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New guidelines arthritis drug cons … Do they help … Or are they evil?
Non-steroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of Treatment Of Arthritis for over 50 years. During the drug hit the market several times and have been used by millions of people. In most cases, the safety profile was one that was predictable. In some unusual cases, security has been problematic leading to the withdrawal from the market at least three drug-Oraflex, Vioxx, Bextra and.
NSAIDs provide both analgesic (Painkillers), and the anti-inflammatory polyarthritis.
Their action depends on their effect by blocking the cyclooxygenase pathway. Cyclooxygenase is an enzyme that is responsible for the production of inflammation producing enzymes called prostaglandins. There are at least two lanes of cyclooxygenase. Trail called a COX-1 is the path blocked by most NSAIDS. These include medications such as ibuprofen (Motrin), naproxyn (Naprosyn) piroxicam (Feldene), sulindac (Clinoril), oxaprocin (Daypro), nabumetone (Relafen), etodolac (Lodine), ketoprofen (Orudis), and meloxicam (Mobic).
COX-2 is the other way blocked by drugs like Celebrex.
Because these drugs are so widely prescribed by Many types of physicians including family physicians, internists, orthopedic surgeons, rheumatologists and by the extent where serious problems of side effects have been treated is unknown. The American College of Rheumatology has recently published its recommendations in an article published in the August 15 issue of Arthritis Care & Research (Arthritis Care and Research. 2008 59: 1058-1073).
The authors acknowledged the that these drugs are often prescribed for patients with cardiovascular risk factors like hypertension and high cholesterol, as well as kidney dysfunction. This means that each patient should be evaluated as an individual. If the patient is on anti-cholesterol medicine or ACE inhibitors for hypertension, or aspirin for heart protection, these factors must be considered before prescribing NSAIDs.
Patients should be counseled regarding the potential toxicity and drug interactions. If the patient agrees that they want to take a NSAIDs, the drug should be monitored. In addition, if the patient fails an NSAID, they may respond to another. Small doses are safer that high doses.
Monitoring of complete blood count and renal and hepatic function should be done regularly.
If a patient is taking aspirin for heart protection, NSAIDs should be taken with caution and stomach protection if possible.
Unfortunately, there is a problem in that patients who need to be on aspirin and heart protection in desperate need NSAIDs for their arthritis are subject to a double whammy. The combination of low-dose aspirin plus an NSAID increases the risk of gastrointestinal complications such as ulcers. At the same time to NSAIDs increase the risk of cardiovascular events such as Stokes and heart attacks.
In addition, it has been demonstrated that the combination of ibuprofen and aspirin reduces the effective protection of the heart medication and aspirin, naproxyn, if used intermittently also increases the risk of cardiovascular disease.
All NSAIDs increase the risk of kidney damage.
Many NSAIDs, particularly diclofenac (Voltaren) increase the risk of liver damage and should be closely monitored and avoided in patients with of pre-existing liver damage.
Patients on anticoagulant therapy should avoid the drugs in the COX-1 class. Even drugs COX-2 may be problematic and should be carefully evaluated.
What is a mother to do?
NSAIDs are drugs potentially dangerous to be used by physicians who have experience with this drug class. Patients should be aware of potential hazards and to discuss frankly with their doctors.
About the Author
Nathan Wei, MD FACP FACR is a board-certified rheumatologist. For more info:
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