Steroidal Anti-inflammatory Drugs Research Articles

AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition.

Management of Osteoarthritis of the Knee (nonarthroplasty) Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies for the nonarthroplasty treatment of osteoarthritis of the knee in adults (ages 17 years and older). The purpose of this clinical practice guideline is to evaluate current best evidence associated with treatment. The scope of this guideline contains nonpharmacologic and pharmacologic interventions for symptomatic osteoarthritis of the knee, including surgical procedures less invasive than knee arthroplasty. It does not provide recommendations for patients with rheumatoid arthritis, arthritis of other joints, or other imflammatory athropathies. This guideline contains 29 recommendations to assist all qualified and appropriately trained healthcare professionals involved in the nonarthroplasty management of osteoarthritis of the knee and provide information for patients. In addition, the work group highlighted the need for better research into intra-articular corticosteroid, hyaluronic acid, and platelet-rich plasma detailing osteoarthritis characterization, including subgroup analyses and osteoarthrosis severity stratification, and clinically relevant outcomes with control subjects for bias and cost-effectiveness analysis. Studies comparing outcomes in patients with mild-to-moderate knee osteoarthritis and an MRI confirmed meniscal tear who have undergone partial meniscectomy after failing to improve with a course of conservative treatment (nonsteroidal anti-inflammatory drugs, steroid injection, and physical therapy) versus those who have undergone partial meniscectomy without a dedicated course of conservative treatment. Prospective randomized trials or prospective cohort studies are still needed to establish efficacy of individual oral nonsteroidal anti-inflammatory drugs within specific subgroups and populations to tailor systemic medications to help increase efficacy and decrease the risk of adverse effects.

X-linked hyper IgM syndrome with severe eosinophilia: a case report and review of the literature

BackgroundHyper IgM syndromes (HIGMS) are a group of rare primary immunodeficiency disorders. There are limited reports about HIGMS combined with severe eosinophilia.Case presentationIn this report, we described a 2-year-old boy with chronic cough and symptoms of hypoxia. Lung computed tomography (CT) scan showed that diffuse ground-glass changes and eosinophils in peripheral blood increased significantly. Subsequent tests revealed a notable decrease in serum IgG and IgA. The lymphocyte subgroup classification was basically normal. Pneumocystis jirovecii were detected from the bronchoalveolar lavage fluid (BALF) of the patient by metagenomic next-generation sequencing (mNGS). After treatments of caspofungin combined with sulfamethoxazole, intravenous immunoglobulin (IVIG) replacement and anti-inflammatory steroid, the clinical symptoms and pulmonary imaging noticeably improved. The absolute eosinophil count (AEC) also returned to normal range. X-linked hyper IgM syndrome was confirmed by gene test. Two months after the diagnosis, the patient underwent allogeneic stem cell transplantation (HSCT) and has recovered well.ConclusionsChildren with HIGMS are prone to opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP). Diffuse interstitial lung disease and hypoglobulinemia in a young child predict the diagnosis of a primary immunodeficiency (PID). mNGS has obvious advantages for obtaining etiological diagnosis of children with PIDs. Severe eosinophilia is rarely reported in this kind of PIDs. Considering literature review and the corresponding reaction to steroid, we proposed that eosinophilia in HIGMS might be related to infections. Steroid therapy can quickly relieve eosinophilia but is easy to rebound if the reduction is too fast. Once the diagnosis of HIGMS is confirmed, the earlier the HSCT, the better the prognosis.

Prevalence of Cannabinoid (CBD) Use in Orthopaedic Sports Medicine Patients.

Background:Although there is some evidence that cannabinoid (CBD) products may provide a therapeutic effect for musculoskeletal pain, little is known about the usage patterns or their prevalence of use in orthopaedic sports medicine patients.Purpose:To report the prevalence and perceived self-efficacy of CBD products in patients evaluated in an orthopaedic sports medicine clinic.Study Design:Descriptive epidemiology study. Level of evidence, 2.Methods:The study population consisted of new patients who visited an orthopaedic surgery sports medicine clinic at a large academic center for consultation with a surgeon between August 2020 and March 2021. All patients were asked to complete a survey that assessed perceived pain and effectiveness of CBD products and other nonsurgical treatment modalities using the Single Assessment Numeric Evaluation score (range, 0-100) and the Numeric Pain Rating Scale (NRS). Descriptive factors were collected via chart review. Descriptive statistics were used to characterize the data.Results:Overall, 823 patients completed the survey (45.4% female; mean age, 51 years [range, 18-87 years]; mean body mass index, 28.9 [range, 17.2-58.4]). Body areas involved included 285 shoulders, 44 elbows, 76 hips, 276 knees, 58 ankles, and 77 other. Of these patients, 19% (152/823) endorsed the use of CBD products before their initial evaluation. The mean NRS for pain was significantly different between non-CBD users and CBD users (5.6 vs 6.1; P = .029). CBD users were significantly more likely to have tried other nonoperative modalities compared with nonusers, including nonsteroidal anti-inflammatory drugs (79.6% vs 69.8%; P = .032), bracing (44.7% vs 34.6%; P = .024), steroid injections (38.8% vs 21.6%; P < .001), and physical therapy (54% vs 36.1%; P < .001). In addition, 30.9% of CBD utilizers reported marijuana use compared with 2.8% of non-CBD users (P < .001) for management of their pain.Conclusion:In the current study, 19% of patients had used CBD products to manage joint-related issues. Sports medicine providers should be aware of this high incidence of usage and the potential interactions CBD products may have with other treatment modalities. Further studies are needed to assess the effectiveness of CBD as a therapeutic agent and the specific interactions it has with other drugs and other forms of treatment.

FORMULATION AND CHARACTERIZATION OF ACECLOFENAC LOADED STARCH MICROSPHERE

Microspheres are a new category of novel drug delivery system which targets to increase the bioavailability and is formulated expediently to obtain prolonged or controlled drug delivery system in the body. Aceclofenac; a non steroidal anti inflammatory drug, is used to treat hurting rheumatic conditions such as osteoarthritis, rheumatoid arthritis and alkylosing spondylitis. It eases pain and reduces inflammation at various sites. Aceclofenac acts by blocking the effect of chemical mediators called cyclo-oxygenase (COX) enzymes which are released at inflamed regions. The aim of this research was to formulate Aceclofenac loaded starch microspheres and evaluate its in vitro properties to enhance the bioavailability of aceclofenac tablet. Aceclofenac loaded starch microspheres were prepared using emulsion cross linking method. Aceclofenac microspheres loaded with starch polymer were characterized, evaluated and it was found to influence all the parameters. The microspheres prepared showed great entrapment efficiency. In vitro release of all prepared polymeric formulations was quite good.

Hydrocortisone Therapy for Critically Ill Trauma Patients to Decrease Ventilator Use in Pneumonia Patients

Secondary infections such as nosocomial pneumonia are one of the highest causes of mortalities for critically ill trauma patients in a hospital. Prevention practices have been appropriately placed in order to lower infection rates. However, clinical data suggests that little improvement of nosocomial pneumonia infections have occurred because of prevention practices. New groundbreaking research of hydrocortisone therapy for trauma patients has shown to be successful in improving not only patient outcomes, but decreasing time with mechanical ventilation and decrease in total hospital days. Hydrocortisone therapy is effective because critically injured patients suffer from a condition called critical injury-related corticosteroid insufficiency (CIRCI). In this condition, the natural proinflammatory response is heavily exaggerated and takes an exacerbated toll on the body of a patient. The natural anti-inflammatory steroids that are normally produced in stress events such as cortisol is severely diminished or nonexistent. Therefore, with the exaggerated inflammatory response, the chances of contracting secondary infections such as nosocomial or ventilator-acquired pneumonia are heightened drastically. Data from clinical research studies have shown that stress dose levels of cortisol therapy for critically injured patients have shown to be efficacious in lowering risks of secondary infection. Furthermore, due to fewer days in the hospital, there is less stress on the limited capacity of an emergency department of a hospital. Moreover, patients are saving $5,000 to $20,000 from avoiding excessive medical expenses that would result from more hospital stays.

Design of an Emulgel for Psoriasis Focused on Patient Preferences

Adherence to topical treatments is low and is known to be influenced by the vehicle properties. Betamethasone dipropionate (BD) is an anti-inflammatory steroid, used in psoriasis treatment in the form of an ointment, cream, or solution. The aim of this work was to develop a new vehicle for BD, focusing on the preferences of patients with psoriasis as a strategy to improve treatment adherence. Two vehicles with an aqueous external phase were explored: an emulgel and a hydrogel based on a cyclodextrin inclusion complex used to improve the aqueous solubility of BD. Since BD solubilization was not fully achieved in the hydrogel, only the emulgel was selected for further characterization. This new vehicle (emulgel) is characterized by its white, shiny appearance and good spreading properties. In comparison with petrolatum, a lower residue, higher evaporation rate, lower stickiness, and reduced ability to stain polyester fabric were observed. This vehicle also showed shear thinning behavior. The impact of this new vehicle on adherence to topical treatments should be further confirmed in clinical settings.

“Comparison Study between Conservative Treatment and Nerve Block Treatment in Foot Pain”

Objective: Ultrasound guidance nerve block in foot pain management is a new method in management of foot pain. It is simple, safe and cheap. We did this trial to compare the pain scores during both rest and activity and the functional ability after doing nerves block in comparison to patients who received non steroid anti-inflammatory drugs (conservative treatment). Materials and methods: We choose 90 patients in this double blind study, all are suffering of foot pain. Their ages ranging between35 and 80years, their weight ranging between 50 and 105 and their VAS pain scores between 6 and 9. We divided them into 2 groups, first group which has 45 patients who received NSAID only while the second group which also contain 45 patients who underwent nerve block. Results: The intensity of pain using VAS pain scores was small in the nerve block group after 6months, 1 year and 2 years in comparison with first group. The function scores of foot using American orthopedics of foot and ankle society scores (AOAFS) also was better in the second group (nerve block group). Conclusion: Ultrasound guidance ankle nerves block is better than using conservative anti-inflammatory drugs in reducing pain scores and improve the function capacity of the patients in patients with foot pain.

In silico study of potential antiviral activity of copper(II) complexes with non–steroidal anti–inflammatory drugs on various SARS–CoV–2 target proteins

In silico molecular docking studies, in vitro toxicity and in silico predictions on the biological activity profile, pharmacokinetic properties, drug–likeness, ADMET (absorption, distribution, metabolism, excretion, and toxicity) physicochemical pharmacokinetic data, and target proteins and toxicity predictions were performed on six copper(II) complexes with the non–steroidal anti–inflammatory drugs ibuprofen, loxoprofen, fenoprofen and clonixin as ligands, in order to investigate the ability of these complexes to interact with the key therapeutic target proteins of SARS–CoV–2 (Severe Acute Respiratory Syndrome Coronavirus 2) 3C–like cysteine main protease (3CLpro/Mpro), viral papain–like protease (PLpro), RNA–dependent RNA polymerase (RdRp), and non–structural proteins (Nsps) Nsp16–Nsp10 2′–O–methyltransferase complex, and their capacity to act as antiviral agents, contributing thus to understanding the role they can play in the context of coronavirus 2019 (COVID–19) pandemic. Cytotoxic activity against five human cancer and normal cell lines were also evaluated.

Chemoprevention for Colorectal Cancers: Are Chemopreventive Effects Different Between Left and Right Sided Colorectal Cancers?

Recent studies have suggested that right- and left-sided colorectal cancers (CRCs) are molecularly distinct. In this study, we examined the association between the risk of right- and left-sided CRC and drug use to estimate their chemopreventive effects METHODS: This multicenter retrospective cohort study was conducted using the data of hospitalized patients between 2014 and 2019 from nine hospital databases. The primary outcomes were right- and left-sided CRC. We evaluated the association of CRCs with drug use and clinical factors. Odds ratios adjusted for age, sex, Charlson Comorbidity Index scores, and smoking status were calculated. We also compared the transcriptional profiling in precancerous lesions, including sessile serrated lesions (SSLs) RESULTS: A total of 307,938 patients, including 2745 with right-sided CRC and 4819 with left-sided CRC, were analyzed. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, cyclooxygenase-2 inhibitors, and steroids was associated with a lower risk of both right- and left-sided CRCs. In contrast, statins, other lipid-lowering agents, and metformin were associated with a lower risk of left-sided CRC. Transcriptomic analysis showed that SSL, which predominantly develops in the right colon, was associated with a lower expression of lipid metabolism-related genes. Targeting lipid metabolism may be useful for chemoprevention of left-sided CRCs, while development of right-sided CRCs may be independent of this pathway.

The Joints Manifestation of Inflammatory Bowel Diseases

Joint manifestations of inflammatory bowel diseases (IBD) are observed in 30% of cases. Their largest share is in total forms of ulcerative colitis (UC) 85-90% and Crohn's disease (CD) involving the colon 30-35% or large and small intestines 60%. The pathogenesis of articular manifestations remains unclear. The importance of increased permeability of the intestinal wall, which is noted in patients with UC and CD, is discussed, as a result of which the components of the membrane wall of bacteria enter the bloodstream. These components act as peptide antigens that can lead to the development of arthritis. Contacting the molecules of histocompatibility complexes and further activating T-lymphocytes, peptides lead to joint inflammation. From the point of view of a rheumatologist, the articular manifestations of IBD are classified as seronegative spondyloarthropathies. During 2013-2020, we studied the frequency of treatment of patients with IBD with extraintestinal articular manifestations for examination to a rheumatologist. We analyzed the ratio of the number of patients with IBD having joints manifestations, which were confirmed and diagnosed by a rheumatologist or consulted in the areas of a gastroenterologist and a surgeon-proctologist. All patients who turned to a rheumatologist with joints manifestations over the years were referred by a gastroenterologist (38%), surgeon-proctologist (14%) and these extraintestinal manifestations of IBD were suspected and confirmed by a rheumatologist (48%). The need for a differentiated approach to the treatment of peripheral arthritis and any axial skeletal lesions is noted, the role of 5-aminosalicylic acid (5-ASA) drugs, steroidal and non-steroidal anti-inflammatory drugs (NSAIDs), immunosuppressant and biological drugs in the treatment of articular syndrome in IBD is evaluated. It is indicated that patients with IBD having of joints manifestations should be observed jointly by a rheumatologist, gastroenterologist and a proctologist. Regional or granulomatous ileitis is a chronic bowel disease (Crohn's disease) that covers all the layers of the intestinal wall (transmural lesions), and sometimes spreads to the mesentery, regional lymph nodes affecting both the small and large intestines, but most often localized in the terminal section of a thin guts (regional, terminal ileitis). These diseases can be accompanied by damage to the peripheral joints, spine, or joints and spine. The clinical manifestations of the joint syndrome in both processes are the same. The pathogenesis of the intestinal process and joint damage has not been fully established, but it is believed that many mechanisms participate in it, and in particular, toxic, immune, autoimmune. In the blood of patients, antibodies to the cells of the intestinal mucosa, lymphocytotoxin antibodies, circulating immune complexes, in which, possibly, antigenic components of intestinal microbes, etc., are also present. In Crohn's disease, articular manifestations usually occur in childhood and adolescence. The development of peripheral arthritis in these diseases is usually not associated with the carriage of the histocompatibility antigen B27. Ankylosing spondylitis is more common in men than in women (3: 1). This disease usually develops in people who have HLA B27. Articular changes with regional ileitis occur more often in patients with other extraintestinal manifestations of the processes - with ulcers of the oral mucosa, exacerbate erythema nodosum, gangrenous pyoderma.

Diosgenin revealed potential effect against cerebral ischemia reperfusion through HIKESHI/HSP70/NF-κB anti-inflammatory axis

BackgroundIt is a research hotspot to use natural compounds in treatment of cerebral ischemia reperfusion (I/R) for a refractory disease throughout the worldwide without available drugs or treatments at present. Our previous study has demonstrated that diosgenin (DIO), a starting material to synthesize various steroid anti-inflammatory drugs in medical industry, showed medicinal effect against I/R via inhibiting aberrant inflammatory reaction induced by I/R. However, the detailed anti-inflammatory network of DIO in treatment of I/R still remains to be further explored. PurposeHIKESHI was firstly identified as a novel target of DIO used for I/R by rat brain proteomic analysis, and mechanistic efforts were focused based on this gene. Hopefully, extensive detailed molecular mechanisms of DIO against I/R was established and confirmed. MethodsThe effect of DIO against I/R was examined in vitro and in vivo, which cells (SH-SY5Y and PC12) and rats were experienced to ORD/RP and MCAO exposures, respectively, to establish I/R modes. Staining was used to evaluate the pathological procedure of DIO used for I/R. Protein changes including expression, interaction, and activity during DIO's anti-I/R effect were assessed with real time PCR, western blot, Co-IP, luciferase reporter assay. ResultsIn the current study, HIKESHI and HSP70 were both upregulated, when I/R cells and rats were treated with DIO in vitro and in vivo. Mechanistically, DIO stimulated the binding of HIKESHI to HSP70 and facilitated the translocation of HSP70 into nucleus. Subsequently, HSP70 blunted the transcription activity of NF-κB after physical interaction with this transcription factor, and therefore led to the suppression of its downstream pro-inflammatory cytokine (TNF-α, IL-1β, and IL-6) release into surrounding I/R lesion area. Conversely, HIKESHI or HSP70 knockdowns attenuated the nuclear translocation and restraint on NF-κB-mediated inflammation, finally resulting in the abolishment of DIO-induced anti-I/R effect. NF-κB activation also relieved the inhibitory inflammation and reversed DIO's effect against I/R, suggesting that NF-κB was the downstream target of HIKESHI and HSP70 in I/R treatment with DIO. ConclusionsThese findings established a novel HIKESHI/HSP70/NF-κB signaling pathway associated with DIO-treated I/R, which might be as therapeutic targets or drugs with potential implications for the therapeutic use of I/R in clinic

Risk Factors for Recurrence of Peptic Ulcer Disease: A Retrospective Study in Tertiary Care Referral Center

BackgroundsPeptic ulcer disease (PUD) is a common gastrointestinal tract disease characterized by mucosal damage secondary to pepsin and gastric acid secretion. This study evaluated the five-year recurrence rate for patients with PUD and risk factors contributing to PUD relapses.MethodsFrom 2016 through 2021, all patients with endoscopy-proved PUD were identified by reviewing medical records (Best-Care system). Possible risk factors including smoking, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, caffeine, and steroids were analyzed by multivariate analysis. Treatment outcomes, 5-year recurrence rate, and mortality rate were assessed.ResultsAmong 223 patients, there were 187 (83.8%) diagnosed with endoscopy-proved PUD and 36 (16.2%) diagnosed with clinical PUD. Among them, 126 (56.5%) patients were males, and the mean age was 62±2 years. The five years recurrence rate of PUD was 30.9%. There was no significant difference in the recurrence rate between the duodenal ulcer (33.3%) and the gastric ulcer (28.8%). By univariate analysis, the use of steroids and NSAID and Helicobacter pylori (H. pylori) infection were potential risk factors for PUD (P < 0.005). The common complication of PUD was gastrointestinal bleeding (34.1%). Patients who had a complicated PUD were associated with a higher rate of recurrence (45.9%) compared to the uncomplicated PUD (19.2%) (P > 0.05).ConclusionOur findings demonstrated that the five years recurrence rate of PUD was 30.9%. The use of steroids and NSAID and H. pylori infection were risk factors for recurrence of PUD. PUD places a significant burden on health care systems. Therefore, a multicenter prospective study is needed for effective management to prevent recurrence and complications of PUD.

POS-475 MINIMAL CHANGE DISEASE ASSOCIATED WITH NON STEROIDAL ANTI-INFLAMMATORY DRUGS: FREQUENCY AND OUTCOMES

It is increasingly recognized that certain drugs such as non steroidal anti-inflammatory drugs (NSAIDs) may be a cause of drug-induced minimal change disease (MCD) either through a delayed hypersensitivity mechanism or a direct toxic effect.Prognosis can be improved with withdrawal of these drugs. This study aimed to describe characteristics and outcomes of adult patients with MCD associated with NSAIDs.

The PDE4 Inhibitor Tanimilast Blunts Proinflammatory Dendritic Cell Activation by SARS-CoV-2 ssRNAs.

Phosphodiesterase 4 (PDE4) inhibitors are immunomodulatory drugs approved to treat diseases associated with chronic inflammatory conditions, such as COPD, psoriasis and atopic dermatitis. Tanimilast (international non-proprietary name of CHF6001) is a novel, potent and selective inhaled PDE4 inhibitor in advanced clinical development for the treatment of COPD. To begin testing its potential in limiting hyperinflammation and immune dysregulation associated to SARS-CoV-2 infection, we took advantage of an in vitro model of dendritic cell (DC) activation by SARS-CoV-2 genomic ssRNA (SCV2-RNA). In this context, Tanimilast decreased the release of pro-inflammatory cytokines (TNF-α and IL-6), chemokines (CCL3, CXCL9, and CXCL10) and of Th1-polarizing cytokines (IL-12, type I IFNs). In contrast to β-methasone, a reference steroid anti-inflammatory drug, Tanimilast did not impair the acquisition of the maturation markers CD83, CD86 and MHC-II, nor that of the lymph node homing receptor CCR7. Consistent with this, Tanimilast did not reduce the capability of SCV2-RNA-stimulated DCs to activate CD4+ T cells but skewed their polarization towards a Th2 phenotype. Both Tanimilast and β-methasone blocked the increase of MHC-I molecules in SCV2-RNA-activated DCs and restrained the proliferation and activation of cytotoxic CD8+ T cells. Our results indicate that Tanimilast can modulate the SCV2-RNA-induced pro-inflammatory and Th1-polarizing potential of DCs, crucial regulators of both the inflammatory and immune response. Given also the remarkable safety demonstrated by Tanimilast, up to now, in clinical studies, we propose this inhaled PDE4 inhibitor as a promising immunomodulatory drug in the scenario of COVID-19.

Doping in Racing Pigeons (Columba livia domestica): A Review and Actual Situation in Belgium, a Leading Country in This Field.

Pigeon racing is a sport in which trained homing pigeons (Columba livia domestica) are released between 60 and 1200 km from their loft and then have to return home as quickly as possible. The first race was held in 1818 in Belgium and since then, Belgium has led the world in pigeon breeding. Unfortunately, as in other sports, doping has become a major issue and doping controls have been implemented. This review provides information about pigeon racing, rules from the Royal Federation Colombophile of Belgium, and laws applicable in Belgium as doping control issues cannot be understood without including them as part of pigeon racing. The main pharmacological data concerning corticoids, non-steroidal anti-inflammatory drugs, anabolic steroids, pain relievers and narcotic analgesics, bronchodilators and β-agonists, drugs acting on the central nervous system and other performance-enhancing drugs, in addition to methods relevant to doping in pigeons are presented. Moreover, the chosen matrix and analytical methods are described.

Эффективность экстракта мартинии душистой (Сустамар) при остеоартритах, поясничной боли и фибромиалгии: обзор исследований

В обзоре представлены результаты исследований клинической эффективности Harpagophytum procumbens (гарпагофитум, мартиния душистая, африканский полевой лютик) при мышечно-скелетной боли. Фармакологические эффекты мартинии душистой связаны с тем, что она подавляет образование и высвобождение из макрофагов провоспалительных цитокинов IL-1β, IL-6 и TNF-α, ингибирует экспрессию циклооксигеназы 2-го типа (COX-2) и индуцибельной NO-синтазы (iNOS) в фибробластах и тормозит развитие перекисного окисления липидов, что приводит к подавлению воспалительной реакции и вторично — к развитию обезболивающего эффекта и хондропротекции. Клиническое применение. Экстракт мартинии душистой (препарат Сустамар) при остеоартрите снижал выраженность боли в среднем на 25–50 % и увеличивал подвижность суставов примерно на 35–50 %; при поясничной боли уменьшал ее выраженность на 40–50 %, боль полностью исчезала у 2,5–20 % пациентов; был эффективен при генерализованной и локализованной формах фибромиалгии. Прием экстракта мартинии душистой при любых видах мышечно-скелетной боли приводил к тому, что примерно 60 % пациентов уменьшали дозу или полностью прекращали прием нестероидных и стероидных противовоспалительных средств. Возможно, эффективность экстракта мартинии душистой соответствует эффективности стандартной дозы рофекоксиба 12,5 мг, однако эти данные требуют уточнения. Безопасность. При приеме экстракта мартинии душистой легкие побочные эффекты (в основном диспептического характера) возникали примерно у 3 % пациентов, что не превышало соответствующую частоту при приеме плацебо. Длительное применение экстракта мартинии душистой (вплоть до 1 года) безопасно и не связано с развитием токсических эффектов. Приверженность к проводимому лечению среди пациентов составляет 96,4 %. Переносимость экстракта мартинии душистой, по-видимому, превышает таковую у селективных ингибиторов COX-2. Выводы. Экстракт мартинии душистой представляет собой эффективное и безопасное средство для лечения мышечно-скелетной боли. Для дальнейшего изучения данного препарата необходимо проводить более крупные исследования более высокого качества.

Successful use of tofacitinib in reactive arthritis refractory to conventional therapies - a case series.

Reactive arthritis is an immune-mediated aseptic arthritis resulting from either genitourinary or gastrointestinal tract in a genetically susceptible host. It commonly presents as oligoarthritis of the lower limbs with or without extra-articular features such as urethritis and non-purulent conjunctivitis. Therapies include non steroidal anti inflammatory drugs (NSAIDs), conventional disease modifying anti-rheumatic drugs (DMARDs) and, rarely, biologics in severe cases. We report the successful use of tofacitinib in four cases of reactive arthritis who failed to respond to conventional therapies.

Treatment of Non-Infectious Corneal Injury: Review of Diagnostic Agents, Therapeutic Medications, and Future Targets.

Corneal injuries can occur secondary to traumatic, chemical, inflammatory, metabolic, autoimmune, and iatrogenic causes. Ocular infection may frequently occur concurrent to corneal injury; however, antimicrobial agents are excluded from this present review. While practitioners may primarily rely on clinical examination techniques to assess these injuries, several pharmacological agents, such as fluorescein, lissamine green, and rose bengal, can be used to formulate a diagnosis and develop effective treatment strategies. Practitioners may choose from several analgesic medications to help with patient comfort without risking further injury or delaying ocular healing. Atropine, cyclopentolate, scopolamine, and homatropine are among the most frequently used medications for this purpose. Additional topical analgesic agents may be used judiciously to augment patient comfort to facilitate diagnosis. Steroidal anti-inflammatory agents are frequently used as part of the therapeutic regimen. A variety of commonly used agents, including prednisolone acetate, loteprednol, difluprednate, dexamethasone, fluorometholone, and methylprednisolone are discussed. While these medications are effective for controlling ocular inflammation, side effects, such as elevated intraocular pressure and cataract formation, must be monitored by clinicians. Non-steroidal medications, such as ketorolac, bromfenac, nepafenac, and diclofenac, are additionally used for their efficacy in controlling ocular inflammation without incurring side effects seen with steroids. However, these agents have their own respective side effects, warranting close monitoring by clinicians. Additionally, ophthalmologists routinely employ several agents in an off-label manner for supplementary control of inflammation and treatment of corneal injuries. Patients with corneal injuries not infrequently have significant ocular surface disease, either as a concurrent pathology or as an exacerbation of previously existing disease. Several agents used in the management of ocular surface disease have also been found to be useful as part of the therapeutic armamentarium for treatment of corneal injuries. For example, several antibiotics, such as doxycycline and macrolides, have been used for their anti-inflammatory effects on specific cytokines that are upregulated during acute injuries. There has been a recent wave of interest in amniotic membrane therapies (AMTs), including topical, cryopreserved and dehydrated variants. AMT is particularly effective in ocular injuries with violation of corneal surface integrity due to its ability to promote re-epithelialization of the corneal epithelium. Blood-based therapies, including autologous serum tears, plasma-enriched growth factor eyedrops and autologous blood drops, have additionally been explored in small case series for effectiveness in challenging and recalcitrant cases. Protection of the ocular surface is also a vital component in the treatment of corneal injuries. Temporary protective methods, such as bandage contact lenses and mechanical closure of the eyelids (tarsorrhaphy) can be particularly helpful in selective cases. Glue therapies, including biologic and non-biologic variants, can also be used in cases of severe injury and risk of corneal perforation. Finally, there are a variety of recently introduced and in-development agents that may be used as adjuvant therapies in challenging patient populations. Neurotrophic corneal disease may occur as a result of severe or chronic injury. In such cases, recombinant human nerve growth factor (cenegermin), topical insulin, and several other novel agents may be an alternate and effective option for clinicians to consider.

Age related effects of selective and non-selective COX-2 inhibitors on bone healing

IntroductionFractures are increasing worldwide and with an aging population, are frequent in the elderly. The healing of fractures progresses through various phases including the inflammatory stage. Aging is associated with slower healing and the use of non steroidal anti-inflammatory drugs (NSAIDs) may interrupt bone healing processes. We designed a study to compare the effect of diclofenac and celecoxib on fracture callus histomorphometry in a rat model of different age groups. MethodsUsing 5 and 15 month old rats, fractures were induced on the left tibia and the animals allocated to receive one of the drugs. Animals were sacrificed at day 21 and 42 and the fracture callus harvested for processing and histological evaluation. Tissue proportions and histological grades were determined and compared across the groups. ResultsAcross all groups, the histological grade increased with time and animals in the young diclofenac group had the highest grade at day 42 (p = 0.004). The proportion of bone increased in all groups and was highest in the young diclofenac group at day 21 and day 42 (p = 0.003). Post hoc analysis showed that the young celecoxib and old celecoxib groups had the least proportion of bone (p = 0.032 and p = 0.003). The proportion of cartilage reduced in all groups at both time points. ConclusionCelecoxib was associated with lower histological grade and lower proportion of bone in older animals. We urge for caution regarding the use of celecoxib in older people for the management of pain associated with fractures. Diclofenac may be a better option in this group.

Joint Manifestations Following COVID-19 Infection- A Case Series of Six Patients

A rare subset of Coronavirus Disease-2019 (COVID-19) positive patients has musculoskeletal manifestations including arthritis, arthralgia, myalgia and non specific body aches. Moreover, postviral Reactive Arthritis (ReA) has been reported following COVID-19 infection. This article reports the characteristic joint manifestations of Severe Acute Respiratory Syndrome-Corona Virus-2 (SARSCoV-2) infection in 6 out of 211 consecutive patients with laboratory-confirmed diagnosis of COVID-19 and treated at dedicated hospital. One 49-year-old female patient developed arthritis while having active COVID-19 infection, one 54-year-old male had post-COVID-19 ReA, and one 48-year-old female was found to have undifferentiated arthritis. One 58-year-old female patient was initially thought to have ReA the diagnosis was reconsidered later when her symptoms resolved without any disease modifying agents. Two patients 37-year-old male and 63-year-old female, developed arthralgia following COVID-19 infection. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and steroids were found to be beneficial in the series of patients. The key point to be noted is that not all arthritis or arthralgia following COVID-19 is ReA.