European journal of rheumatology and inflammation最新文献

Musculoskeletal disorders such as soft tissue injuries have traditionally been treated with oral NSAIDs, despite the significant side-effects associated with their clinical use. However, four separate multicentre, double-blind, double-dummy clinical trials have shown that the efficacy of the topical NSAID, felbinac, is equivalent to that of the oral NSAID, ibuprofen, in the treatment of soft tissue injuries, and to that of oral ibuprofen or fenbufen in mild to moderate osteoarthritis. In general practice the incidence of side-effects with felbinac is low, while oral NSAIDs have been associated with significant problems, particularly in the gastrointestinal system. Consequently, the cost of treating side-effects is reduced with felbinac treatment compared with oral NSAIDs, making it a logical treatment alternative from an economic view point as well as for reasons of efficacy and safety.

In a double-blind study, the efficacy and tolerability of nimesulide 200mg/day, administered orally, was compared with etodolac 600mg/day in the treatment, for 3 months, of 200 patients suffering from osteoarthritis of the knee. Although spontaneous pain showed a significant improvement during the course of the study, there was no difference in the efficacy of either compound. Similarly, there was a progressive and significant reduction in the Lequesne functional index although no statistical difference was found between nimesulide and etodolac. The physician's overall assessment of efficacy was significantly in favour of nimesulide but the same assessment for patients who completed all 12 weeks showed no such bias. Adverse events (AEs) were generally mild or moderate and were commonly gastrointestinal in origin. There was no difference in the rate of incidence of AEs and, with the exception of week 8 where etodolac was apparently better tolerated, there were no statistical differences in tolerability between the two therapies.

A double-blind, randomised, parallel-group study was conducted in eight countries to compare the efficacy of a fixed combination of diclofenac sodium (50 mg) and misoprostol (200 mcg) with a fixed combination of diclofenac sodium (50 mg) and placebo in treating the signs and symptoms of rheumatoid arthritis (RA). A total of 346 patients with RA who had been stabilised on diclofenac for at least 30 days were randomly assigned to receive either diclofenac/misoprostol BID or TID (n = 177) or diclofenac/placebo BID or TID (n = 169) for 12 weeks. Primary analyses of efficacy, made upon admission and at 4-week intervals, consisted of physician's global assessment of the arthritic condition, patient's global assessment of the arthritic condition, patient's global assessment of joint tenderness/pain, and physician's assessment of joint swelling. In this study, the fixed combination tablet of diclofenac sodium 50 mg/misoprostol 200 mcg administered BID or TID demonstrated no statistically significant difference in efficacy in the treatment of the signs and symptoms of RA compared with diclofenac sodium 50 mg/placebo administered BID or TID.

Objective: To determine the effects of nabumetone, compared with tiaprofenic acid and etodolac, on anti-inflammatory efficacy and gastrointestinal irritancy in the rat when dosed orally for one month at a high anti-inflammatory dose.

Methods: Carrageenan paw edema was used as a model of inflammation. Gastrointestinal mucosal integrity was assessed by concurrently measuring ulcer formation. mucosal and tissue prostanoid production and plasma haptoglobin. Haemoglobin, present in the cecal contents, was used as a measure of blood loss.

Results: Nabumetone, tiaprofenic acid and etodolac inhibited inflammation. Etodolac induced marked gastrointestinal damage and blood loss whereas tiaprofenic acid caused only gastric damage. Nabumetone was found not to alter mucosal integrity.

Conclusion: Nabumetone proved to be an effective anti-inflammatory agent that was devoid of gastrointestinal irritancy.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have become valuable therapeutic agents in the treatment of arthritic conditions. In 1971, Vane demonstrated that the primary mechanism of action of aspirin and related drugs was inhibition of synthesis of prostaglandins from arachidonic acid. Although Vane's prostaglandin hypothesis has been generally accepted, various studies have suggested that additional mechanisms may have a role in the effects of NSAIDs. With the increasing number of NSAIDs available and with recent information on the side effects associated with NSAID therapy, it becomes important to examine whether these drugs are being used in the most appropriate manner.

Analgesics continue to be the mainstay of therapy in osteoarthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) play an important role, particularly where there is a significant inflammatory component to the osteoarthritis. Piroxicam-beta-cyclodextrin (PBC) is a new formulation in which piroxicam has been complexed with beta-cyclodextrin, a cyclic oligosaccharide. This results in an increase in the rate of absorption of the active compound and, consequently, in an earlier onset of analgesic action. PBC, like piroxicam, is administered once daily. PBC has been used in the treatment of osteoarthritis. In comparison with piroxicam, PBC showed a more rapid analgesic-anti-inflammatory action after the first administration in patients with active osteoarthritis. Subsequent evaluations at the second, fifth and last day of treatment demonstrated a comparable efficacy of the two drugs. The efficacy and tolerability of PBC was compared with other NSAIDs given intramuscularly, such as diclofenac and ketoprofen. The three compounds provided marked pain relief within thirty minutes and this increased progressively until the third to fourth hour. The efficacy of oral PBC was comparable to that of intramuscular diclofenac or ketoprofen. In comparison with metamisole PBC achieved a more rapid and sustained reduction in pain intensity during the first twelve hours of treatment. This rapid and marked reduction in pain intensity with PBC was also observed in patients with low-back pain when compared with etodolac. In view of its efficacy, tolerability and rapid onset of action, piroxicam-beta-cyclodextrin appears to be an useful analgesic and a prominent progress in the treatment of acute rheumatic pain.