Non-steroidal anti-inflammatory drugs and the classical arthritides: focus on five-years of piroxicam experience.

Abstract

In recent years, we have seen immense progress in our understanding of rheumatic diseases. As we learn more about the pathogenetic mechanisms of disease, we can begin to classify the disorders more rationally. However, treatment lags behind understanding; we still direct our attention toward inflammation in a non-specific manner. At the beginning of the century, aspirin became a widely used treatment for all forms of arthritis. By the early 1960s, phenylbutazone and then indomethacin were introduced, and later, ibuprofen, naproxen, sulindac, and a variety of other agents had become available. Within the last five years two new agents were introduced that were characterised by a once-a-day regimen. One piroxicam - worked by attacking the cyclooxygenase pathway. The other--benoxaprofen--inhibited both the cyclooxygenase and lipoxygenase pathways, but had to be withdrawn because it was toxic. Since piroxicam was introduced in 1980, eight nonsteroidal anti-inflammatory drugs (NSAIDs) have been withdrawn from the market in the United Kingdom. By contrast, piroxicam is now available in over 90 countries and has been used safely and successfully in millions of people of different ages and in different clinical settings. Short-term open studies, controlled studies, and more recent long-term studies lasting over periods of more than three years give further evidence of effectiveness and tolerance.