Rheumatoid arthritis osteoarthritis

NSAIDs are used as the first-line treatment of rheumatoid arthritis, osteoarthritis, systemic lupus erythematosis and other inflammatory diseases, and are thus amongst the most widely used dtugs in the developed world. This widespread use inevitably entailed a considerable associated morbidity, in particular a high incidence of gastric toxicity. In the USA alone, perforations, ulcers and bleeds lead to the hospitalisation of 100,000 patients per year, and about 15% of these die while under intensive care. 

The first two selective COX-2 inhibitors to be marketed and subjected to in depth clinical trials were celecoxib and rofecoxib. Both compounds are as effective as standard NSAIDs in rheumatoid arthritis, osteoarthritis and for pain following orthopaedic or dental surgery. Gastrointestinal side effects were far fewer than with comparator diugs and in fact were no... 

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

Haringman JJ, Smeets TJ, Reinders-Blankert P, Tak PP. Chemokine and chemo-kine receptor expression in paired peripheral blood mononuclear cells and synovial tissue of patients with rheumatoid arthritis, osteoarthritis, and reactive arthritis. Ann Rheum Dis 2006 65(3) 294-300. 

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. 

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, osteoarthritis, ankyiosing spondyiitis, pain, dysmenorrhea, acute tendinitis, and bursitis ... 

Temporary relief of pain from rheumatoid arthritis, osteoarthritis, and relief of neuralgias such as the pain following shingles (herpes zoster) or painful diabetic neuropathy. 

Diclofenac Voltaren) is a phenylacetic acid derivative that is a potent inhibitor of COX and that has analgesic, antiinflammatory, and antipyretic effects. Its use is accompanied by side effects similar to those of other NSAIDs. Indications for the drug include rheumatoid arthritis, osteoarthritis, and ophthalmic inflammation (use of an ophthalmic preparation). 

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. 

Diclofenac (Voltaren, Cataflam) is approved for use in rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, dysmenorrhea, and topically for the treat-... 

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. 

Acute or chronic rheumatoid arthritis, osteoarthritis, migraine pain, gouty arthritis PO... 

Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis PO 250-500 mg naproxen (275-550 mg naproxen sodium) twice a day or 250 mg naproxen (275 mg naproxen sodium) in morning and 500 mg naproxen (550 mg naproxen sodium) in... 

Rheumatoid arthritis, osteoarthritis pain PO Initially, 3 g/day in 2-3 divided doses. Maintenance 2-4 g/day. 

Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis PO Initially, 150 mg twice a day may increase up to 400 mg/day. 

Rheumatoid arthritis, osteoarthritis PO Initially, 400 mg 3 times/day (including 1 dose upon arising, 1 dose at bedtime). Adjust dose at 1-2 wk intervals. Maintenance 600-1,800 mg/day in 3-4 divided doses. 

It is used in rheumatoid arthritis, osteoarthritis and other conditions including rheumatic pain, neuralgia, gout and ankylosing spondylitis etc. 

Clinical use Celecoxib (Graul et al., 1997 Wallace and Chin, 1999) is a second generation selective COX-2 inhibitor and the first drug of this group which reached the market. Its selectivity for COX-2 compared to COX-1 is about 375-fold greater in human recombinant enzyme preparations and about 8-fold in a whole blood assay. Celecoxib has been approved for rheumatoid arthritis, osteoarthritis, acute pain and primary dysmenorrhoea in the US and has been launched in an increasing number of countries since 1999. 

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. 

It is used orally (8-24 mg/day) for the treatment of mild to moderate pain including postoperative pain, rheumatoid arthritis, osteoarthritis and ankylosing spondylitis (Balfour et al., 1996). 

Clinical use Rofecoxib (Sorbera et al., 1998) is a second generation COX-2 selective inhibitor. It was the second COX-2 selective drug to reach the market in 1999. Rofecoxib is used for the treatment of rheumatoid arthritis, osteoarthritis and pain. 

Rofecoxib is used for a once-daily treatment of rheumatoid arthritis, osteoarthritis (12.5-25 mg/day) and pain (50 mg/day). 

The effectiveness of ketoprofen at dosages of 100-300 mg/d is equivalent to that of other NSADDs in the treatment of rheumatoid arthritis, osteoarthritis, gout, dysmenorrhea, and other painful conditions. In spite of its dual effect on prostaglandins and leukotrienes, ketoprofen is not superior to other NSAIDs. Its major adverse effects are on the gastrointestinal tract and the central nervous system. 

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