Rheumatism

Review Problem 5 Brufen (TM 80), Boots anti-rheumatic compound, is one of Britain s top ten drugs. How could it be made ... 

Rheology Rheology of foam Rheometer Rheopexy Rheosyst Rheotron Rheovibron Rheumatic fever Rheumatoid arthritis... 

Rheumatic disorders and coUagen diseases Ophthalmic, otic, and nasal disorders Dermatologic diseases Respiratory diseases... 

The sulfas also remain clinically useful in the treatment of chancroid, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, and the fungus-related nocardiosis (7). In combination with pyrimethamine, they are recommended for toxoplasmosis (8) and have been used for chloroquine-resistant falciparium malaria (4,9). There has also been some use of sulfas for the prophylaxis of rheumatic fever. The sulfone, dapsone, remains an accepted treatment for all forms of leprosy (4). 

Implantable valves, particularly mechanical valves which continue to encroach on tissue valves, are unique. Methods such as valvuloplasty, mitral valve repair, or use of ultrasound are unlikely to reduce the number of valve replacements into the twenty-first century. Valve selection remains in the hands of the surgeon because of the critical nature of the procedure. If anything goes wrong, the result can be catastrophic to the patient. Cost of a valve, from 3000— 4000, is a relatively small part of the cost of open-heart surgery which can mn as high as 30,000. Growth of the cardiovascular valve market has slowed in the United States with the decline of the threat of rheumatic fever. 

A large number of salts of sahcyhc acid have been prepared and evaluated for therapeutic or other commercial use. Table 7 hsts those most frequently referenced. Sodium sahcylate has analgesic, antiinflammatory, and antipyretic activities and was used extensively in the sixteenth and seventeenth centuries as a remedy, prepared from natural sources, for arthritis and rheumatism. In the 1990s the salt can be obtained directly from Kolbe-Schmitt carboxylation or by the reaction of sahcyhc acid with either aqueous sodium bicarbonate or sodium carbonate. The resulting mixture is heated until effervescence stops the salt is then isolated by filtration and evaporation to dryness at low temperatures. Generally, the solution must be kept slightly acidic so that a white product is obtained if the mixture is basic, a colored product results. The USP product contains 99.5—100.5% NaC H O (anhydrous). The May 1996 price was 8.15/kg (18). 

As a pharmaceutical, methyl salicylate is used in liniments and ointments for the relief of pain and for rheumatic conditions. As a flavor and fragrance agent, it is used in confectioneries, dentifrices, cosmetics, and perfumes. Other commercial applications for methyl salicylate are as a dye carrier, as a uv-light stabilizer in acrylic resins, and as a chemical intermediate. The May 1996 price was 5.50/kg (18). 

Folic acid deficiency Hyperthermia Phenylketonuria Rheumatic disease Virilizing tumors Drugs and chemicals Androgenic chemicals Angiotensin-converting enzyme inhibitors Captopril, enalapril Antibiotics... 

Disease-modifying Anti-rheumatic Drugs (DMARDs)... 

NSAIDs Non-steroidal anti-rheumatic dmgs NSAR (aspirin-like dmgs, Inflammation)... 

Various pain states (e.g. headache, toothache and migraine), primarily pathophysiological inflammatory pain, e.g. rheumatic pain and pain caused by bone metastases... 

Indomethacin treatment is associated with a high incidence (30%) of side effects typical for those seen with other NSAIDs (see above). Gastrointestinal side effects, in particular, are more frequently observed after indomethacin than after administration of other NSAIDs. The market share of indomethacin ( 5%) is therefore low compared to that for other non-steroidal anti-rheumatic agents. 

Oxicams, e.g. piroxicam, tenoxicam, meloxicam and lornoxicam are non-specific inhibitors of COX. Like diclofenac, meloxicam inhibits COX-2 ten times more potently than COX-1. This property can be exploited clinically with doses up to 7.5 mg per day, but at higher doses COX-1-inhibition becomes clinically relevant. Since the dose of meloxicam commonly used is 15 mg daily, this agent cannot be regarded as a COX-2-selective NS AID and considerable caution needs to be exercised when making comparisons between the actions of meloxicam and those of other conventional NSAIDs. The average daily dose in anti-rheumatic therapy is 20 mg for piroxicam and tenoxicam, 7.5-15 mg for meloxicam and 12-16 mg for lornoxicam. Oxicams have long elimination half-lives (lornoxicam 3-5 h, meloxicam - 20 h, piroxicam 40 h and tenoxicam 70 h). 

The treatment approach to RA has undergone a major evolutionary change in recent years with a move away from predominantly symptomatic treatment approaches towards much earlier intervention with diseasemodifying anti-rheumatic drug (DMARD) therapy and... 

Arnett FC et al (1988) The American Rheumatism Association. 1987 revised criteria for classification of rheumatoid arthritis. Arthritis Rheum 31 315—324... 

Treatment of inflammatory conditions, such as rheumatoid arthritis, osteoarthritis, and rheumatic fever ... 

The skeletal muscle relaxants are contraindicated in patients with known hypersensitivity. Baclofen is contraindicated in skeletal muscle spasms caused by rheumatic disorders. Carisoprodol is contraindicated in patients with a known hypersensitivity to meprobamate. Cyclobenzaprine is contraindicated in patients with a recent myocardial infarction, cardiac conduction disorders, and hyperthyroidism, hi addition, cyclobenzaprine is contraindicated within 14 days of the administration of a monoamine oxidase inhibitor. Oral dantrolene is contraindicated in patients with active hepatic disease and muscle spasm caused by rheumatic disorders and during lactation. See Chapter 30 for information on diazepam. 

The corticosteroids may be used to treat rheumatic disorders such as ankylosing spondylitis, rheumatoid arthritis, gout, bursitis (inflammation of the bursa, usually the bursa of the shoulder), and osteoarthritis. 

Lupus erythematosus, acute rheumatic carditis, systemic dermatomyositis DERMATOLOGIC DISEASES... 

The ghicocorticoids are used as replacement therapy for adrenocortical insufficiency, to treat allergic reactions, collagen diseases (eg, systemic lupus erythematosus), dermatologic conditions, rheumatic disorders, shock, and other conditions (see Display 50-1). The anti-inflammatory activity of these hormones make them valuable as anti-inflammatories and as immunosuppressants to suppress inflammation and modify the immune response... 

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