Aspirin rheumatoid arthritis

Uses. Aspirin has analgesic, antiinflammatory, and antipyretic activity. It is used for the reHef of less severe types of pain, such as headache, neuritis, acute and chronic rheumatoid arthritis, and toothache. Aspirin can be purchased in a variety of OTC and prescription dosage forms made and formulated by many companies. Tablets, ie, buffered, plain, or enteric-coated, are the most familiar in the United States, but other forms such as powder and effervescent formulations are of considerable importance in other parts of the world. 

CH, a 42-year-old man, comes into the emergency department after his sister discovered him seizing at home. He has a history of hypertension, diabetes, epilepsy, and rheumatoid arthritis. His medications include hydrochlorothiazide, gly-buride, phenytoin, and aspirin. He smokes one pack per day, drinks heavily on the weekends, and has a history of cocaine use. Upon further discussion with his sister, you discover that he stopped taking his phenytoin 4 days ago due to failure to obtain a refill from his doctor. He is currently unarousable since his last seizure 10 minutes ago. 

Aspirin in doses used to treal rheumatoid arthritis can result in uncoupling of oxidative phosphorylation, increased oxygen consumption, depletion of hepatic glycogen, and the pyref c effect of toxic doses of salicylate. Depending on the degree of salicylate intoxication, the symptoms can vary from tinnitus to pronounced CNS and acid-base disturbance. 

Benorylate (315) [4 -(acetamido)phenyl-2-acetoxybenzoate] is another example. It is the ester between two well-known antiinflamatory drugs, aspirin and paracetamol, and is employed in rheumatoid arthritis therapy. In view of the chemical structure with three photolabile groups (two esters and one amide), its possible phototoxicity has been investigated. From the preparative irradiations, it has been concluded that the PFR takes place with breaking of the central C—O bond to yield 5-acetamido-2 -acetoxy-2-hydroxybenzophenone (316). This product undergoes transacetylation to 5 -acetamido-2 -acetoxy-2-hydroxy-benzophenone (318) (Scheme 80) [300]. 

An important class of compounds that have members from both prescription and over-the-counter drugs are those that relieve pain. Aspirin is a common type of analgesic. It is also an antipyretic, that is, it lowers abnormally high body temperatures. A third use is in reducing inflammation caused by rheumatic fever and rheumatoid arthritis. Salicylic acid has been known for its analgesic properties since the early 1800s. Kolbe and... 

Diclofenac possesses all of the properties unique to the series of propionic acid drugs, yet in terms of anti-inflammatory and analgesic strength it exceeds that of aspirin, analgin, and ibnprofen. It is used in acnte rheumatism, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, arthrosis, back pain, neuralgia, and myalgia. It rarely causes side effects. The most common synonym is voltaren. 

Aspirin and related salicylates are the primary treatment for mild to moderate pain, such as that associated with headache, joint and muscle pain, and dysmenorrhea. At higher doses aspirin is an effective analgesic in rheumatoid arthritis (see Chapter 36). The analgesic effects of salicylates are thought to be due to the inhibition of prostaglandin synthesis in the periphery and to a less well documented mechanism at cortical areas. 

The arylpropionic acid derivatives are useful for the treatment of rheumatoid arthritis and osteoarthritis, for reduction of mild to moderate pain and fever, and for pain associated with dysmenorrhea. Side effects of the drugs are similar to but less severe than those described for the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions when taking ibuprofen and related drugs. Acute hypersensitivity to ibuprofen has been reported in patients with lupus. The hypersensitivity reaction to sulindac can be fatal. The use of sulindac has also been linked to cases of acute pancreatitis. The use of dimethylsulfoxide (DMSO) topically in combination with sulindac has been reported to induce severe neuropathies. The concurrent use of ibuprofen with aspirin reduces the antiinflammatory effects of both drugs. Ibuprofen is contraindicated in patients with aspirin sensitivity leading to bronchiolar constriction and in patients with an-gioedema. As with all NSAIDs, renal and liver function should be normal for adequate clearance of the drugs. 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

Tolmetin (Tolectin) is indicated for the relief of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and moderate pain. It is ineffective in gouty arthritis for unknown reasons. Tolmetin can inhibit both COX-1 and COX-2 but has a moderate selectivity for COX-1. The most frequently reported side effects are GI disturbance and CNS reactions (e.g., headache, asthenia, and dizziness). These effects are less frequently observed than after aspirin or indomethacin use. Blood pressure elevation, edema, and weight gain or loss have been associated with tolmetin administration. Tolmetin metabolites in urine have been found to produce pseudoproteinuria in some laboratory tests. 

Fenoprofen (Nalfon) is chemically and pharmacologically similar to ibuprofen and is used in the treatment of rheumatoid arthritis, osteoarthritis, and mild to moderate pain. GI effects such as dyspepsia and pain are most common, although dizziness, pruritus, and palpitations may occur. GI bleeding, sometimes severe, has been reported, and interstitial nephritis has been rarely associated with this drug. Concomitant administration of aspirin decreases the biological half-Ufe of fenoprofen by increasing the metabolic clearance of hydroxy-lated fenoprofen. Chronic administration of pheno-barbital also decreases the drug s half-life. 

Two pyrrole derivatives bearing a significant structural resemblence to indomethacin are tolmetin (10) and chlopirac (11) (78MI30600, 76MI30600). Tolmetin has received clinical comparison with aspirin and with indomethacin in rheumatoid arthritis and generally was found to have comparable effectiveness, but a somewhat diminished tendency to cause lesions in the digestive tract. Like indomethacin, it seems to function as a prostaglandin synthetase inhibitor. 

Special interest in the prostaglandins has focused on pain of inflammation and allergic responses. The medical significance is easy to see. Five million Americans have rheumatoid arthritis, an inflammatory disease. Bronchial asthma and other allergic diseases are equally important. Our most common medicine is aspirin, an anti-inflammatory drug. Both the inflammatory response and the immune response are normal parts of the defense mechanisms of the body, but both are potentially harmful, and it is their regulation that is probably faulty in rheumatoid arthritis and asthma. Overproduction of prostaglandins may be a cause of menstrual cramps.308... 

ASPIRIN. [CAS 50-78-2]. A drug used for nearly a century to relieve headaches and geneial aches and pains and to leduce the swelling and pain associated with joints (gout, ague, rheumatoid arthritis). In recent years, attention to aspirin for its apparent role m reducing heart attacks (coronary thrombosis) and strokes has increased, Trial studies also are underway for its use in reducing the risk of fatal colon cancer. 

A 47-year-old woman developed a gastrocolic fistula during treatment with aspirin (dosage and duration of therapy not stated) and prednisone for chronic rheumatoid arthritis (148). 

Aspirin and other NSAIDs are effective in treating mild-to-moderate pain of various origins, including headache, toothache, and diffuse muscular aches and soreness. Aspirin appears to be especially useful in treating pain and inflammation in musculoskeletal and joint disorders.71,87,89 The safe and effective use of aspirin in both rheumatoid arthritis and osteoarthritis is well documented (see Chapter 16).53,66,84 Aspirin is also recommended for treating the pain and cramping associated with primary dysmenorrhea.70... 

Rheumatoid arthritis and osteoarthritis represent two distinct forms of joint disease that can produce devastating effects on the structure and function of synovial joints. Fortunately, management of these conditions has improved substantially through advancements in drug therapy. Rheumatoid arthritis can be treated pharmacologically with NSAIDs, glucocorticoids, and various DMARDs. NSAIDs, including aspirin, repre-... 

Aspirin is employed for mild to moderate pain of varied origin but is not effective for severe visceral pain. Aspirin and other NSAIDs have been combined with opioid analgesics for treatment of cancer pain, where their anti-inflammatory effects act synergistically with the opioids to enhance analgesia. High-dose salicylates are effective for treatment of rheumatic fever, rheumatoid arthritis, and other inflammatory joint conditions. 

The efficacy of flurbiprofen at dosages of 200-400 mg/d is comparable to that of aspirin and other NSAIDs in clinical trials for patients with rheumatoid arthritis, ankylosing spondylitis, gout, and osteoarthritis. It is also available in a topical ophthalmic formulation for inhibition of intraoperative miosis. Flurbiprofen intravenously has been found to be effective for perioperative analgesia in minor ear, neck, and nose surgery and in lozenge form for sore throat. 

As discussed in Section 5.4.4, individuals consuming large quantities of antacid formulations, anti-ulcerative medications, buffered analgesics, or antidiarrheal medications are exposed to higher than background doses of aluminum in their diet. Lione (1985a) estimated that from 126 to 728 mg and 840 to 5,000 mg were possible daily doses of aluminum consumed in buffered aspirins for rheumatoid arthritis and antacid products, respectively. These doses are from 6 to 40 times and 42 to 250 times greater, respectively, than aluminum doses obtained from consumption of foods (20-24 mg/day). 

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