Choice Of Nonsteroidal Anti-inflammatory Drugs Research Articles

Non-steroid anti-inflammatory drugs: recommendations and precautions for safe use in a multidisciplinary surgical department

Aim of the study. Conducting a safety analysis of the use of non-steroidal anti-inflammatory drugs in order to develop informed recommendations and precautions for medical practice.Materials and methods. A retrospective analysis of inpatient medical records of 250 patients in the multidisciplinary surgery department was conducted for the period from December 2023 to February 2024.Results and discussion. Based on the results of the analysis of inpatient medical records, such criteria as the presence of indications for the prescription of non-steroidal anti-inflammatory drugs (according to the diagnosis, clinical pain syndrome and according to pain assessment scales), compliance of the choice of non-steroidal anti-inflammatory drugs with national protocols/international recommendations, compliance with age, the patient's physiological/ pathological condition and allergy history for the prescription of non-steroidal anti-inflammatory drugs were 100%. The indicator for compliance of a single therapeutic dose, route of administration, frequency, duration and an appropriate diluent of non-steroidal anti-inflammatory drugs with instructions for use was 86%, where medication errors were mainly made in the frequency of use of drugs. The percentage of polypharmacy was 20%. The criterion for assessing drug-drug interactions between drugs taken by patients showed that interactions of high clinical significance (major) were 8%, while those of moderate clinical significance (moderate) were 40%.Conclusions. Nonsteroidal anti-inflammatory drugs are convenient and affordable drugs that are widely used in the treatment of diseases of various organs and systems. Therefore, to ensure the rational and safe use of drugs in this group, it is necessary to introduce effective recommendations and precautions:1. Timely completion of pain assessment scales and diary records in the Damumed medical information system;2. Development in the Damumed medical information system of divisions of appointments into planned and pro re nata (as necessary), introduction into the system of accurately recording the time of execution of doctors’ prescriptions by nursing staff for strict compliance with the intervals between doses of non-steroidal anti-inflammatory drugs allowed by the instructions.3. Introduction into the practice of doctors the use of tools to combat polypharmacy in patients ≥65 years old: Beers criteria;4. Conducting educational activities, covering both medical personnel and patients, in order to increase the level of registration of unwanted adverse reactions.

Pharmacological management of osteoarthritis: judicious use of nonsteroidal anti-inflammatory drugs

Background: Osteoarthritis (OA) is a chronic disease characterized by persistent pain and joint deformation. Effective pain management in patients with OA necessitates accurate diagnosis and appropriate treatment planning, considering the prolonged therapy required for OA. Although non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management in patients with OA, their long-term use can lead to various adverse effects that warrant careful consideration.Current Concepts: NSAIDs inhibit cyclo-oxygenase (COX) enzymes and produce an anti-inflammatory and analgesic effect. However, this mechanism of action can produce adverse gastrointestinal, cardiovascular, and renal effects. The relative risk of gastrointestinal and cardiovascular adverse events depends on the COX selectivity of NSAIDs. Consequently, selective COX-2 inhibitor or concomitant proton pump inhibitor administration is recommended in patients at a high risk of gastrointestinal complications. Minimizing NSAID use is advised in patients at a high risk of cardiovascular adverse events; however, if this is unavoidable, short-term administration of naproxen or low-dose celecoxib should be considered. COX selectivity is not associated with adverse renal events. Therefore, acetaminophen is preferred in patients with impaired renal function, and short-term use of NSAID patches or topical formulations may be useful.Discussion and Conclusion: The choice of NSAIDs for OA should be tailored to patients’ needs, considering their risk factors, potential drug interactions, and other relevant factors. Additionally, incorporation of nonpharmacological interventions can minimize the NSAID dosage and reduce the risk of adverse effects, and regular monitoring is essential to identify adverse effects.

Management of Idiopathic Viral Pericarditis in the Pediatric Population.

Idiopathic (viral) pericarditis (IP) is one of the most common etiologies of acute and recurrent pericarditis in children. IP is associated with significant morbidity, and recurrence rates of IP are high and require treatment to decrease risk of recurrence and pericarditis-related chest pain. Despite significant morbidity, sparse guidance exists to comprehensively address management of IP in children. The purpose of this review is to provide an overview of the pharmacotherapy of IP in children, including clinical pearls for managing pediatric patients. Clinicians should consider using the combination of colchicine and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, in order to reduce the risk of recurrence and foster symptom improvement in IP. Colchicine dosing may vary depending on patient age, weight, concomitant pharmacotherapies, and disease states. Choice of NSAID should be based on cost, tolerability, and adverse drug events (ADEs). Children should receive higher NSAID attack dosing for >1 week to ensure a reduction in high sensitivity C-reactive protein concentrations and symptom relief. Corticosteroids should be considered last-line for treatment of IP in children, because they increase the risk of recurrence. Immunotherapies may be considered for children with multiple recurrences related to IP despite the use of NSAIDs, colchicine, and/or corticosteroids. Similar to adults, diligent monitoring should be implemented, to prevent drug-drug interactions, drug-disease interactions, and/or ADEs in children.

The problem of long-term pain control in chronic rheumatic diseases

Pain is one of the main symptoms and the most distressing manifestation of rheumatic diseases (RD). Currently, non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the symptomatic treatment of RD in real clinical practice, but the effectiveness and tolerability of their longterm use remain insufficiently studied. Many patients with RD require long-term use of NSAIDs. In this case, the presence of comorbid pathology and risk factors for the development of drug complications should be taken into consideration, so the choice of NSAIDs should be based primarily on considerations of patient safety. Aceclofenac (Aertal®) has a pronounced analgesic potential and a good safety profile, which allows us to recommend it for long-term use.

Topikalni preparati u lečenju mišićno-skeletnog bola

Musculoskeletal pain is a global health and socioeconomic problem. Chronic musculoskeletal pain (MSC) is a pain that lasts for at least 3 months, becomes a disease itself. Given the constant increase in the frequency of musculoskeletal pain, it is necessary to work on improving prevention, early diagnosis and therapy, in order to improve outcomes and reduce treatment costs. Causes of MSC pain can be degenerative and / or inflammatory changes of joint and extra-articular structures, as well as dynamic vertebral segment. The use of symptomatic therapy for pain and swelling must be based on adequate patient selection, selection of the painful condition, with a balance between the risks of use and benefits. The stepwise approach of the WHO (World Health Organization) analgesic ladder represents an escalation strategy from weak to strong analgesics in pain therapy. Nonsteroidal anti-inflammatory drugs are used in the treatment of mild to moderate acute and chronic musculoskeletal pain with an inflammatory component. The choice of nonsteroidal anti-inflammatory drugs in the treatment of pain is useful as monotherapy and as a component of multimodal analgesic therapy. The average prescribed daily dose, as well as the length of drug use in the treatment of musculoskeletal pain must be in accordance with the guidelines. Topical application of NSAID-s is the therapy of choice within the pharmacological approach in elderly patients, with acute and chronic musculoskeletal pain in accordance with modern guidelines.

Possibilities of individual choice of NSAIDs on the example of the oxicam class, taking into account clinical and pharmacological characteristics

Nonsteroidal anti-inflammatory drugs (NSAIDs) are traditionally used to relieve pain syndromes. The class of NSAIDs includes oxicams (meloxicam, tenoxicam, lornoxicam) - drugs with pronounced analgesic and anti-inflammatory effects. Oxicams have common properties of the class, but at the same time, due to structural differences from all other NSAIDs, they differ in a number of clinical and pharmacological characteristics, knowledge of which will help to individualize the choice of the drug.

Which NSAID to choose for treatment of pain syndrome in polymorbid patients?

A polymorbid patient is a patient with several diseases occurring simultaneously at different stages and phases of their development. Patients with polymorbid pathology have a statistically significant almost 2.5 times higher risk (odds ratio [OR] = 2.41; p = 0.01) of pain syndrome and other diseases (for example, depression, arterial hypertension, etc.), which will contribute to the progression of polymorbidity. Individuals with chronic pain have a significantly increased risk of all causes’ death (hazard ratio [HR] = 1.95; 95 % confidence interval [CI]: 1.26–3.03) and cardiovascular causes (RR = 2.72; 95 % CI: 1.41–5.26) compared to patients without chronic pain. Therefore, in order to improve the prognosis and quality of life of the patient, both acute and chronic pain must be treated with non-pharmacological (exercise therapy, taping, virtual reality, etc.) and pharmacological methods. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for mild to moderate pain. The rational choice of NSAIDs in polymorbid patients can be difficult due to the presence of pathologies that limit their use or conditions that are risk factors of complications of drug therapy. In this article, the author present approaches to choosing the optimal NSAID in polymorbid patients, and justify efficacy and safety of administration of original meloxicam in these individuals (Movalis®, Boehringer Ingelheim International).

Long-term use of nonsteroidal anti-inflammatory drugs for pain control in patients with osteoarthritis: results of the 12-month observational study AELITA (Analgesia: Effective Treatment Using The Therapeutic Algorithm)

Non-steroidal anti-inflammatory drugs (NSAIDs) are the primary means of managing chronic osteoarthritis (OA) pain. The choice of NSAIDs is based on an analysis of the risk of adverse reactions (ARs). Objective: to evaluate the efficacy and safety of long-term use of NSAIDs for pain control in patients with OA in real clinical practice.Patients and methods. To assess the results of long-term use of NSAIDs in OA, a 12-month observational non-interventional study was conducted. It included 611 patients with knee, hip and generalized OA, and nonspecific back pain associated with OA of the facet joints. All patients were prescribed aceclofenac (Aertal®) 200 mg/day. The patients' condition was assessed 2 weeks, 3, 6, 9 and 12 months after the start of therapy. The following parameters were determined: the intensity of pain during movement and the general health assessment (GA) according to the visual analogue scale (VAS, 10 cm); pain intensity according to the Likert verbal rating scale (VRS) (0–4); the number of patients with a pain reduction of ≥50% from baseline; patients' assessment of the result of therapy according to Likert VRS (1–5). The development of ARs was recorded at each visit.Results and discussion. By month 12, 46.8% of patients had dropped out of observation. In patients who continued the study, the average severity of pain according to the VAS at baseline, after 2 weeks, 3, 6, 9 and 12 months was: 6.5±1.2; 4.8±1.4; 3.2±1.4; 2.6±1.4; 2.2±1.1; 1.4±1.1 cm, respectively (significant differences compared to the baseline for all points – p<0.05). The same differences were obtained in GA assessment.Within the indicated time frame, the number of patients with moderate / severe pain (on the Likert scale) decreased from 77.8 to 24.9; 2.9; 2.3; 0.9 and 0%, respectively. The number of patients with a pain reduction of ≥50% from baseline was 12.0; 65.1; 81.0; 88.5 and 84.0%, respectively. A good or excellent assessment of treatment results after 2 weeks was given by 63.3% of patients, and after 12 months – by 95.6%. ARs were observed in about 30% of patients, mainly mild or moderate dyspepsia (in 11.1–23.3%) and arterial hypertension (in 7.1–10.9%). No serious ARs were registered.Conclusion. Aceclofenac is an effective and relatively safe drug for the long-term management of chronic pain in OA.

A survey study on the recognition and treatment of pain in dogs and cats by Slovenian veterinarians

ObjectiveTo obtain information on pain management in dogs and cats by Slovenian veterinarians, and to compare it with reports from other countries. Study designProspective online survey. MethodsThe questions were uploaded using open source survey software and pertained to demographic data, self-evaluation of acquired and current knowledge, attitude towards pain and evaluation of actual knowledge, assessment of chronic and acute pain and pain due to surgery or medical conditions, and the use of analgesics. Descriptive statistics were used to summarize frequency distribution. Wilcoxon signed rank test, Mann-Whitney U test and Spearman’s rho were applied where appropriate. ResultsThe response rate was 11%. From 680 registered members of the Veterinary Chamber of Slovenia, 73 veterinarians completed the survey. Most of the respondents were women (71.2%) working in small (60.3%) or mixed (21.9%) animal practices. A more recent year of graduation was positively correlated to the self-reporting of knowledge acquired during undergraduate studies (rs = 0.339, p = 0.003) and to current knowledge about the topic (rs = 0.293, p = 0.012). Cats were assigned higher scores than dogs for signs of acute (p < 0.001) pain. Female respondents assigned higher scores than male respondents for chronic pain in dogs. Dogs were assigned higher pain scores than cats for surgical procedures and medical conditions. The most frequently used non-steroidal anti-inflammatory drugs (NSAIDs) in dogs and cats were meloxicam and carprofen, and butorphanol was the most commonly used opioid. The choice of NSAID was influenced by perceived effectiveness, experience with use and anti-inflammatory effect. Opioid use was influenced by experience with use and perceived effectiveness. Conclusions and clinical relevanceSlovenian veterinarians acknowledged the importance of pain management as reported for other European countries. However, the use of multimodal analgesia is limited, and inadequacies remain in the pain management of cats.

Impact of a multimodal analgesic protocol modification on opioid consumption after cesarean delivery: a retrospective cohort study

Introduction Adequate pain control is a mainstay in enhanced recovery after surgery (ERAS) protocols. ERAS protocols are widely accepted in colorectal and gynecologic surgeries and are increasingly implemented in the obstetric setting. Multimodal analgesia incorporating non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen is a mainstay of ERAS protocols for cesarean delivery, but little research has focused on the choice of NSAIDs or timing of initiation in women undergoing cesarean delivery. At our institution, patients undergoing cesarean delivery receive a standardized multimodal analgesic regimen consisting of neuraxial morphine with NSAIDs and acetaminophen. Our initial protocol involved starting the oral analgesics in the recovery room. There was variability in whether these medications were given in a timely manner or withheld in the setting of postoperative nausea and vomiting. We modified this protocol and performed a retrospective analysis to assess the impact of this change on postoperative opioid rescue requirements in women undergoing cesarean delivery under neuraxial anesthesia. Methods This retrospective analysis included patients who underwent cesarean deliveries from 1 July 2014 to 22 August 2017. With the initial analgesic protocol, patients received neuraxial morphine, followed by naproxen 500 mg PO Q12 hours and acetaminophen 650–975 mg PO Q6 hours initiated in the recovery room. After protocol revision in January 2016, the same neuraxial morphine dose was used in addition to acetaminophen 975 mg PR at the start of the case and ketorolac 15–30 mg IV at the end of the case. Postoperatively, patients received acetaminophen PO 975 mg Q6 hours, ketorolac IV 15 mg Q6 hours for 3 doses, transitioning to ibuprofen 600 mg Q6 hours. Fentanyl, oxycodone, and intravenous hydromorphone were given for breakthrough pain with both protocols. The primary outcome of the study is the need for rescue opioid analgesia. Secondary outcomes are total opioid usage, time to first rescue opioid, maximum reported pain scores, and need for rescue antiemetics. Univariate and multivariate analyses were performed controlling for variables significantly different between the two cohorts. Results 3250 patients were included in our analysis (1574 in the old protocol and 1676 in the new protocol). There was no significant difference in patient demographics or intraoperative characteristics between the two cohorts except for more primiparous women (25% vs. 17%), more Pfannenstiel incision (98% vs. 96%), and less repeat cesarean deliveries (40% vs. 44%) in the new protocol cohort. Need for rescue opioids was reduced with the new protocol at 2, 24, and 48 h [(36.46% vs. 75.73%, p < .0001), (74.28% vs 91.99%, p < .0001), (87.53% vs 95.49% p < .0001), respectively]. Among those who received opioids, opioid consumption over 48 h was reduced (median [IQR]: 55 [30, 95] vs. 40 [20, 70] mg oxycodone equivalents) after protocol revision (GMR 0.75, 95% CI 0.7, 0.80, p < .0001). The time to first rescue opioid medication was significantly longer in the new protocol compared to the old protocol (175 [79, 1057] min vs 51 [28, 104] min, p < .001). Conclusion There was a significant decrease in the need for and the dose of rescue opioid medications with the new protocol. This highlights the importance of optimizing the choice of agents, as well as route and timing of administration of the components of the postoperative multimodal analgesic regimen.

Chronic lower back pain: diagnosis and current principles of therapy

Chronic nonspecific lower back pain (LBP) is one of the most common causes of adult disability. The chronic course of back pain is often supported by the patient's unhealthy lifestyle and the use of ineffective treatments. The combination of cognitive behavioral therapy, therapeutic exercises, gradually increased physical activity, and rational pharmacotherapy are effective in most cases of chronic non-specific LBP. In this disease, nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-choice drugs that should be prescribed in a short cycle. The choice of NSAIDs is determined by the presence of concurrent diseases in the patient and by the risk of developing adverse events. The paper discusses the efficacy and safety of meloxicam in non-specific NSAIDs.

Management of acute nonspecific lumbosacral pain: modern guidelines and new approaches in pharmacotherapy

Acute nonspecific lumbosacral pain (LSP) is one of the most common reasons people visit their doctor. This disease has a favourable prognosis, however, the low back pain can progress to a chronic course, if the treatment is inadequate. In this regard, timely diagnosis and adequate treatment of acute nonspecific LSP are of great clinical importance. The diagnosis of acute non-specific LSP is established after discogenic radiculopathy, lumbar stenosis and other specific causes of back pain have been excluded. 15 clinical guidelines for the treatment of acute nonspecific LSP were reviewed in 2018, and it was concluded that they match in basic therapeutic principles. The basis for effective treatment of acute nonspecific LSP includes informing the patient about a favourable prognosis of pain, the recommendation to maintain an active lifestyle and optimal pharmacotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving the low back pain. The choice of NSAIDs depends on the concomitant diseases of the patient and the risk of side effects. If NSAIDs provide poor efficacy, a drug from the muscle relaxants group can be added. NSAIDs combined with B vitamins (thiamine, pyridoxine, cyanocobalamin) is a new direction in the pharmacotherapy of acute non-specific LSP. The article discusses the results of clinical trials of the efficacy and safety of NSAIDs combined with B vitamins, the advantages of this combination in patients with LSP. The authors analyse the use of B vitamins-containing Milgamma as a co-analgesic drug combined with NSAIDs in acute nonspecific back pain.

Skuteczność i bezpieczeństwo stosowania niesteroidowych leków przeciwzapalnych w okulistyce

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used groups of drugs in ophthalmic pharmacotherapy. Numerous indications for the use of this group of drugs as well as the role of prostaglandins in the pathomechanism of the formation of eye diseases make this group of drugs still developing. The ophthalmologist has several NSAIDs available, which differ mainly in pharmacokinetic parameters. The choice of NSAIDs should be individualized to select the most effective and safest drug for a particular patient

Choice of non-steroidal anti-inflammatory drugs in equine colic

While non-steroidal anti-inflammatory drugs (NSAIDs) can be used to manage abdominal discomfort in horses, they also are often a valid diagnostic tool to aid decision making around the need for surgery or referral of these patients. Knowledge of the pharmacokinetic properties and licensing of available drugs in the UK is of pivotal importance to select the most appropriate NSAID for the patient. This review focuses on the relevant characteristics of NSAIDs licensed for treatment of colic in horses: flunixin meglumine, metamizole, meloxicam and ketoprofen. Other NSAIDs such as phenylbutazone and firocoxib are licensed for use in horses but not for the treatment of colic; their role with colic is evaluated in light of available literature.

Proportion of nonsteroidal anti‐inflammatory drug prescription in equine practice

There is little knowledge of the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) and whether their prescription varies between countries. To describe prescription practices of NSAIDs in equids in the United Kingdom (UK), United States of America (USA) and Canada. Descriptive observational study. Free-text electronic medical records from 141,543 equids from 10 equine practices in the UK, 255,777 equids from 7 equine practices with 20 branches from the USA and 2 practices with 7 branches from Canada were evaluated. A validated text-mining technique was used to describe the proportion of equids prescribed NSAIDs at least once in these countries. The choice of NSAIDs in orthopaedic and colic cases was evaluated. The prescription of NSAIDs is more common in the USA (42.4%) and Canada (34.2%) than in the UK (28.6%). Phenylbutazone and flunixin meglumine were the drugs mostly prescribed in all countries. While flunixin meglumine was most prescribed with colic cases in all countries, a proportion received phenylbutazone despite this drug being licensed for use only with musculoskeletal disease. Phenylbutazone was the most commonly prescribed drug in cases with orthopaedic disease followed by flunixin meglumine in all countries. Only a small proportion of cases received meloxicam, ketoprofen or firocoxib. The retrospective design might have resulted in an unknown number of incomplete records, particularly in the reporting of colic and orthopaedic disease. Although the data set is large, the relatively small number of practices recruited from each country may introduce bias. Clinical practice can differ between countries although the influence of individual practitioners and practice-specific policy on apparent intercountry differences requires further research. Despite several other NSAIDs being available and a substantial effort being made to evaluate their efficacy, the prescription of NSAIDs other than phenylbutazone and flunixin meglumine remains rather limited.

Penetration and pharmacokinetics of non-steroidal anti-inflammatory drugs in rat prostate tissue.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) involves inflammation of the prostate and affects the quality of life of men of all ages. It is well reported in clinical studies that the treatment for CP/CPPS using nonsteroidal anti-inflammatory drugs (NSAIDs) produced favorable outcomes. However, currently, there are no guidelines on choice of the NSAIDs for the treatment of CP/CPPS. Therefore, in the current research study, we evaluated the prostate tissue penetration of four NSAIDs in rats to provide guidance on choice of NSAIDs for the treatment of CP/CPPS. Male Sprague-Dawley rats were administered orally with four NSAIDs viz. celecoxib, diclofenac, ibuprofen, and naproxen at 500 mg/kg dose. The animals were then sacrificed at various time points, and their prostate tissues were harvested. The NSAIDs were then extracted from the prostate tissues using liquid extraction technique, and their concentration in prostate tissue was quantified using high-performance liquid chromatography (HPLC). The prostate tissue penetration and related pharmacokinetic parameters were evaluated by non-compartmental analysis. The HPLC method for quantifying NSAIDs in prostate tissue resulted in single, sharp peaks without any interference and all validation parameters were within limits. Celecoxib showed the highest area under the curve (AUC) [146.50 ± 2.75 μg/mL*h] of all NSAID's. A two-factor analysis of variance (ANOVA) with replication indicated an overall statistically significant difference in the pharmacokinetic parameters for celecoxib, diclofenac, ibuprofen, and naproxen. This study for the first time reported the relative prostate tissue penetration of four NSAIDs. The pharmacokinetic data indicated that celecoxib has the highest penetration and retention in rat prostate tissues. Therefore, celecoxib may be considered as a better choice for the treatment CP/CPPS involving NSAIDs.

Prescription audit of NSAIDs and gastroprotective strategy in elderly in primary care.

The use of non-steroidal anti-inflammatory drug (NSAIDs) is deemed amajor risk factor for peptic ulcer disease in elderly population that requires concomitant therapy with gastroprotective agents (GPAs). This study evaluated the rational prescribing of NSAIDs and GPAs, and extent of adherence to the guideline recommendations in primary care. Nationwide audit of prescriptions issued to elderly patients (≥65 years) with hypertension or diabetic hypertension in primary care. Among 2090 elderly, 45.9% were on low-dose aspirin, and 13.5% on other NSAIDs. Diclofenac-XR was the most frequently prescribed NSAIDs to three-quarter patients whereas naproxen, the safest NSAID for patients with high cardiovascular (CV) risk, was rarely prescribed. Among those on NSAID, 82.9% were on ascheduled dosing regimen; of these 78.8% received long-term NSAID therapy (3.9±0.9 months). The prescription rate of GPAs was low: 29.2% for aspirin and 33.3% for other NSAIDs. Aquarter of the patients on histamine type-2 receptor antagonists received ranitidine at subtherapeutic single-dose for gastroprotection. Approximately half of the patients on proton pump inhibitors (PPIs) were prescribed supra-therapeutic double-dose regimen: omeprazole and esomeprazole accounted for 63.2% of overall prescribed PPIs. The rational choice of NSAIDs and physicians' adherence to gastroprotective measures was suboptimal in primary care. The choice of NSAIDs and gastroprotective strategy in elderly be guided by the CV and gastrointestinal adverse events likelihood due to the NSAIDs and risk profile of patients for such adverse events.

Efficacy of Cox-2 inhibitors in the Clinical Management of TMJ Arthritis: A Review

In the clinical management of arthritis, the choice of nonsteroidal anti-inflammatory drug (NSAID) remains confusing and controversial. The main objective of this review is to addresses the main arguments for the pharmacological and clinical use of COX-2 inhibitors for the clinical management of arthritis. This review concluded that, COX-2 inhibitors are effective and are associated with increased risk of GI, renal, and CV, adverse effects. Complete understanding of the patient's co-morbid conditions and concomitant medications, coupled with precise monitoring during the treatment, may help to decrease the threat of adverse effects induced by selective COX-2 inhibitors.

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS: A DIFFICULT CHOICE OF ANESTHESIA DURING JOINT SURGERY

Nonsteroidal anti-inflammatory drugs (NSAIDs) are an important component of a multimodal pain management program in patients with rheumatic diseases in the perioperative period. NSAIDs have comprehensive analgesic, antiinflammatory, and antipyretic effects associated with blockade of the enzyme cyclooxygenase-2 and suppression of the synthesis of prostaglandins, one of the main mediators of pain and inflammation, which are synthesized in response to surgical tissue injury. NSAIDs can ease the suffering of patients in the pre- and postoperative periods and reduce the need for opioid analgesics and the frequency of adverse events (AE) caused by the latter. The choice of NSAIDs is largely determined by the risk of AE: gastrointestinal, cardiovascular and postoperative bleeding. The paper considers whether different NSAIDs can be chosen for patients with joint diseases during surgical treatment in terms of their efficacy and safety.

The assessment of compliance of the inpatient stage pharmacotherapy when treating rheumatoid arthritis with provisions of industry standards

The ongoing monitoring of the inpatient stage of treatment is the necessary condition for improving the quality of pharmacotherapy of such costly diseases as rheumatoid arthritis (RA) and optimizing the costs for its implementation. According to the data of 100 case histories of patients with RA the use of glucocorticoids (GCs), non-steroidal anti-inflammatory drugs (NSAIDs) and gastroprotective drug prevention of complications associated with their use at the inpatient stage of treatment has been analyzed, and compliance of prescriptions with the provisions of the updated national unified clinical protocol of 2014 (UCPMC RA), as well as the recommendations of the European League Against Rheumatism (EULAR) in taking GCs and NSAIDs for rheumatoid diseases has been identified. It was formulated that GCs for systemic use and NSAIDs were prescribed according to the regimens specified in UCPMC RA and in compliance with the algorithm of the rational choice of NSAIDs for RA. It was determined that for the levels of prescriptions of GCs and NSAIDs set the gastroprotective drug prevention of complications associated with their use in the rheumatology department was carried out properly and according to the recommendations of UCPMC RA and EULAR. A high level of compliance by practitioners of a healthcare institution with the provisions of the current UCPMC RA has been determined, and it will allow both preventing in advance possible undesired effects of using GCs and NSAIDs and reducing the costs of their correction.