Rheumatoid arthritis symptomatic treatment

Acute or long-term symptomatic treatment of mild to moderate pain, rheumatoid arthritis, and osteoarthritis. 

Usually, overdosage and adverse events can be managed by dosage reduction, the addition of colestyramine, and symptomatic therapy (36). However, in one study in patients with rheumatoid arthritis, leflunomide 10 mg/ day compared with 20 mg/day was associated with less efficacy and more adverse events leading to treatment withdrawal (24). Colestyramine 3x8 g/day for 11 days is recommended to wash out leflunomide, if A77 1726 plasma concentrations do not fall to 0.02 mg/1 or less, additional colestyramine is advised. Without this washout procedure, it can take up to 2 years to reach A77 1726 plasma concentrations of 0.02 mg/1. Oral activated charcoal 50 g every 6 hours for 24 hours also reduced plasma A77 1726 concentrations (80). 

Despite the fact that acetylsalicylic acid has been used for many years, it is only recently that controlled trials have demonstrated its efficacy in the symptomatic treatment of rheumatoid arthritis - . The results of a 3 year multi-centre trial comparing cortisone acetate and acetylsalicylic acid, given in the lowest dosage needed to keep each patient symptom-free, indicate that the efficacy of both drugs is similar in almost all respects . The condition of the patients after 3 years was better than at the start of the trial, but radiological deterioration occurred in both groups. 

Propionic acid derivatives are approved for use in the symptomatic treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gouty arthritis they also are used as analgesics, for acute tendinitis and bursitis, and for primary dysmenorrhea. 

Nabumetone is indicated for the acute and chronic treatment of the signs and symptoms of osteoarthritis and rheumatoid arthritis. The recommended starting dosage is 1,000 mg as a singie dose with or without food. More symptomatic reiief of severe or persistent symp-toms may be obtained at doses of 1,500 or 2,000 mg/day. 

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). 

Etoricoxib is a selective cyclooxygenase (COX-2) inhibitor, approved in Europe for the symptomatic treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and acute gouty arthritis. Etoricoxib does not have Food and Drug Administration approval. 

Based on previous reports of antiinflammatory activity, a 1989 double-blind, placebo-controlled, randomized study evaluated the effect of dried leaves (70-86 mg) in the treatment of rheumatoid arthritis. Over the 6-week trial, 41 female patients with symptomatic rheumatoid arthritis received feverfew or placebo. More than 13 laboratory and/ or clinical parameters were assessed. The authors concluded that there were no important differences between the control group and those receiving feverfew. Participating patients, however, had not previously responded to conventional therapies. The results do not preclude possible benefits for the use of feverfew in osteoarthritis and soft tissue lesions. Later in vivo studies showed that both feverfew extract and parthenolide possessed antiinflammatory and antinociceptive activities in mice and rats and that such activities were dose dependent. The extract, parthenolide, and some of the constituent flavonoids were also shown to inhibit the arachidonic acid pathways in leukocytes. Another possible mechanism for the anti-inflammatory effect of feverfew is the inhibition of the expression of intercellular adhesion molecule-1 (ICAM-1). ... 

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