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[COX-2 inhibitors: a new treatment in rheumatic diseases]
1Dipartimento di Medicina Interna e dell'Invecchiamento, Policlinico S. Orsola-Malpighi, Bologna, Italia.
Abstract:
Progressive increase of the average lifespan pushed up the number of the elderlies in the population. The subsequent spread of degenerative conditions such as osteoarthritis has inflated the request of NSAID despite their frequent toxicity. Side effects of NSAID are sometimes severe and mainly target gastrointestinal tract, renal and platelets function. It has been estimated that around 70% of the patients treated with NSAID develop some degree of gastric damage, ranging from aspecific dyspeptic syndromes to ulcerative diseases. Drugs are now available that selectively inhibit the cyclooxygenase-2: this enzyme is involved in the synthesis of prostaglandins during the inflammatory response. These new drugs have opened new perspectives in the treatment of arthritis; they allow COX-1 to work regularly, so that those prostaglandins that are involved in the maintenance of a regular function of the gastrointestinal tract mucosa and of the platelets. Celecoxib was the firstborn of these new drugs. Differently from FANS, COXIB has got less side effects on gastrointestinal tract and platelets function. Based on the evidence of the more recent clinical experience COXIB has to be recommended; in particular celecoxib, at a schedule of 200-400 mg/die, was shown to be highly effective in the symptomatic treatment of osteoarthritis and rheumatoid arthritis.
Insights
Non-steroidal anti-inflammatory drugs (NSAID) cause significant gastrointestinal damage. Newer drugs like celecoxib selectively inhibit cyclooxygenase-2 (COX-2), offering a safer alternative for arthritis pain relief with fewer side effects.
Area of Science:
- Pharmacology
- Gastroenterology
- Rheumatology
Background:
- Increasing lifespan leads to a higher elderly population.
- Degenerative conditions like osteoarthritis are rising.
- NSAID use is increasing but associated with significant toxicity.
Purpose of the Study:
- To evaluate the efficacy and safety of COX-2 inhibitors.
- To compare COX-2 inhibitors with traditional NSAIDs.
- To assess celecoxib as a treatment for osteoarthritis and rheumatoid arthritis.
Main Methods:
- Review of clinical experience with NSAID and COX-2 inhibitors.
- Focus on selective cyclooxygenase-2 inhibition.
- Analysis of celecoxib's effectiveness and side effect profile.
Main Results:
- NSAID cause gastric damage in approximately 70% of patients.
- COX-2 inhibitors, like celecoxib, have fewer gastrointestinal and platelet side effects.
- Celecoxib (200-400 mg/day) is effective for symptomatic treatment of osteoarthritis and rheumatoid arthritis.
Conclusions:
- COX-2 inhibitors represent a significant advancement in arthritis treatment.
- Celecoxib is recommended due to its improved safety profile.
- Selective COX-2 inhibition offers a better therapeutic option for managing inflammatory arthritis.