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LAM KID

SEPTEMBER 20, 2012

[The effect of nonsteroidal anti-inflammatory drugs on articular cartilage]

GÁTI Tamás, JUHÁSZ István, ROJKOVICH Bernadette

[In developed countries, the treatment of osteoarthritis costs up to 1-2% of the GNP. The poor hygroscopy of hyaline cartilage and of glycosaminoglycan (GAG) molecules that are components of proteoglycans plays a key role in the development of the disease. Age-related osteoarthritis mostly affects the weight-bearing joints of the lower extremities, the hips and knees, and - more frequently than the former ones - the small joints of the hands, causing chronic pain and disability. Nonsteroidal anti-inflammatory drugs (NSAIDs) used for the treatment of osteoarthritis-related pain influence not only pain but also cartilage metabolism, and - among others - GAG molecules. NSAIDs diminish the biosynthesis of prostaglandins (PG) that have a role in inflammatory processes, and influence oxygen free radicals, the levels of interleukins (ILs) and the function of metalloproteinases. The ideal NSAID for the joints stimulates cartilage formation, reduces cartilage resorption, and the level of katabolic cytokines. Aceclofenac was found to have the most beneficial effect on multiple aspects of cartilage metabolism.]

Lege Artis Medicinae

JULY 14, 2008

[THE EFFECTS AND SIDE-EFFECTS OF COXIBS IN THE RHEUMATOLOGICAL PRACTICE]

GÉHER Pál

[The author reviews the various tools of pain control in rheumatic disorders, with special attention to the pharmacological modalities, focusing on the use of cyclo-oxygenase inhibitors (coxibs). The new pain control drugs have different side-effect profiles, and even though these are more favourable than those of the traditional drugs, not all of them meet the strict safety requirements. The new drugs that are available in Hungary have a lower gastrointestinal side effect risk than the traditional nonsteroidal anti-inflammatory drugs, still with comparable effectiveness. The non-steroidal antiinflammatory drugs - including the selective cyclo-oxygenase inhibitors - increase the risk of cardiovascular disease, though to varying extent. When choosing a drug to control pain and inflammation in the diseases of the locomotor system, the physician should balance between the effectiveness and the most common side effects (gastrointestinal, cardiovascular).]

Lege Artis Medicinae

MAY 16, 2007

[NSAID-ASSOCIATED GASTROPATHY: RECENT ASPECTS OF PREVENTION]

HERSZÉNYI László

[Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs worldwide. Gastroduodenal ulcers are found at endoscopy in 15 to 30% of patients who use NSAIDs regularly. The annual incidence of severe upper gastrointestinal complications such as bleeding or perforation is 1.0 to 1.5%. From a cost-benefit perspective, prevention strategies should consider both gastrointestinal, and recently, cardiovascular risk factors. No prophylaxis is necessary with low gastrointestinal risk. There are currently four possible strategies to reduce the risk of adverse gastrointestinal effects: 1. the use of selective COX-2 inhibitors or coxibs rather than traditional NSAIDs; 2. cotherapy, primarily with proton pump inhibitors, to ensure protection to gastric mucous membrane; 3. co-therapy with a coxib and a proton pump inhibitor in patients with very high risk (eg., history of bleeding); 4. eradication of Helicobacter pylori infection in patients with a history of ulcer. The use of coxibs decrease the risk of gastrointestinal damage by roughly 50%. In the presence of gastrointestinal risk factors or for patients on aspirin also treated with an NSAID or a coxib, protection with a proton pump inhibitor is recommended. Proton pump inhibitor therapy is also useful for the prevention and treatment of NSAID-induced dyspepsia. The beneficial effects of proton pump inhibitors cannot solely be explained by their profound antisecretory action. Therefore, several acid secretion- independent mechanisms of action have been proposed.]

Lege Artis Medicinae

NOVEMBER 30, 2004

[PHARMACEUTICAL PREVENTION OF THE UPPER GASTROINTESTINAL SIDE-EFFECTS OF NSAID THERAPY]

HERSZÉNYI László, TULASSAY Zsolt

[Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation in patients with rheumatoid arthritis and osteoarthritis. However, they are also associated with a significant risk of gastrointestinal events with clinical and economic consequences. It is mandatory to rationalise the use of different NSAID treatment strategies in patients with varying degrees of gastrointestinal and cardiovascular risk. In patients for those aged <65 years with no previous gastrointestinal event and not concurrently on aspirin (low risk patients), the use of an NSAID should be considered as appropriate. For patients with a previous gastrointestinal event (high risk patients) or who concurrently received aspirin, an NSAID alone should be rated as inappropriate and either a coxib or selective cyclooxygenase-2 inhibitor, or an NSAID + proton pump inhibitor combination is considered as appropriate. Finally, for patients aged >65 years with a previous gastrointestinal event and on aspirin (patients with very high risk) a coxib in conjunction with a proton pump inhibitor is considered to be the best therapeutic strategy.]

Lege Artis Medicinae

NOVEMBER 30, 2004

[FROM ASPIRIN TO COXIBS - JANUS-FACE OF THE NONSTEROIDAL ANTI-INFLAMMATORY THERAPY]

NEMESÁNSZKY Elemér

[Since the introduction of aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) proved to be the most commonly used drugs in the world. One of the major factors limiting their use is gastrointestinal toxicity. It has long been recognised that NSAID use is associated with serious, sometimes life-threatening adverse effects, like gastrointestinal ulcers, bleeding and perforation. Recent studies have indicated that the combination of NSAID and aspirin significantly increases the risk of complications. Aspirin is like a two-edged sword, balancing cardiovascular prevention with the risk of gastrointestinal side effects. Past history of ulcer carries the highest individual risk and other contributing factors include age, concurrent anticoagulation, cortocisteroid therapy, as well as high-dose or multipleforms of NSAID use. The mechanism of action of NSAID is to inhibit prostaglandin production through cyclooxygenase (COX). The inhibition of COX-2 isoenzyme reduces inflammatory-mediated prostaglandins, while the inhibition of COX-1 reduces the level of prostaglandins needed for normal protecting mechanism of the gastric mucosa. Non-selective NSAID has impact on both COX-enzymes, while selective COX-2-inhibitors (such as coxibs) exert their effects without affecting mucosal defence significantly. It is important to note that the risk of complications can not be reduced to zero by any therapeutic approach. The most appropriate treatment modality is to administer PPI co-therapy for the sake of gastro-protection, especially in high-risk cases. Histamine-2-receptor antagonists are not effective in reducing ulcer and complication in that particular group of patients. It has turned out that the inhibition of the synthesis of COX-2 by rofecoxib increases the risk of developing thromboembolic events and myocardial infaction. This has led to the withdrawal of Vioxx from the market on 30. 09. 2004. Studies conducted in recents years shed new light on numerous beneficial effects of NSAID other than alleviate pain, cure inflammatory processes and diminish higher temperature. The incidence of colon polyps and adenomas as well as cancers is reduced among people who are on maintanance NSAID therapy. The process of stone formation in the biliary tract is also reduced in patients who are on NSAID treatment. Development of Alzheimer's disease seems to be hindered, however, this finding can not yet be considered as evidence based.]