Rheumatoid arthritis clinical management

Tetracyclines also seem to have anti-inflammatory and immunomodulating effects.53,71 Although the exact reasons for these effects are unclear, tetracyclines have been used in a variety of noninfectious diseases with an inflammatory or autoimmune basis, including scleroderma and rheumatoid arthritis.71 Clinical studies will continue to investigate how these drugs can be used effectively in the long-term management of chronic disease. 

The use of cytokine antagonists (monoclonal antibodies to cytokines) used in the management of rheumatoid arthritis and Crohn s disease has some beneficial effect on Graves orbitopathy. A recent stndy of 10 patients with mild to moderately severe Graves orbitopathy showed that the administration of etanercept, an antitrunor necrosis fector drug (25 mg a week for 3 months) was associated with a significant improvement of the clinical activity score and ophthalmopathy index in approximately 60% of patients. 

If insulin revolutionized diabetes mellitus treatment, cortisone discovery was another revolution in inflammatory and arthritis management. The discovery of corticosteroids as a therapeutic can be linked to Thomas Addison (1793-1860), who made the connection between the adrenal glands and the rare Addison s disease in 1855.Edward C, Kendall (1886-1972) at the Mayo Clinic (Rochester, USA) and Tadeus Reichstein (1897 -1996) at the University of Basel (Switzerland) independently isolated several hormones from the adrenal cortex. In 1948, Kendall and Philip S. Hench (1896-1965) demonstrated the successful treatment of patients with rheumatoid arthritis using cortisone. Kendall, Reichstein, and Hench were awarded the 1950 Nobel Prize in Physiology or Medicine for determining the structure and biological effects of adrenal cortex hormones. 

Celecoxib is currently indicated for the relief of signs and symptoms of osteoarthritis and rheumatoid arthritis and to reduce the number of adenomatous colorectal polyps in familial adenomatous polyposis as an adjunct to usual care. Celecoxib is at least as effective as naproxen in the symptomatic management of osteoarthritis and at least as effective as naproxen and diclofenac in the symptomatic treatment of rheumatoid arthritis, and it is less likely to cause adverse Gl effects. Celecoxib appears to be effective in the management of pain associated with both of these arthritic conditions, but effectiveness in acute or chronic pain has not been fully demonstrated. Unlike aspirin, celecoxib does not exhibit antiplatelet activity. Concomitant administration of aspirin and celecoxib may increase the incidence of Gl side effects. Another notable potential drug interaction with celecoxib is its ability, like other NSAIDs, to reduce the blood pressure response to angiotensin-converting enzyme inhibitors. A more detailed discussion of the chemical, pharmacological, pharmacokinetic, and clinical aspects of celecoxib is available (81). 

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