in Chapter 26. 

Finally, acetaminophen (paracetamol) products may provide some temporary analgesic effects in people with rheumatoid arthritis, but these products are not optimal because they lack anti-inflammatory effects. As discussed in Chapter 15, acetaminophen can be used to treat mild-to-moderate pain, but the lack of anti-inflammatory effects makes acetaminophen fall short of NSAIDs for conditions such as rheumatoid arthritis. Hence, patients with rheumatoid arthritis usually prefer the effects of NSAIDs to acetaminophen,110 and acetaminophen products are not typically used for the routine treatment of this disease. 

Drug treatment of osteoarthritis differs somewhat from that of rheumatoid arthritis, with management of pain by using NSAIDs and acetaminophen constituting the major forms of drug therapy. A newer technique known as viscosupplementation has also been used to help restore the lubricating properties of... 

The nonnarcotic analgesics are widely used as nonprescription drugs. They are also efficient for the relief of mild pain and symptoms of rheumatoid arthritis [9], For example, acetaminophen, 15, sold under the trade name Tylenol, is a widely used nonprescriptive drug. Acetaminophen is usually prepared by reacting p-aminophenol with a mixtime of glacial acetic acid and acetic anhydride [8]. 

Comparative studies with acetaminophen indicate that metabolism in the hamster resembles more closely that in man than in mouse. d-Limonene (32) is metabolized in rat, rabbit and hamster preferentially to C-l carboxylic acid derivatives, whereas dog and man largely form the 8,9-diol, and the guinea pig metabolizes 32 by these two pathways to the same extent . Compound 41 is substantially oxidized by rat and guinea pig, but not man, to biphenylacetic acid this possibly explains the ineffectiveness of 41 in rheumatoid arthritis . Sedative-hypnotic 42 is N-hydroxvIated in the cat, a more... 

Acetaminophen (paracetamol JV-acetyl-p-aminophenoF, TYLENOL, others) is an effective alternative to aspirin as an analgesic-antipyretic agent however, its anti-inflammatory effects are much weaker. While it is indicated for pain relief in patients with noninflammatory osteoarthritis, it is not a suitable substitute for aspirin or other NSAIDs in chronic inflammatory conditions such as rheumatoid arthritis. Acetaminophen is well tolerated and has a low incidence of GI side effects. It is available without a prescription. Acute overdosage can cause severe hepatic damage, and the number of accidental or deliberate poisonings with acetaminophen continues to grow. Chronic use of less than 2 g/day is not typically associated with hepatic dysfunction. 

Acetaminophen does not irritate the intestinal tract and yet has comparable analgesic (pain-relieving) and antipyretic (fever-reducing) effects. Acetaminophen is available in a stable liquid form suitable for administration to children and other patients who have difficulty taking tablets or capsules. Unlike aspirin, acetaminophen has virtually no anti-inflammatory effect and is therefore a poor substitute for aspirin in the treatment of inflammatory disorders such as rheumatoid arthritis. The overuse of acetaminophen has been linked to liver and kidney damage. 

In a 24-week multicenter study enrolling 88 patients with active rheumatoid arthritis refractory to conventional treatment leflxmomide treatment was added to regular therapy (low-dose prednisone <10mg/day methotrexate >12.5mg/week and NSAIDs or acetaminophen). Of the 88 patients, eight patients withdrew due to adverse events, of which four were due to elevation of transaminases. Abnormal aspartate aminotransferase or alanine aminotransferase levels were seen in 35% and 48% of patients respectively [75 ]. 

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