Nonsteroidal antiinflammatory drug withdrawal in patients with stable rheumatoid arthritis.

OBJECTIVE: To evaluate the effect of nonsteroidal antiinflammatory drug (NSAID) withdrawal on blood pressure (BP), 44-joint Disease Activity Score (DAS44), and functional assessments in patients with stable rheumatoid arthritis (RA). METHODS: NSAID was withdrawn from 30 patients with stable RA (DAS44 ≤ 2.8). Other prescribed medication continued. Clinical and laboratory measures were taken at baseline, 6 weeks, and 12 weeks. RESULTS: No participants required NSAID reintroduction during the study period. Significant improvement in systolic BP was noted: maximal median reduction was 7 mm Hg (baseline to 12 weeks). There was no significant deterioration in DAS44 or function. Eleven participants required additional intervention. CONCLUSION: NSAID withdrawal resulted in improvement in BP without loss of disease control.

Celecoxib in arthritis: relative risk management profile and implications for patients.

Celecoxib is a selective cyclo-oxygenase 2 inhibitor licensed for use in musculoskeletal symptoms as well as in primary dysmenorrhea and acute pain. One advantage celecoxib has over traditional nonsteroidal anti-inflammatory drugs is that of significantly fewer gastrointestinal side-effects associated with its use. Much has been published on the potential cardiovascular and cerebrovascular complications of its administration. This review details the available evidence to allow prescribers to make informed decisions in the light of potentially conflicting evidence. The overall cardiovascular risk is increased with higher doses of celecoxib but is comparable with nonselective nonsteroidal anti-inflammatory use. As with all of these drugs, the potential cardiovascular and gastrointestinal risks of prescription need to be weighed up against possible benefits for each individual patient and discussed with the patients themselves.

Role for TNF in atherosclerosis? Lessons from autoimmune disease.

Inflammatory pathways have been implicated in the initiation and progression of cardiovascular diseases. Accelerated atherosclerosis has been described in patients with chronic inflammatory diseases, particularly rheumatoid arthritis, disproportionate to individuals' detectable traditional vascular risk factors. This finding suggests that other pathways associated with inflammation might account for increased vascular risk in such diseases. Highly specific biologic agents can precisely block the activity of cytokines generated during inflammatory cascades; the effects of these inflammatory moieties on vascular physiology and overall risk of cardiovascular events has been directly evaluated. This review summarizes key epidemiologic, physiologic and model data, which together suggest that tumor necrosis factor, a pivotal cytokine in the inflammatory cascade, is directly involved in vascular pathophysiology and that its inhibition might confer an overall advantage to the recipient. Moreover, such data obtained in chronic inflammatory diseases likely have relevance to primary atherosclerosis.

Update on the use of analgesics versus nonsteroidal anti-inflammatory drugs in rheumatic disorders: risks and benefits.

PURPOSE OF REVIEW: In the last 2 years, there have been numerous publications on the safety of nonsteroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors. An evaluation of the potential risks and benefits of other analgesics has also followed. In this time of greater analysis of analgesic use, this review seeks to present the most recent evidence. RECENT FINDINGS: Concerns of potential hepatotoxicity of therapeutic doses of paracetamol have been highlighted in the last 18 months. The efficacy and risks of long-term opioid use have also been reevaluated. The debate over nonsteroidal anti-inflammatory drug and cyclo-oxygenase-2 inhibitor safety continues. SUMMARY: Recent evidence has prompted a reassessment of the safety of paracetamol in certain groups of patients. Further clarification on the risks of nonsteroidal anti-inflammatory drug and cyclo-oxygenase-2 therapy for individuals is covered. Their use, increased cardiovascular risk and long-term implications need to be evaluated.

The problem with NSAIDs: what data to believe?

Patients with rheumatoid arthritis and osteoarthritis have relied upon NSAIDs as a cornerstone of their analgesic regime for decades. The choice of anti-inflammatory agents broadened for this group of patients when the selective inhibitors of cyclooxygenase-2 enzyme were developed. Much has been published in the past few years regarding the superior gastrointestinal safety of this class of drugs when compared with traditional NSAIDs. Their triumphant debut was swiftly followed by the emergence of data detailing their associated increased serious cardiovascular risks. This also led to a reevaluation of data concerning more traditional NSAIDs, and surprisingly, a similar trend was seen. The US Food and Drug Administration has recommended that both classes of drugs carry a black box warning with regard to gastrointestinal and cardiovascular risks.