European journal of rheumatology and inflammation最新文献

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 The other--benoxaprofen--inhibited both the cyclooxygenase and lipoxygenase pathways, but had to be withdrawn because it was toxic. Since piroxicam was introduced in 1980, eight nonsteroidal anti-inflammatory drugs (NSAIDs) have been withdrawn from the market in the United Kingdom.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.

In two multicentre double-blind, parallel studies, piroxicam was found to be as well tolerated and significantly more effective than placebo in relieving moderate and severe pain, swelling, and limitation of movement resulting from acute musculoskeletal injuries. The efficacy and toleration of piroxicam were then compared with those of indomethacin and naproxen in two international multicentre double-blind trials involving 1,004 patients suffering from acute sprains or tendinitis resulting from sports injuries; a common study protocol was used in all centres. In all treatment groups, spontaneous pain, pain on movement, joint swelling, and tenderness were reduced significantly as early as three days after the start of treatment, and overall assessment of efficacy was excellent or good in more than 80% of patients. The study results indicated that the efficacy of all drugs was comparable, but analysis of side effects reports showed that piroxicam was significantly (p less than 0.005) better tolerated by the patients.

The therapeutic activity of tenoxicam, a thienothiazine derivative with analgesic and anti-inflammatory properties, has been studied by 15 investigators in Argentina and Brazil. Twenty-nine clinical trials were performed in a total of 747 patients suffering from rheumatoid arthritis (270), cox- and gonarthrosis (190), extra-articular inflammation (250) and acute gout (37). Out of the patients studied, 507 received tenoxicam and 240 were given comparative preparations. In 76% of the patients 20 mg tenoxicam was given as a single daily dose. In most patients duration of treatment was either six weeks or six months. Therapeutic results were evaluated according to the evolution of pain in various conditions as well as that of the articular, clinical and functional status. Once treatment was concluded a global evaluation of efficacy and tolerance was performed. The statistical analysis showed a significant improvement, in comparison to baseline, in all parameters considered under the different conditions. Double-blind studies showed no significant statistical differences between tenoxicam and the comparative preparations. Tolerance to tenoxicam was considered excellent, granting that some patients referred to adverse effects of the gastrointestinal type, such as epigastric discomfort, pyrosis and flatulence of moderate intensity. Tenoxicam is a new non-steroidal anti-inflammatory compound which is well tolerated and has excellent activity in the treatment of diverse rheumatoid conditions.

From ancient times until the middle of the last century--the beginning of the modern scientific era--the description, classification, and study of rheumatologic phenomena played an important role in medicine. There are numerous examples in the literature, beginning with Hippocrates' observations on gout through the discoveries of Sydenham and Heberden. The detection of uric acid as "materia peccans" in gouty arthritis and the differentiation of the chronic arthritides by Garrod in 1853 marked the start of research into the aetiology and pathogenesis of rheumatic diseases. After Garrod's discovery, observation and description of rheumatic diseases lagged, and the only treatment in common usage was symptomatic and left to spas. In the last few decades, interest in the classification of rheumatic disease revived, and the union of clinical rheumatology with basic research provided the basis of a period of rapid progress in the knowledge of pathogenesis and in the development of symptomatic therapies, including non-steroidal anti-inflammatory drugs (NSAIDs). Two major therapeutic goals mark the future of rheumatology: the search for optimum treatment to halt the manifestations of rheumatic diseases and the search for the aetiology, which would lead eventually to prevention and cure.