Rheumatoid arthritis nonsteroidal anti-inflammatory drugs

The salicylates and nonsteroidal anti-inflammatory drug (NSAIDs) are important in the treatment of arthritic conditions. For example, the salicylates and NSAIDs are used in the treatment of rheumatoid arthritis (a chronic disease characterized by inflammatory changes within the body s connective tissue) and osteoarthritis (a noninflammatory joint disease resulting in degeneration of the articular cartilage and... 

Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis The CLASS study A randomized, controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000 284 1247-1255. 

A. Muhlberg, C. Linz, E. Bern, L. Tucker, M. Ver-have, and R. Grand, Identifaction of nonsteroidal anti-inflammatory drug induced gastrointestinal injury in children with juvenile rheumatoid arthritis, J. Pediatr, 122, 647 (1993). 

COX-2 Inhibitor Celecoxib (Celebrex, Pfizer) inhibits the enzyme COX-2, which is involved in pain and inflammation, but it has no effect on the COX-1 enzyme, which helps to maintain stomach lining. It is prescribed for the relief of pain and symptoms of osteoarthritis and rheumatoid arthritis. Previously, nonsteroidal anti-inflammatory drugs (NSAIDs) were used. NSAIDs inhibit both COX-1 and COX-2 enzymes and cause stomach bleeding (see Case Study 2). 

As was already mentioned, piroxicam also is a nonsteroidal, anti-inflammatory drug. It is used in inflammatory and degenerative diseases of the musculoskeletal system that are accompanied by painful symptoms. It is used for rheumatic heart disease, nonspecific infectious polyarthritis, gouty arthritis, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, arthrosis, back pain, nenralgia, myalgia, and other diseases associated with inflammation. Synonyms for piroxicam are feldene, dexicam, roxenan, and others. 

Nonsteroidal anti-inflammatory drug (NSAID)-associated gastric ulcers For reducing the risk of NSAID-associated gastric ulcers in patients with a history of documented gastric ulcer who require the use of an NSAID for treatment of the signs and symptoms of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. 

Rheumatoid arthritis (RA enteric-coated tablets) Treatment of patients with RA who have responded inadequately to salicylates or other nonsteroidal anti-inflammatory drugs (NSAIDs). 

Seed oil, administered orally to 10 patients with rheumatoid arthritis at a dose of 20 mL/ day for 12 weeks, produced mixed clinical results. The patients abstained from nonsteroidal anti-inflammatory drugs during the trial period. Thromboxane B-2 level increased in four patients " . 

K. M. Verburg, and G. S. Geis. 2000. Gastrointestinal Toxicity with Celecoxib vs Nonsteroidal Anti-inflammatory Drugs for Osteoarthritis and Rheumatoid Arthritis The CLASS Study A Randomized Controlled Trial. JAMA 284 1247-1255. 

Clinical use Diflunisal (Brogden et al., 1980) is a nonsteroidal anti-inflammatory drug used in the treatment of mild to moderate pain including osteoarthritis, rheumatoid arthritis and primary dysmenorrhoea. It is used as base or lysine- or arginine-salt for oral or parenteral application. 

Clinical use Ibuprofen (Busson, 1986) is a nonsteroidal anti-inflammatory drug, commonly used for the treatment of mild to moderate pain. It is used in conditions like rheumatoid arthritis, osteoarthritis, joint and soft tissue pain, dental pain, postoperative pain, dysmenorrhoea and headache, including acute migraine attacks. 

Clinical use Ketoprofen (Hommeril et al., 1994) is a nonsteroidal anti-inflammatory drug used for the treatment of a variety of acute and chronic pain and inflammatory conditions including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, postoperative pain and dysmenorrhoea. It is given by oral, rectal, topical or intramuscular application (100-200 mg/day, maximal dose 300 mg/day) as the sodium or lysine salt. 

Clinical use Niflumic acid (Auclair et al., 1989) is a nonsteroidal anti-inflammatory drug used for the treatment of inflammation and pain in musculoskeletal and joint disorders such as rheumatoid arthritis as well as traumatic and postoperative pain. Niflumic acid is used in oral, rectal or topical preparations (up to 750 mg/day). 

Wienecke T, Gotzsche PC. Paracetamol versus nonsteroidal anti-inflammatory drugs for rheumatoid arthritis. Cochrane Database Syst Rev. 2004 CD003789. 

Methotrexate is also used in the treatment of rheumatoid arthritis (Chapter 36 Nonsteroidal Anti-Inflammatory Drugs, Disease-Modifying Antirheumatic Drugs, Nonopioid Analgesics, Drugs Used in Gout) and psoriasis. 

Singh G, Ramey DR, Morfeld D, Shi H, Hatoum HT, Fries JF. Gastrointestinal tract comphcations of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observational cohort study. Arch Intern Med 1996 156(14) 1530-6. 

Upadhyay R, Howatson A, McKinlay A, Danesh BJ, Sturrock RD, Russell RI. Campylobacter pylori associated gastritis in patients with rheumatoid arthritis taking nonsteroidal anti-inflammatory drugs. Br J Rheumatol 1988 27(2) 113-16. 

VoutUainen M, Sokka T, Juhola M, Farkkila M, Hannonen P. Nonsteroidal anti-inflammatory drug-associated upper gastrointestinal lesions in rheumatoid arthritis patients. Relationships to gastric histology, Helicobacter pylori infection, and other risk factors for peptic ulcer. Scand J Gastroenterol 1998 33(8) 811-16. 

Caselli M, Pazzi P, LaCorte R, Aleotti A, Trevisani L, Stabellini G. Campylobacter-like organisms, nonsteroidal anti-inflammatory drugs and gastric lesions in patients with rheumatoid arthritis. Digestion 1989 44(2) 101-4. 

SUverstein FE, Graham DY, Senior JR, Davies HW, Struthers BJ, Bittman RM, Geis GS. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-con-troUed trial. Ann Intern Med 1995 123(4) 241-9. 

Altman RD, Perez GO, SfakianakisGN. Interaction ofcyclosporine Aand nonsteroidal anti-inflammatory drugs on renal function in patients with rheumatoid arthritis. Am J Med 1992 93 396-402. 

---