Basis and current scope of rational anti-inflammatory therapy

With the increased understanding of inflammation today, it is clear that those therapeutic agents that control noxious effects of inflammation without blocking the protective aspects are more desirable. In the past 30 years, numerous new classes of anti-inflammatory agents have emerged, having first passed stringent clinical pharmacologic testing. Of the available nonsteroidal anti-inflammatory agents, most act through blockade of the cyclo-oxygenase pathway, and some through specific effects on the lipoxygenase pathway. Each of the major categories of nonsteroidal anti-inflammatory agents is discussed briefly with regard to these actions and their clinical effects. The use of nonsteroidal anti-inflammatory agents is also discussed in the context of the elderly patient in whom physiologic aspects of aging must be considered.