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Patient benefit–risk in arthritis—a rheumatologist’s perspective
There is a range of pharmacological options available to the rheumatologist for treating arthritis. Non-selective NSAIDs or Cox-2 selective inhibitors are widely prescribed to reduce inflammation and alleviate pain; however, they must be used with caution in individuals with an increased cardiovascu...
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Formato: | Texto |
Lenguaje: | English |
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Oxford University Press
2010
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857791/ https://www.ncbi.nlm.nih.gov/pubmed/20407136 http://dx.doi.org/10.1093/rheumatology/keq057 |
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author | Bijlsma, Johannes W. J. |
author_facet | Bijlsma, Johannes W. J. |
author_sort | Bijlsma, Johannes W. J. |
collection | PubMed |
description | There is a range of pharmacological options available to the rheumatologist for treating arthritis. Non-selective NSAIDs or Cox-2 selective inhibitors are widely prescribed to reduce inflammation and alleviate pain; however, they must be used with caution in individuals with an increased cardiovascular, renal or gastrointestinal (GI) risk. The potential cardiovascular risks of Cox-2 selective inhibitors came to light over a decade ago. The conflicting nature of the study data reflects some context dependency, but the evidence shows a varying degree of cardiovascular risk with both Cox-2 selective inhibitors and non-selective NSAIDs. This risk appears to be dose dependent, which may have important ramifications for arthritis patients who require long-term treatment with high doses of anti-inflammatory drugs. The renal effects of non-selective NSAIDs have been well characterized. An increased risk of adverse renal events was found with rofecoxib but not celecoxib, suggesting that this is not a class effect of Cox-2 selective inhibitors. Upper GI effects of non-selective NSAID treatment, ranging from abdominal pain to ulceration and bleeding are extensively documented. Concomitant prescription of a proton pump inhibitor can help in the upper GI tract, but probably not in the lower. Evidence suggests that Cox-2 selective inhibitors are better tolerated in the entire GI tract. More evidence is required, and a composite end-point is being evaluated. Appropriate treatment strategies are needed depending on the level of upper and lower GI risk. Rheumatologists must be vigilant in assessing benefit–risk when prescribing a Cox-2 selective inhibitor or non-selective NSAID and should choose appropriate agents for each individual patient. |
format | Text |
id | pubmed-2857791 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-28577912010-04-22 Patient benefit–risk in arthritis—a rheumatologist’s perspective Bijlsma, Johannes W. J. Rheumatology (Oxford) Reviews There is a range of pharmacological options available to the rheumatologist for treating arthritis. Non-selective NSAIDs or Cox-2 selective inhibitors are widely prescribed to reduce inflammation and alleviate pain; however, they must be used with caution in individuals with an increased cardiovascular, renal or gastrointestinal (GI) risk. The potential cardiovascular risks of Cox-2 selective inhibitors came to light over a decade ago. The conflicting nature of the study data reflects some context dependency, but the evidence shows a varying degree of cardiovascular risk with both Cox-2 selective inhibitors and non-selective NSAIDs. This risk appears to be dose dependent, which may have important ramifications for arthritis patients who require long-term treatment with high doses of anti-inflammatory drugs. The renal effects of non-selective NSAIDs have been well characterized. An increased risk of adverse renal events was found with rofecoxib but not celecoxib, suggesting that this is not a class effect of Cox-2 selective inhibitors. Upper GI effects of non-selective NSAID treatment, ranging from abdominal pain to ulceration and bleeding are extensively documented. Concomitant prescription of a proton pump inhibitor can help in the upper GI tract, but probably not in the lower. Evidence suggests that Cox-2 selective inhibitors are better tolerated in the entire GI tract. More evidence is required, and a composite end-point is being evaluated. Appropriate treatment strategies are needed depending on the level of upper and lower GI risk. Rheumatologists must be vigilant in assessing benefit–risk when prescribing a Cox-2 selective inhibitor or non-selective NSAID and should choose appropriate agents for each individual patient. Oxford University Press 2010-05 2010-04-07 /pmc/articles/PMC2857791/ /pubmed/20407136 http://dx.doi.org/10.1093/rheumatology/keq057 Text en © The Author(s) 2010. Published by Oxford University Press on behalf of The British Society for Rheumatology. http://creativecommons.org/licenses/by-nc/2.5 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Reviews Bijlsma, Johannes W. J. Patient benefit–risk in arthritis—a rheumatologist’s perspective |
title | Patient benefit–risk in arthritis—a rheumatologist’s perspective |
title_full | Patient benefit–risk in arthritis—a rheumatologist’s perspective |
title_fullStr | Patient benefit–risk in arthritis—a rheumatologist’s perspective |
title_full_unstemmed | Patient benefit–risk in arthritis—a rheumatologist’s perspective |
title_short | Patient benefit–risk in arthritis—a rheumatologist’s perspective |
title_sort | patient benefit–risk in arthritis—a rheumatologist’s perspective |
topic | Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857791/ https://www.ncbi.nlm.nih.gov/pubmed/20407136 http://dx.doi.org/10.1093/rheumatology/keq057 |
work_keys_str_mv | AT bijlsmajohanneswj patientbenefitriskinarthritisarheumatologistsperspective |