European journal of rheumatology and inflammation最新文献

A four-way single-blind crossover study was used to compare the efficacy and tolerance of four non-steroidal anti-inflammatory drugs. In addition, pain intensity was compared during the day, at night, at rest, on walking, in the most painful joint, and with the patients most painful activity. Ninety-six patients with rheumatoid arthritis took single daily doses of controlled release naproxen (N), diclofenac S.R. (D), indomethacin S.R. (I) and standard piroxicam (P). The greatest changes from baseline after treatment were seen in those patients with the highest initial pain measurement scores. Assessments of pain in the morning, in the most painful joint and the most painful activity were more discriminating than those at noon or at rest. Of the treatments, 'N' and 'P' were the most effective in reducing pain, with statistically significant differences from baseline. 'I' was the most effective in reducing morning stiffness. Adverse experiences were generally mild, occurring more frequently on 'I' than on other treatments.

Endoscopic studies with nabumetone have consistently shown a lower incidence of gastro-duodenal erosive lesions than comparable non-steroidal anti-inflammatory drugs (NSAIDs) including naproxen and ibuprofen.

Forty-two patients with ankylosing spondylitis were entered into a double-blind study to compare treatment with indomethacin and a new non-steroidal anti-inflammatory drug, nabumetone. Clinical, laboratory and side-effect profiles were measured over a three month period. Both drugs were effective in relieving pain and morning stiffness, indomethacin was better in alleviating general stiffness, nabumetone resulted in less side-effects. Objective measurements of spinal movements revealed no difference between the two drugs. Nabumetone, available as Relifex, appears as effective as indomethacin in relieving the symptoms of ankylosing spondylitis and is possibly better tolerated.

Osteoarthritis is a common problem in general practice and a major indication for NSAIDs. Many patients with osteoarthritis are elderly and therefore particularly at risk from adverse reactions. Co-morbidity and co-prescription may lead to drug interactions. For these reasons, safe NSAIDs are the first choice for this disease.

Long term studies with nabumetone have confirmed that it is an effective NSAID, comparable to other agents including aspirin and naproxen. Large scale post-marketing studies have shown high response rates and good tolerance.

The efficacy and safety of droxicam were compared with piroxicam in a pilot study in twenty patients with degenerative joint disease. After a one week washout period a baseline gastroscopy was carried out. Treatment during the following 4 weeks was randomised to droxicam or piroxicam. Safety and tolerance parameters were monitored at weekly intervals. Pain was evaluated with two visual analogue scales (VAS) (patient and investigator). Affected joints, articular index (AI), patient's status and a daily living activities questionnaire were also evaluated. Another gastroscopy was carried out at the end of the treatment period. Droxicam and piroxicam relieved all symptoms significantly without statistically significant clinical differences. Both groups showed no drug related side effects in the laboratory values. In the gastroscopic examinations two patients of the droxicam group and four of piroxicam group had minor gastric erosions after four weeks of treatment without any accompanying clinical symptoms.

Droxicam acts by inhibition of PGE2 varies. Although it belongs to the oxicam family, it is characterised by being a pro-drug of piroxicam, the molecule undergoing conversion by hydrolysis once dissolved in the digestive tract. This allows us to suppose in principle that, there being less contact between the active drug (piroxicam) and the gastric mucosa, the side effects in the said mucosa would be slight. The studies which have already been performed in healthy volunteers and in patients with osteoarthritis and rheumatoid arthritis, to evaluate the efficacy and the tolerance of droxicam in patients suffering from such clearly inflammatory processes demonstrate an analgesic potential and anti-inflammatory effects which become noticeable after two weeks of treatment, and the drug is well-tolerated.

This study analyses the results of 8 randomized, controlled clinical trials and one open study carried out with droxicam (a new NSAID, pro-drug of piroxicam), comparing the adverse events and gastrointestinal tolerance of this compound against those of the control drugs used in these trials. The frequency of adverse events was lower in the droxicam treated patients. Adverse events concerning the gastrointestinal area were also lower. No differences were found in the distribution of adverse events by age of sex among the drugs compared. The pattern of side effects found was that expected in all non-steroidal anti-inflammatory agents. These results seem to sustain the hypothesis of a better tolerance of droxicam than that of piroxicam, indomethacin or diclofenac, especially in the gastrointestinal area.

This double-blind clinical trial compares droxicam, a new non-steroidal anti-inflammatory agent and the reference compound diclofenac sodium. After a 7 day placebo run-in period, 80 patients with gonarthrosis and coxarthrosis were randomized to receive 20mg/day of droxicam and 150mg/day of diclofenac for 6 weeks. Evaluations were carried out at weeks 0 (placebo run-in), 2,3, and 6. Both drugs showed statistically significant improvements in all clinical measurements (index of severity, pain intensity, morning stiffness, maximal forced flexion and extension of the knee) after 6 weeks of treatment. Investigator's and patient's opinions were consistent with these results. The consumption of paracetamol was significantly lower amongst patients treated with droxicam. Withdrawals due to lack of therapeutic efficacy did not occur. A lower incidence of side effects, mostly upper gastrointestinal symptoms, was noticed amongst droxicam-treated patients. However, two patients in the droxicam group were withdrawn at week 3 and two days after week 6 because of epigastric pain and nausea, and cutaneous rash, respectively. Both study drugs are of benefit in reducing pain and improving joint motion and function in patients with coxarthrosis and gonarthrosis.