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ABSTRACT: NSAIDs (non steroidal anti-inflammatory drugs) are a crucial component for the therapy of pain induced by inflammatory and degenerative joint diseases. Nevertheless their known therapeutic efficacy is contrasted by significant side effects. The recently developed selective COX-2-inhibitors appear to have a better gastrointestinal safety profile, especially relevant to patients with an increased risk for gastrointestinal ulcers and bleeding. However, this effect may similarly be reached by the combination of NSAIDs with proton pump inhibitors. Recent data relate to an elevated myocardial infarction rate in patients using COX-2-inhibitors. This risk may also occur in conventional NSAIDs. Therefore an individual risk calculation is necessary before COX-2-inhibitors or NSAIDs are used. Treatment should be performed with the lowest dosage for the shortest time possible. Combination therapy with salicylic acid seems to abolish the protective effect of COX-2-inhibitors in the GI-tract. Definite risk factors for the treatment with NSAIDs and COX-2-inhibitors have to be defined in further studies providing the best treatment schedule for an individual patient.
Der Internist 06/2006; 47(5):533-4, 536-8, 540. · 0.30 Impact Factor
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ABSTRACT: Nichtsteroidale Antirheumatika (NSAR) sind nach wie vor ein zentraler Bestandteil der Schmerztherapie bei degenerativen und entzndlichen Erkrankungen des Skelettapparates. Der guten therapeutischen Wirksamkeit steht allerdings ein ausgedehntes Spektrum an Nebenwirkungen gegenber. Coxibe als Weiterentwicklung der konventionellen NSAR erscheinen geeignet, die gastrointestinale Sicherheit vor allem bei Risikopatienten zu verbessern. Dieser Effekt ist offenbar auch in der Kombination von NSAR mit Protonenpumpenhemmern zu erzielen. Die Behandlung mit Coxiben ist allerdings mit einem erhhten Risiko kardiovaskulrer Nebenwirkungen verknpft. Mglicherweise trifft dies auch fr konventionelle NSAR zu. Deshalb sollten Patienten mit entsprechendem Risikoprofil diese Substanzen nicht erhalten. Ansonsten gilt, dass die Behandlung so kurz und niedrig dosiert wie mglich durchzufhren ist. Zu beachten ist, dass eine begleitende Therapie mit Acetylsalicylsure den protektiven Effekt der Coxibe am Gastrointestinaltrakt aufzuheben scheint. Ziel knftiger Studien sollte es sein, Risikogruppen klarer zu definieren, um dann die Therapie mit dem besten Nutzen-Risiko-Profil fr den Patienten individuell auswhlen zu knnen.NSAIDs (non steroidal anti-inflammatory drugs) are a crucial component for the therapy of pain induced by inflammatory and degenerative joint diseases. Nevertheless their known therapeutic efficacy is contrasted by significant side effects. The recently developed selective COX-2-inhibitors appear to have a better gastrointestinal safety profile, especially relevant to patients with an increased risk for gastrointestinal ulcers and bleeding. However, this effect may similarly be reached by the combination of NSAIDs with proton pump inhibitors. Recent data relate to an elevated myocardial infarction rate in patients using COX-2-inhibitors. This risk may also occur in conventional NSAIDs. Therefore an individual risk calculation is necessary before COX-2-inhibitors or NSAIDs are used. Treatment should be performed with the lowest dosage for the shortest time possible. Combination therapy with salicylic acid seems to abolish the protective effect of COX-2-inhibitors in the GI-tract. Definite risk factors for the treatment with NSAIDs and COX-2-inhibitors have to be defined in further studies providing the best treatment schedule for an individual patient.
Der Internist 01/2006; 47(5):533-540. · 0.30 Impact Factor
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P. H. Hofschneider,
U. Winter,
E. -M. Lemmel,
B. Brölz,
W. Gaus,
S. Schmid,
H. -J. Obert,
C. Stetter,
I. O. Auer,
C. Papst, [......],
S. Meske,
M. Schattenkirchner, K. Krüger,
R. Sprekeler,
H. D. Waller,
J. G. Saal,
H. Warnatz,
G. Lemm,
K. Wilms,
T. Stolzenburg
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ABSTRACT: The controlled clinical trial reported here is part of a multicenter clinical and basic research project, sponsored by the German Federal Minister of Science and Technology, directed by a standing commission of the president of the Max-Planck-Gesellschaft, and coordinated by the Max-Planck-Institut fr Biochemie, Mnchen. Overall, 249 patients with rheumatoid arthritis (RA) were enrolled by 16 participating hospitals. In addition to NSAID treatment, patients were randomly given either interferon gamma (IFN-) or placebo. In the IFN- group, 107 patients were evaluated and in the control group, 116 patients were evaluated. The response rate after 3 months of treatment, according to joint pain indexes, was significantly higher in the IFN- group with an error probability of 1%. IFN- was able to reduce the quantity of corticosteroids administered. Compared with the control group, the IFN- group benefited considering all parameters measured. Most important side effects were transient fever and transient influenza-like symptoms; all other adverse events were comparable in both groups.
Rheumatology International 10/1992; 12(5):175-185. · 1.88 Impact Factor
