Prescribing pattern and adverse drug effects monitoring of anti-rheumatoid drugs in rheumatoid arthritis patients in a tertiary care hospital

Background: Rheumatoid arthritis (RA) is a common disease that causes substantial morbidity in most patients and premature mortality in many. All the drugs used in the treatment of rheumatoid arthritis show significant toxicity and hence it is important to monitor the drugs for adverse drug reaction. This study will estimate the prescribing pattern and bring out the possible adverse drug reactions in patients with rheumatoid arthritis.Methods: This study included 200 patients with rheumatoid arthritis who fulfilled the study criteria were observed for three months. Their prescriptions were collected and analysed. The symptoms of adverse drug reaction were documented through questionnaire. The causality assessment was done by WHO-UMC assessment scale and severity by using modified Hartwig-Seigel severity assessment scale.Results: This study showed most of the patients were female (86%). Majority of them were in age group of 51-60 years. Average number of drugs per prescription was 10.57. Out of 200 patients, 2% were on single DMARD and 50.5% were on two DMARDs. 40% and 7.5% were taking three and four DMARDs respectively. A total of 450 adverse drug reactions were reported, out of which 68.4% due to steroid,12.5% due to DMARDs and 19.1 due to use of NSAIDs, DMARDs and glucocortisteroids. Chloroquine maculopathy occurred in 3 patients and elevated liver enzymes due to methotrexate in 3 patients, which necessitated DMARD withdrawal. Most patients had 1-3 ADRs. 6% of ADRs were severe and 54% belongs to probable category of causality assessment.Conclusions: Treatment of rheumatoid arthritis is mainly based on DMARDs, glucocorticosteroids and NSAIDs. So, occurrence of ADR is much common. Proper monitoring of therapy and timely modification of drugs and lifestyle can reduce the ADR occurrence.

Appropriate Use of Non-steroidal Anti-inflammatory Drugs during the Perioperative Period: a Retrospective Multicenter Study / 中国药学杂志

OBJECTIVE: To evaluate the appropriateness of nonsteroidal anti-inflammatory drugs (NSAIDs) used in the perioperative period. METHODS: This was a retrospective multicenter study with three stages: ①characterization of the application of NSAIDs through questionnaires; ②establishment of an expert group and development of the standard for prescription evaluation; ③random enrollment of cases using NSAIDs during the perioperative period from October 2016 to March 2017 and evaluation of prescriptions. RESULTS: The study was conducted in 16 tertiary-care hospitals and included 960 cases. NSAIDs were commonly used in 15 hospitals (93.8%) during the perioperative period. Flurbiprofen axetil injection, parecoxib sodium injection and celecoxib capsule were NSAIDS with the top three expenses. Ten (62.5%) hospitals did not routinely intervene for the irrational use of NSAIDs, and only two (12.5%) hospitals established the regulatory regime of NSAIDs.The overall irrational rate was 23.3% (n=224). Too long continuous medication duration and inappropriate combination of NSAIDs were the main problems, involving 98 cases (10.2%) in 10 hospitals and 76 cases (7.9%) in 11 hospitals, respectively. Other problems were: 26 cases (2.7%) used drugs beyond contraindication, and 24 cases (2.5%) administrated drugs in irrational route.CONCLUSION: NSAIDs are widely used in the perioperative period. Lack of regulatory regime, insufficient clinical intervention and irrational prescriptions are the current status of NSAIDs usage. Therefore, it is necessary to take powerful measures and effective pharmaceutical intervention to improve the use of NSAIDs.

Protective mechanisms of L-glutamate in gastrointestinal and drug development / 药学学报

L-Glutamate is an important amino acid in protein. It has many physiological functions, such as nutrient metabolism, energy supply, immune response, oxidative stress, and signaling pathways regulation. Recent studies have found that glutamate prevents gastrointestinal damage induced by non-steroidal anti-inflammatory drugs (NSAIDs) and promotes the healing of the lesions. It can inhibit colonization of Helicobacter pylori and cell apoptosis caused by NH3. Hence, it has a potential value in protection of gastrointestinal from damage caused by NSAIDs and Helicobacter pylori. This article provides a review of the metabolism and physiological function of glutamate and its protective mechanisms of gastrointestinal injury caused by NSAIDs and Helicobacter pylori, which may serve as a reference in the study of glutamate in drug development.

Non-steroidal anti-inflammatory drug in adjuvant treatment of intravitreal triamcinolone acetonide for macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To study the clinical value of non-steroidal anti-inflammatory drug in adjuvant treatment of intravitreal triamcinolone acetonide ( IVTA ) for macular edema caused by retinal vein occlusion ( RVO) .?METHODS: Forty - eight eyes in 48 patients were randomly divided into trial and control group ( 24 eyes each ) in this prospective study. In the trial group, additional pranoprofen drops was administered from 1d before IVTA to 30d after injection. Central foveal thickness ( CFT ) was measured with optical coherence tomography ( OCT ) . Available documents of best corrected visual acuity ( BCVA ) , CFT, intraocular pressure and complications pre- and post-injection at 3d, 1,2wk, 1 and 3mo were evaluated.?RESULTS: After IVTA, BCVA was improved in both groups at different levels; but there was no statistically significant between two groups at each time point ( P>0. 05). The CFT values were 629 ± 43μm vs 605 ± 57μm before IVTA in the trail vs control groups (P>0. 05). The values were 432±74μm vs 511±32μm (t=7. 533, P<0. 05), and 275±54μm vs 379±29μm (t=13. 212, P<0. 05) of the trial vs control groups at 1 and 3mo after IVTA, respectively. Ocular hypertension occurred in 5 eyes after injection in trail group, and was controlled with anti-glaucoma medication and one eye with filtration surgery. Progression of cataract was noted in 3 of 35 phakic eyes and cataract surgery was performed in 2 eyes at 4-12mo after injection in trail group. Progression of cataract was noted in 4 eyes and cataract surgery was performed in 2 eyes at 4- 12mo after injection in control group. No retinal detachment and endophthalmitis happened during the whole period of follow-up.?CONCLUSION: Application of non - steroidal anti -inflammatory eye drops in perioperative period can be useful to improve the outcome of IVTA for macular edema, which needs further evaluation.

Treatment of Bartter syndrome. Unsolved issue, / Tratamento da síndrome de Bartter. Problema não resolvido,

Objective: To describe the results of a long-term follow-up of Bartter syndrome patients treated with different drugs. Method: Patients were diagnosed according to clinical and laboratory data. Treatment protocol was potassium supplementation, sodium, spironolactone, and non-steroidal anti-inflammatory drug. Patients who developed proteinuria were converted to angiotensin conversion enzyme inhibitor. The variables evaluated for each drug were Z-score for weight and stature, proteinuria, creatinine clearance, gastrointestinal complaints, amount of potassium supplementation, serum potassium and bicarbonate levels, and findings of upper digestive endoscopy. Results: 20 patients were included. Follow-up was 10.1 ± 5.2 years. 17 patients received indomethacin for 5.9 ± 5.3 years; 19 received celecoxib, median of 35 months; and five received enalapril, median of 23 months. During indomethacin, a statistically significant increase was observed in the Z-score for stature and weight, without a change in the creatinine clearance. Seven of 17 patients had gastrointestinal symptoms, and upper digestive endoscopy evidenced gastritis in three patients and gastric ulcer in four patients. During celecoxib use, a significant increase was detected in the Z-score for stature and weight and a reduction of hyperfiltration; seven patients presented gastrointestinal symptoms, and upper digestive endoscopy evidenced mild gastritis in three. During enalapril use, no significant changes were observed in the Z-score for stature, weight and creatinine clearance. The conversion to enalapril resulted in a significant reduction in proteinuria. Conclusion: The authors suggest starting the treatment with celecoxib, and replacing by ACEi if necessary, monitoring the renal function. The safety and efficacy of celecoxib need to be assessed in larger controlled studies. .

Objetivo: Descrever os resultados de um acompanhamento de longo prazo de pacientes com síndrome de Bartter tratados com diferentes medicamentos. Método: Pacientes diagnosticados segundo os dados clínicos e laboratoriais. Protocolo de tratamento: suplementação de potássio, sódio, espironolactona e medicamento anti-inflamatório não esteroidal. Os pacientes que desenvolveram proteinúria foram submetidos a inibidor da enzima de conversão da angiotensina. As variáveis avaliadas durante o uso de cada medicamento foram: escore Z para peso e estatura, proteinúria, depuração da creatinina, queixas gastrointestinais, quantidade da suplementação de potássio, níveis séricos de potássio e bicarbonato e achados da endoscopia digestiva alta. Resultados: Foram incluídos 20 pacientes. O acompanhamento foi de 10,1 ± 5,2 anos. No total, 17 pacientes receberam indometacina por 5,9 ± 5,3 anos, 19 receberam celecoxib por aproximadamente 35 meses e cinco receberam enalapril por aproximadamente 23 meses. Durante o uso de indometacina, observamos um aumento estatístico significativo no escore Z para estatura e peso, sem alteração na depuração da creatinina. 7/17 pacientes apresentaram sintomas gastrointestinais, e a endoscopia digestiva alta mostrou gastrite em três pacientes e úlcera gástrica em quatro. Durante o uso de celecoxib, detectamos um aumento significativo no escore Z para estatura e peso e uma redução da hiperfiltração; sete pacientes apresentaram sintomas gastrointestinais e a endoscopia digestiva alta mostrou gastrite leve em três pacientes. Durante o uso de enalapril, não observamos alterações significativas no escore Z para estatura, peso e depuração da creatinina. A mudança da medicação para enalapril resultou em uma ...

Tepoxalin on renal function and liver enzymes in cats exposed to hypotension with isoflurane / Tepoxalina sobre a função renal e as enzimas hepáticas em gatos submetidos à hipotensão com isofluorano

This study aimed to evaluate the possible renal and hepatic toxicity of tepoxalin administered before or after isoflurane-induced hypotension, as well as for five consecutive days. Twelve healthy mixed-breed cats, adult males, weighing 4.0±0.8kg were allocated into two groups. They received 25mgkg-1 of tepoxalin orally, two hours before the anesthetic procedure (PRE) or after the procedure (POST) and daily for five days. Cats were anesthetized with isoflurane and the concentration was increased until mean arterial pressure reached 40-60mmHg and kept at this level for 60 minutes. During hypotension, the physiological variables were measured at time 0 and every 10 minutes until 60 minutes, and bleeding time was measured at time 0, 30 and 60 minutes. Blood samples were drawn for a hemogram and determination of concentrations of alanine aminotransferase, alkaline phosphatase, urea, creatinine and Na+ at baseline, 24 hours, 48 hours and 7 days post-hypotension. Urine was collected at baseline, 24 hours, 48 hours and 7 days post-hypotension for determination of concentrations of creatinine, gamma-glutamyltransferase, urine specific gravity, protein, albumin and Na+. During the anesthetic procedure there were no important variations in physiological variables and bleeding time. There were differences only in fractional excretion of Na+, which was elevated at 7 days of evaluation in PRE and in the urine protein/creatinine ratio in PRE, which was higher than in POST at 24 and 48 hours post-hypotension. We conclude that tepoxalin does not cause alterations in hepatic enzymes but can cause discrete renal injury, resulting in proteinuria, in cats subjected to 60min of hypotension.

Este estudo teve como objetivo a avaliação da possível toxicidade renal e hepática da tepoxalina administrada antes ou após hipotensão induzida por isofluorano, assim como a sua administração nos cinco dias seguintes à hipotensão. 12 gatos adultos hígidos, machos, sem raça definida e com peso de 4,0±0,8kg foram alocados em dois grupos (n=6). Os animais receberam 25mgkg-1 de tepoxalina pela via oral, duas horas antes do procedimento anestésico (PRE) ou após o procedimento (POST) e diariamente por cinco dias consecutivos. Os gatos foram anestesiados com isofluorano, aumentando-se a sua concentração até que se atingisse uma pressão arterial média entre 40 e 60mmHg, sendo mantida durante 60 minutos. Durante o procedimento de hipotensão, os parâmetros fisiológicos foram mensurados no tempo 0 e a cada dez minutos até o fim do procedimento. O tempo de sangramento da mucosa oral foi avaliado no tempo 0 e aos 30 e 60 minutos de hipotensão. Amostras sanguíneas foram colhidas para a determinação de hemograma, alanina aminotransferase, fosfatase alcalina, ureia, creatinina e sódio no período basal e às 24 horas, 48 horas e sete dias pós-hipotensão. Amostras de urina foram colhidas por meio de cistocentese para a determinação de creatinina, gammaglutamiltransferase, densidade específica, proteínas, albumina e sódio. Durante o período anestésico, não ocorreram alterações referentes aos parâmetros fisiológicos e ao tempo de sangramento. Ocorreram alterações apenas na excreção fracionada de sódio, a qual demonstrou elevação no PRE aos sete dias, e na razão proteína/creatinina na urina, a qual demonstrou elevação do PRE em relação ao POST às 24 e às 48 horas de avaliação. Concluiu-se que a tepoxalina não causou alterações nas enzimas hepáticas, mas pode causar discreta injúria renal, com a presença de proteinúria, em gatos que foram submetidos à hipotensão.

Comparison of clinical effects between bromfenac sodium versus glucocorticoid following LASIK / 中华实验眼科杂志

Background Laser in-situ keratomileusis (LASIK) has been widely used to correct myopia,and the glucocorticoid-induced complication is increased.Bromfenac sodium 0.1％ is a non-steroidal anti-inflammatory drug used post-LASIK,but if it is better in clinical effects,safety and tolerance than glucocorticoid is unclear.Objective This study was to evaluate the safety,effectiveness,compliance of bromfenac sodium ophthalmic solution compared with glucocortieoid following LASIK.Methods A prospective randomized controlled trail were performed.Two hundred thirty-eight myopic eyes of 119 patients for LASIK were included in Peking Union Medical College Hospital from January 2011 to May 2012.The myopic eyes were firstly assigned to moderate and low spherical equivalent (SE) group (≤-6.0 D) or high SE group(＞-6.0 D) and then were further randomized into a NSAIDs subgroup and a glucocorticoid subgroup.Bromfenac sodium ophthalmic solution 0.1％ was topically administered 4 times per day for 10 days in the NSAIDs subgroup,and 0.1％ dexamethasone eye drops was used in the same way in the glucocorticoid subgroup after the LASIK.Uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),intraocular pressure (IOP),corneal topography,clinical symptom were examined and compared between the groups 1 day,10 days,1 month,3 months and 6 months after LASIK.Results There was no statistically significant postoperative difference in visual acuity and corneal topography (K1,K2,surface asymmetry index [SAI],surface regular index [SRI] and cylinder) between the NSAIDs and control group (P＞0.05).Postoperative IOP was significantly lower than that in preoperation,and lower IOP was found in the NSAIDs group than that of the glucocorticoid group.The IOP values in the moderate and low SE subjects of the NSAIDs group and glucocorticoid group were (13.31±2.44) mmHg and (16.62±4.74) mmHg on postoperative 10 days,(12.93±2.25) mmHg and (12.82± 1.72) mmHg in 1 month,(13.83±3.08) mmHg and (13.33 ±2.10) mmHg in 3 months,(11.67 ±2.48) mmHg and (13.64± 1.37)mmHg in 6 months after operation,respectively,showing significant differences among the groups and various timepoints (Fgroup =4.067,P =0.045 ; Ftime =10.689,P =0.000 ; Finteraction =2.897,P =0.023).In the high SE subjects of the NSAIDs and glucocorticoid group,the IOP values were (12.36± 1.30) mmHg and (17.32±4.74) mmHg in postoperative 10 days,(12.10t2.12)mmHg and (14.81 ±2.26)mmHg in postoperative I month,with a significant difference among the groups and timepoints (Fgroup =2.188,P =0.121 ;Ftime =14.025,P =0.000 ;Fi tion =15.805,P=0.000).No haze or diffuse lamellar keratitis (DLK) appeared in both groups,and the epithelial flaps were wellpositioned with satisfying healing process except for one eye in the moderate and low SE eyes of the NSAIDs group.Bromfenac sodium ophthalmic solution 0.1％ was well tolerated by all patients in the NSAIDs group,but discontinuation sensation occurred in 8 eyes of 6 patients and the antiglaucoma drugs were administered due to elevated IOP in the glucocorticoid group.The refractive status remained stable for patients of the moderate and low SE group.Conclusions Bromfenac sodium ophthalmic solution 0.1％ is safe,effective and well tolerated after topically administered following LASIK,and its outcomes in recovery of visual acuity,anti-inflammation and stabilizing refractive status and IOP are satisfying.But long-term attention should be payed to the high-myopic eyes.

Repeated Administration of Newly Synthesized Aceclofenac Sustained Release Form Causes Agranulocytosis: Case Report of an Unforeseen Adverse Event during the Phase 1 Trial

Aceclofenac is a non-steroidal anti-inflammatory drug (NSAIDs) for inflammatory diseases. In this report, we report a serious adverse event (AE) occurred during the phase I clinical trial for a new sustained-release (SR) formulation of aceclofenac. There was a serious adverse event (AE), agranulocytosis, induced by aceclofenac SR form. An open-labeled, repeated-doses, randomized, crossover study was conducted at Kyung Hee University Hospital and 26 Korean healthy male volunteers were enrolled. All subjects received both aceclofenac SR 200 mg once daily and aceclofenac IR 100 mg twice daily for 4 days with 11 days washout period. After 11 days washout period, one subject showed a serious decrease in the segment neutrophil (267/mm3) on a laboratory test prior to the reference drug administration in period 2. We first report a case of agranulocytosis, during a phase I clinical trial.

Clinical Features of Fixed Drug Eruption at a Tertiary Hospital in Korea

PURPOSE: Fixed drug eruption (FDE) is characterized by a well-defined erythematous patch, plaque, or bullous eruption that recurs at the same site as the result of systemic exposure to a causative drug, and resolves with or without hyperpigmentation. This study was carried out to identify the common causative drugs and clinical features of FDE in Korea. METHODS: We reviewed electronic medical records of all patients diagnosed with FDE from January 2000 to December 2010 at a tertiary hospital in Korea. RESULTS: A total of 134 cases were diagnosed as FDE. The mean age was 35.9 years (range, 0-82 years) and 69 (51.5%) of the patients were male. The mean duration from the first event to attending hospital was 1.9 years (range, 1-20 years). The mean number of recurrences was 2.6 (1-10), and 72.6% of patients sought medical care after experiencing symptoms twice or more. Four patients (3.1%) needed hospitalization. The most common sites were the upper extremities (47.7%), followed by the lower extremities, face, abdomen, chest, buttocks and perineum. Clear documentation on the causative drugs was available for 38 patients (28.4%), and among these, non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen accounted for 71.1% of cases, and antibiotics accounted for 15.8%. Eighty patients (59.7%) underwent active treatment for FDE, and topical steroids were most frequently prescribed (43.3%), with systemic steroids used in 11.2% of patients. CONCLUSIONS: NSAIDs and acetaminophen were the main causative agents of FDE, however, the causative agents were not assessed in 25% of patients.

Formulation development of directly compressed Naproxen SR tablet using Kollidon SR and Avicel PH 102 polymer.

Naproxen is a well-known non-steroidal anti-inflammatory drug (NSAID). This work has been done for developing a formulation of 280 mg sustained release (SR) tablet where 150 mg active pharmaceutical ingredient (Naproxen) were used along with other excipients like Kollidon SR, Avicel PH 102, Lactose MH, Povidone K 30 and Mg-Stearate. Naproxen SR tablet was prepared by direct compression method aiming to enhance its dissolution properties. The physical parameters (hardness, thickness, diameter, average weight and friability) and drug release profile of this tablet were evaluated. The hardness of tablets from F1 and F2 formulation were highest and rest of them was also satisfactory. F2 formulation did not meet the friability test. But rests of the formulations were acceptable which indicate that others formulations can handle pressure during storage, transportation and packaging. All the formulations released 90% of drug within 120 minutes except F4 formulation. Among the six formulations, release was prompt in F1 formulation because of usage of higher concentration of polymer Kollidon SR. The outcome of this study indicates that the rate of dissolution of Naproxen SR tablet can be considerably improved with Kollidon SR.

Mechanism of nonsteroidal anti-inflammatory drugs induced gastric mucosa injury / 中国综合临床

Objective To study the expression of Vascular Endothelial Growth Factor (VEGF),Malondialdehyde (MDA),Hypoxia Inducible Factor-1 α (HIF-1 α) in the Non-Steroidal Anti-Inflammatory Drug (NSAID)-associated gastric mucosa injury tissue,and to understand the mechanism of NSAID induced gastric mucosa injury.Methods We collected 114 biopsy specimen of gastric mucosa under endoscope from patients admitted to our hospital,including 70 cases with NSAID-associated chronic erosive gastritis or gastric ulcer (NSAID group) and 44 cases with chronic superficial gastritis who never take NSAID as controls (the control group).Immunohistochemistry technique was used to detect the positive expressions of VEGF,MDA,HIF-1α in patients.Results The positive rate of VEGF expression in the NSADI group was significantly lower than that in the normal control group (25.7％ (18/70) vs.54.5％ (24/44),x2 =9.70,P ＜ 0.05).The positive rates of MDA and HIF-1α in the NSADI group were significantly higher than these in the normal control group (MDA:62.9％ (44/70) vs.27.3％ (12/44),x2 =13.70,P ＜0.05; HIF-1α:45.7％ (32/70) vs.13.6％ (6/44),x2 =12.50,P ＜ 0.05).Conclusion NSAID drugs may induce gastric mucosa injury by decreasing the expression of VEGF and increase the levels of MDA and HIF1-α in gastric mucosa tissue.

Evaluation of the phototoxicity of non-steroidal anti-inflammatory drugs by in vitro BALB/c 3T3 cytotoxicity method / 中国药学杂志

OBJECTIVE: To evaluate the phototoxicity of several commonly used non-steroidal anti-inflammatory drugs by in vitro BALB/c 3T3 cytotoxicity method. METHODS: The half inhibitory concentration (IC50) values of test articles with and without irritation were compared to calculate photo-irritation factor (PIF), then phototoxicity was judged based upon PIF values. RESULTS: The PIF values of ketoprofen and naproxen were greater than 134.4 and 6.69, respectively, and that of fenbufen equaled to 5.96, all suggesting phototoxicity; ibuprofen and indometacin showed non-phototoxicity. CONCLUSION: The results of this study are consistent with previous reports. It is verified that in vitro BALB/c 3T3 cell phototoxicity method has excellent predictability and suitability. Combining this method with other tests is believed as the inevitable trend to fully estimate the potential phototoxicity of compounds.

Application and notice of a new generation of non-steroidal eye drops in refractive surgery / 中华实验眼科杂志

The efficacy and safety of excimer laser corneal refractive surgery for refractive error correction have been widely recognized,and effective and appropriate application of perioperative medication also greatly improved patients' satisfaction with surgery.Topical application of glucocorticoid is indispensable for the excimer laser corneal refractive surgery,and it can not be replaced by any other medication for more than 20 years.However,adverse reactions and complications after the application of glucocorticoid are not rare,especially in patients who are long-term users.Therefore,in recent years,non-steroidal anti-inflammatory drugs are becoming more widely used in ophthalmology.Bromfenac sodium,an inhibitor of cyclooxygenase-2,could assume the role as low-concentration glucocorticoids with good medical effects and less adverse effects.But whether it could attain the same therapeutic effects as glucocorticoids in corneal refractive surgery is a subject worth studying.

Pharmacological Treatment of Osteoarthritis / 대한정형외과연구학회지

Osteoarthritis (OA) is a slowly progressive degenerative disorder of weight-bearing joints, mainly characterized by joint pain and functional limitation. Current pharmacological treatment of OA mainly focuses on the alleviation of symptom, with few interventions available for modifying the degeneration of cartilage. In this review, various pharmacological options would be presented with the discussion of treatment efficacy mainly regarding pain control. Evidence for some agents indicating potential prevention of disease progression would also be presented.

A Case of Nicolau Syndrome Treated with Non-steroidal Anti-inflammatory Drug Injection Therapy / 대한피부과학회지

Nicolau syndrome, also known as livedoid dermatitis or embolia cutis medicamentosa, is a rare cutaneous adverse drug reaction characterized by the acute onset of cutaneous and soft-tissue necrosis following intramuscular drug injection. The typical presentation is pain around the injection site, developing into erythema, a livedoid patch, and necrosis of the skin, subcutaneous fat, and muscle tissue. We report a 72-year-old man who presented with a painful, erythematous patch on his left buttock. The patient was treated with non-steroidal anti-inflammatory drug (diclofenac sodium) injection.

Multiple Gastrointestinal Drug Induced Ulcers Associated with Aspirin and Non-steroidal Anti-inflammatory Drugs: A Case Report and Review of the Literature / 대한소화기내시경학회지

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed drugs, and they are known to be responsible for many cases of gastroduodenal ulcerations by inhibiting prostaglandin synthesis via blocking the cyclo-oxygenase production. Colonic side effects of these drugs are rare, but they are increasingly being reported to be due to the popularization of colonoscopy and the new formulations of drugs such as enteric coated pills or slow release pills. There is currently no consensus for making the clinical diagnosis and administering the proper therapy for drug-induced colonopathy in Korea. We experienced the patient who had multiple colonic ulcers after ingesting large amounts of aspirin and NSAIDs. In near future, we hope to determine the clinical and endoscopic features of drug associated colon injury.

Guidelines of Prevention and Treatment for NSAID-related Peptic Ulcers / 대한소화기학회지

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications in Korea. Gastrointestinal toxicity, including peptic ulcer, is a common adverse effect of NSAIDs. Risk factors for NSAID-related peptic ulcer include a previous history of peptic ulcer, advanced age, high dose, concomitant use of corticosteroids, anticoagulants, other NSAIDs including low-dose aspirin. Preventive measure(s), such as COX-2 inhibitor, proton pump inhibitor or misoprostrol, should be done for patients requiring NSAID therapy who have high-risk factor(s) for peptic ulcer. Low dose aspirin also increases the risk of peptic ulcer, so preventive measure(s) should be done for high-risk patients. The eradication of Helicobacter pylori is recommended for high-risk NSAID-users. Treatment strategies for peptic ulcers in NSAID users are mostly the same for peptic ulcers in NSAID non-users.

Efeito clínico do uso do parecoxib em modelo de sinovite induzida em pôneis / Clinical effect of parecoxib in induced synovitis in horses

Um modelo experimental de sinovite em pôneis foi usado para avaliar o efeito do parecoxib, um antiinflamatório não-esteroidal (AINE) seletivo injetável. Cinco dias após indução da sinovite, três pôneis foram tratados com 0,55mg/kg/dia (IV) de parecoxib e três receberam solução salina 0,9 por cento (IV) por cinco dias. A avaliação de parâmetros clínicos dos animais e físico-químicos do líquido sinovial foi realizada antes da indução de sinovite, antes e 12, 24, 48, 72, 96 e 120 horas após o início do tratamento. A injeção intra-articular com adjuvante completo de Freund induziu sinovite de intensidade moderada a grave. Os pôneis tratados com parecoxib apresentaram diminuição do grau de claudicação; manutenção da flexão articular, do comprimento do passo, da temperatura retal e da freqüência cardíaca; e atenuação do grau de efusão articular. Embora o parecoxib, na dose utilizada, não tenha apresentado efeito sobre os parâmetros do líquido sinovial das articulações com sinovite, sua ação antipirética, antiinflamatória e principalmente analgésica foi observada.

An experimental synovitis model was used in ponies to evaluate the effect of parecoxib, a selective non steroidal anti-inflammatory drug (NSAID). Five days after synovitis induction, three ponies received parecoxib (IV) 0.55mg/kg/day and three ponies received sterile 0.9 percent saline solution (IV) for five days. Clinical parameters and synovial fluid were evaluated before synovitis induction, prior treatment and 12, 24, 48, 96, and 120 hours after the first treatment. The intra-articular injection of Freund's complete adjuvant induced a moderate to severe synovitis. The parecoxib treated ponies showed lameness reduction; maintenance of stride length, articular flexion, temperature, and heart rate; and attenuation of articular effusion. Although the used dosage of parecoxib had no effect on evaluated synovial fluid parameters, antipyretic, anti-inflammatory, and especially analgesic effects were observed.

The Management of Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joint, for which treatment strategies have remained suboptimal for a long time. The treatment of RA has changed dramatically during the past decade due to the better understanding of its pathogenesis. Especially in early RA, early diagnosis and appropriate treatment is highlighted, with the treatment goal being clinical remission. In order to prevent joint damage and long-term disability, early use of disease-modifying anti-rheumatic drugs (DMARDs) is a key. Aggressive treatment such as combination of DMARDs and glucocorticoids or biological agents can induce a high rate of remission, suppression of joint damage and provide better outcome than DMARD monotherapy in early RA and should be considered in high-risk patients. Timely adjustment of therapy until patients have achieved low levels of disease activity is also crucial. On the other hand, treatment for osteoarthritis has mainly been focused on the alleviation of pain, while the goal of disease modification still remains elusive. Because the long-term use of non-steroidal anti-inflammatory agents poses significant risk of adverse events on the elderly, nonpharmacologic therapy including weight reduction, muscle strengthening, and exercise is recommended first. Recent advances in the understanding of the pathogenesis of osteoarthritis may provide a clue that will ultimately lead to disease modification.

Non-steroidal anti-inflammatory drug with corticosteroid induced acute gut injury and bacterial translocation in rat / 대한내과학회지

BACKGROUND: Use of corticosteroid appears to increase the risk of upper gastrosintestinal side effects associated with NSAIDs. But, there is no study for the effects of these drugs to NSAID induced small intestinal damage. Therefore, we examed the effects of corticosteroid to NSAID induced enteropathy and bacterial translocation. METHODS: Rat received no drug, NSAID alone (diclofenac 80 mg/kg per os), corticosteroid alone (dexamethasone 5 mg/kg intraperitoneal, 2 times) or NSAID with corticosteroid. Amounts of food intakes, body weight, intestinal permeability, enteric aerobic bacterial counts in small and large intestine, serum biochemical profiles, and pathologic findings of ileum were measured. Cultures of the mesenteric lymph nodes, as well as liver, spleen and systemic blood were taken. RESULTS: Diclofenac or dexamethasone alone administration caused gut barrier damage, enteric bacterial overgrowth and increased bacterial translocation. The supplements with dexamethasone increased NSAID induced gut barrier damage, villous atrophy, enteric bacterial overgrowth and bacterial translocation to mesenteric lymph nodes, liver, spleen and systemic blood. Also, these increased diclofenac induced body weight loss, but not hypoproteinemia. CONCLUSION: Corticosteroid increase NSAID induced body weight loss, gut barrier dysfunction, villous atrophy, enteric bacterial overgrowth and bacterial translocation in experimental animals.