scholarly journals AB0589 STUDY OF THE EFFECTIVENESS OF PELOID THERAPY IN THE TREATMENT OF OSTEOARTHRITIS OF THE KNEE JOINTS IN THE CONDITIONS OF THE SANATORIUM “ CHUVASHIYAKURORT»

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1331.2-1332
Author(s):  
N. Zhuravleva ◽  
L. Karzakova ◽  
S. Kudryashov ◽  
A. Arkhipova
Keyword(s):  
Morning Stiffness ◽  
Publishing House ◽  
Medical Rehabilitation ◽  
Knee Joints ◽  
Osteoarthritis Of The Knee ◽  
Basic Therapy ◽  
Number Of Patients ◽  
Anti Inflammatory ◽  
Peloid Therapy ◽  
The Right

Background:Peloids are successfully used in the treatment of various diseases. The sapropel mud-silt deposits of freshwater reservoirs are the most widely used for joint diseases. The sapropel mud from the freshwater lake «Kogoyar» (Russia, Cheboksary) has unique properties. The right to extract and use sapropel belongs to the sanatorium “Chuvashiyakurort” (Russia) [1]. The organic biostimulants of the sapropel mud (bitumen, fatty and humic acids, amino acids, hormones, lipids) have a pronounced anti-inflammatory effect on cartilage. High humidity (87%) provides sapropel high thermal qualities.Objectives:The aim of the research was to study the effectiveness of peloid therapy in patients with osteoarthritis of the knee joints at the II X-ray stage using the sapropel mud of Lake «Kogoyar».Methods:The object of the study was 150 patients of the sanatorium “Chuvashiyakurort” aged from 55 to 62 years (89 women and 61 men). The patients were randomly divided into 2 groups. The first group (75 people) received basic therapy - chondroprotectors (Teraflex) and nonsteroidal anti-inflammatory drugs (NSAIDs) on demand. The second group (75 people) received basic therapy with the addition of peloid application. The peloid was used in the natural, minimally modified, undiluted form. The peloid therapy protocol: the peloid was heated to 50 °C before use and applied to the affected joint with a layer of 4-5 cm thick and wrapped with a warm cloth on top. The procedure took 30 minutes. Five three-day cycles of applications with one-day breaks were performed. At the end of the procedure, a patient was unraveled, the mud was removed from him and he took a warm shower. Then he had a rest for 30 to 40 minutes in the recreation room. Before the start of treatment and after its completion, a survey of patients was conducted with the fixation of pain on the VAS scale, the duration of morning stiffness, fatigue and decreased performance, general discomfort, dependence on taking NSAIDs.Results:The analysis of the survey results revealed a decrease in VAS pain and morning stiffness in both groups. However, patients in the second group had a more pronounced reduction in the average VAS pain score (26% lower compared to the first group) and the duration of morning stiffness (20% lower compared to the first group). In addition, the number of patients who indicated a decrease in dependence on taking NSAIDs was 28% higher than in the group that received only standard therapy.Conclusion:Peloid therapy enabled to reduce the pain on the back, reduce the frequency of the need for NSAIDs, improve the condition of patients, which is the reflection of the positive clinical dynamics in patients with osteoarthritis of the knee joints, and contributed to the effectiveness of treatment.References:[1]Sakharova A.S. Modern methods of medical rehabilitation in the practice of doctors of various specialties. Cheboksary: Publishing House of Chuvash State University, 2019: 110-115.Disclosure of Interests:None declared.

COMPARISON OF INTRA-ARTICULAR APPLICATION OF POLYDEOXYRIBONUCLEIC ACID AND HYALURONIC ACID IN EXPERIMENTALLY INDUCED OSTEOARTHRITIS IN RATS

2020 ◽  
Vol 23 (03) ◽  
pp. 2050009
Author(s):  
Nazım Karahan ◽  
Ilyas Arslan ◽  
Ahmet Oztermeli ◽  
Mehmet Mufit Orak ◽  
Ahmet Midi ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Chloride Solution ◽  
Sodium Chloride Solution ◽  
Acid Group ◽  
Saline Group ◽  
Knee Joints ◽  
Osteoarthritis Of The Knee ◽  
Significant Difference ◽  
The Right ◽  
Experimentally Induced

Purpose: This study was conducted to histopathologically compare the results of the administration of intra-articular PDRN and HA injections in experimentally induced OA in rats. Methods: Osteoarthritis of the knee joints was induced in a total of 30 rats. Rats were randomly divided into three groups; polydeoxyribonucleic (PDRN) acid group, hyaluronic acid (HA) group, and saline group. The PDRN group was injected with 12 mg/0.05 ccPDRN acid. The HA group was injected with 12 mg/0.05 ccHA, whereas the saline group was injected with 50 [Formula: see text]l (0.05 cc) of 0.9% sodium chloride solution. All rats were sacrificed on postinjection day 29, and the right knee joints were prepared and evaluated histologically using the Mankin scoring system. Results: Total Mankin scores showed a significant difference among all groups ([Formula: see text] = 0.001). According to bilateral comparisons performed to identify the group that showed a difference, the total Mankin scores of the PDRN acid and HA groups were found to be significantly lower than those of the saline group. In PDRN acid group, tidemark continuity wasobserved in all specimen. Conclusion: Intra-articular injections of PDRN acid resulted in greater chondroprotective effects and less degeneration than those of HA and saline in experimentally induced OA of the knee joints in rats.

scholarly journals Comparison of histological effects of polydeoxyribonucleic acid and hyaluronic acid in experimentally induced osteoarthritis of the knee joints of rats

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0008
Author(s):  
Nazım Karahan ◽  
İlyas Arslan ◽  
Müfit Orak ◽  
Ahmet Midi ◽  
İstemi Yücel
Keyword(s):  
Hyaluronic Acid ◽  
Saline Solution ◽  
Acid Group ◽  
Saline Group ◽  
Knee Joints ◽  
Osteoarthritis Of The Knee ◽  
The Right ◽  
Chondroprotective Effect ◽  
Acl Transection ◽  
Experimentally Induced

Aim: The histological effects of intra-articular polydeoxyribonucleic acid and hyaluronic acid in experimentally induced osteoarthritis of the knee joints of rats were investigated. Methods: Thirty rats were divided into three groups, i.e. polydeoxyribonucleic acid group, hyaluronic acid group and saline group. Osteoarthritis of the knee joints of the rats were induced by acl- transection. The polydeoxyribonucleic group was injected with 100 µg (0.05 cc) polydeoxyribonucleic acid. The hyaluronic acid group was injected with 100 µg (0.05 cc) hyaluronic acid, and the saline group was injected with 50 µl (0.05 cc) of 0.9% sodium chloride solution. All of the rats were sacrificed on day 29 and the right knee joints were prepared, and evaluated histologically by Mankin classification. Findings: The differences in total Mankin scores between the three groups were statistically significant (P < 0.01). The differences in total Mankin scores between the polydeoxyribonucleic acid group and the hyaluronic acid group were statistically significant (P < 0.01). The differences in total Mankin scores between hyaluronic acid group and saline group were statistically significant (P < 0.01). Tidemark continuity in all the specimens of the polydeoxyribonucleic acid group was noteworthy. Conclusion: The present study shows that more chondroprotective effect and less degeneration was observed with intra-articularly delivered polydeoxyribonucleic acid compared to hyaluronic acid and saline solution in the experimentally induced osteoarthritis of the knee joints of rats.

scholarly journals Many years of experience in using a combination of glucosamine and chondroitin in clinical practice

2020 ◽  
pp. 113-119
Author(s):  
I. S. Dydykina ◽  
P. S. Kovalenko ◽  
A. A. Kovalenko
Keyword(s):  
Clinical Evidence ◽  
Knee Joints ◽  
Osteoarthritis Of The Knee ◽  
Lower Back ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Timely Administration ◽  
Nuclear Factor Kb

The article presents the main approaches to choosing the treatment of osteoarthritis and the main links in the pathogenesis of this disease. The effects of glucosamine and chondroitin on the main pathogenetic mechanisms of osteoarthritis that prevent its progression are described. There are discussed an effectiveness and safety of treatment of the disease with a focus on the use of a combination of glucosamine hydrochloride and chondroitin sulfate (Arthra), as well as their combination with methylsulfonylmethane and sodium hyaluronic acid (Arthra MSM). Methylsulfonylmethane reduces pain, it is involved in the processes of maintaining and regeneration of connective tissue, in the synthesis of sulfated glycosaminoglycans and collagen. It is suggested that this compound may have analgesic and anti-inflammatory properties due to the inhibition of the nuclear factor kB signaling pathway, which allows to reduce the local and systemic inflammatory response, as well as suppressing the expression of proinflammatory cytokines and much more. This article also presents experimental and clinical evidence of the effectiveness and safety of these compounds. It has been convincingly demonstrated the possibility with these drugs to reduce joint pain and the need for analgesics and non-steroidal anti-inflammatory drugs, to improve the quality of life. Currently, symptomatic slow-acting drugs, which include the discussed ones, are recommended to be prescribed as first-line drugs for the treatment of osteoarthritis. Timely administration of symptomatic slow-acting drugs, their long-term use contributes not only to reducing the progression of the disease, but also makes it possible to avoid or delay endoprosthetics. In this article there is indicated the contribution of Russian scientists to obtaining evidence of the effectiveness and safety of Arthra and Arthra MSM in the application of various treatment modes in osteoarthritis of the knee joints and lower back pain.

scholarly journals Stromal Vascular Fraction for Osteoarthritis of the Knee Regenerative Engineering

2021 ◽  
Author(s):  
Chinedu C. Ude ◽  
Shiv Shah ◽  
Kenneth S. Ogueri ◽  
Lakshmi S. Nair ◽  
Cato T. Laurencin
Keyword(s):  
Quality Of Life ◽  
Clinical Evidence ◽  
Point Of Care ◽  
Stromal Vascular Fraction ◽  
Clinic Visit ◽  
Osteoarthritis Of The Knee ◽  
Clinical Patient ◽  
Inflammatory Proteins ◽  
Anti Inflammatory

Abstract Purpose The knee joint is prone to osteoarthritis (OA) due to its anatomical position, and several reports have implicated the imbalance between catabolic and anabolic processes within the joint as the main culprit, thus leading to investigations towards attenuation of these inflammatory signals for OA treatment. In this review, we have explored clinical evidence supporting the use of stromal vascular fraction (SVF), known for its anti-inflammatory characteristics for the treatment of OA. Methods Searches were made on PubMed, PMC, and Google Scholar with the keywords “adipose fraction knee regeneration, and stromal vascular fraction knee regeneration, and limiting searches within 2017–2020. Results Frequently found interventions include cultured adipose-derived stem cells (ADSCs), SVF, and the micronized/microfragmented adipose tissue-stromal vascular fraction (MAT-SVF). Clinical data reported that joints treated with SVF provided a better quality of life to patients. Currently, MAT-SVF obtained and administered at the point of care is approved by the Food and Drug Administration (FDA), but more studies including manufacturing validation, safety, and proof of pharmacological activity are needed for SVF. The mechanism of action of MAT-SVF is also not fully understood. However, the current hypothesis indicates a direct adherence and integration with the degenerative host tissue, and/or trophic effects resulting from the secretome of constituent cells. Conclusion Our review of the literature on stromal vascular fraction and related therapy use has found evidence of efficacy in results. More research and clinical patient follow-up are needed to determine the proper place of these therapies in the treatment of osteoarthritis of the knee. Lay Summary Reports have implicated the increased inflammatory proteins within the joints as the main cause of osteoarthritis (OA). This has attracted interest towards addressing these inflammatory proteins as a way of treatment for OA. The concentrated cell-packed portion of the adipose product stromal vascular fraction (SVF) from liposuction or other methods possesses anti-inflammatory effects and has been acclaimed to heal OA. Thus, we searched for clinical evidence supporting their use, for OA treatment through examining the literature. Data from various hospitals support that joints treated with SVF provided a better quality of life to patients. Currently, there is at least one version of these products that are obtained and given back to patients during a single clinic visit, approved by the FDA.

scholarly journals AB0713 EVALUATION OF THE EFFECTIVENESS OF LASER THERAPY IN THE TREATMENT OF RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1388.1-1388
Author(s):  
N. Zhuravleva ◽  
L. Karzakova ◽  
S. Kudryashov ◽  
E. Petrova
Keyword(s):  
Rheumatoid Arthritis ◽  
Laser Therapy ◽  
Medical Therapy ◽  
Joint Pain ◽  
Morning Stiffness ◽  
Activity Index ◽  
Clinical Indicators ◽  
On Demand ◽  
Number Of Patients ◽  
Basic Medical

Background:Despite the fact that the introduction of biological disease-modifying antirheumatic medicines (bDMARDs) and the early start of treatment for rheumatoid arthritis (RA) can effectively stop the inflammatory process in RA, a fairly large number of patients continue to experience joint pain [1]. It is assumed that in some cases, joint pain in patients with RA is not associated with the inflammation, so it requires consideration of the possibility of using alternative strategies for the treatment of RA.Objectives:The aim of the research is to study the effectiveness of laser therapy in the treatment of RA.Methods:114 patients with RA aged from 32 to 53 years have been monitored for 6 months. There were 82 women (71.9 %) and 32 men (28.1%) among them. The patients were randomly divided into 2 groups. The first group of patients (57 people) received basic medical therapy with methotrexate 15 mg intramuscularly once a week and nonsteroidal anti-inflammatory medicines (NSAIDs) on demand. The dose of methotrexate was selected taking into account the disease activity index DAS 28. The second group of patients (57 people) received basic medical therapy with methotrexate 15 mg intramuscularly once a week and NSAIDs on demand. In addition, the cutaneous low-intensity laser irradiation of the joints was added along the projection of the joint gap in a pulse mode with a wavelength of 0.89 microns. The pulse frequency is 80-1500 Hz, the pulse power is 5 W, the exposure time in the field is 1-2 minutes and the total radiation time per session is no more than 10 minutes [2]. The course of treatment consisted of 10 procedures (the device “Milta F-8 RD”, Russia, Moscow). The course of laser therapy was repeated after 4 weeks. To assess clinical indicators, patients were examined using the SF-36 questionnaire before treatment and 6 months after the start of treatment.Results:The survey after 6 months revealed the significant decrease in the severity of pain on the VAS from the initial average indicator 4.5±0.2 to 3.69±0.2 points (p<0.01) and morning stiffness from 60±5 to 40.8±4 minutes (p<0.01). In the first group, the dynamics of clinical indicators were not statistically significant: the intensity of pain decreased from 4.6±0.2 to 4.2±0.3 points (p>0.05) and the duration of morning stiffness reduced from 62±7 to 58.6±6 minutes (p>0.05). In the second group the decrease in the need for NSAIDs was observed in 21 patients, while in the first group the same was observed only in 10 patients (px2 = 0.020).Conclusion:Laser therapy in the treatment of patients with RA enabled to decrease the frequency of the need for NSAIDs and reduce morning stiffness. We recommend using laser therapy in patients with RA at the second radiological stage as an addition to basic therapy.References:[1]Altawil R et al. Arthritis Care Res (Hoboken). 2016; 68(8): 1061-1068.[2]Burger M et al. Physiother Theory Pract. 2017; 33(3): 184-197.Disclosure of Interests:None declared

scholarly journals Beyond the guidelines management of juvenile idiopathic arthritis: a case report of a girl with polyarticular disease refractory to multiple treatment options and Leri Weill syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vana Vukić ◽  
Ana Smajo ◽  
Mandica Vidović ◽  
Rudolf Vukojević ◽  
Miroslav Harjaček ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Case Report ◽  
Treatment Options ◽  
Janus Kinase ◽  
Musculoskeletal Symptoms ◽  
Multiple Treatment ◽  
Number Of Patients ◽  
Systemic Glucocorticoids ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Background The last two decades brought new treatment options and high quality guidelines into the paediatric rheumatologic practice. Nevertheless, a number of patients still present a diagnostic and therapeutic challenge due to combination of vague symptoms and unresponsiveness to available treatment modalities. Case presentation We report a case of sixteen years old girl suffering from polyarticular type of juvenile idiopathic arthritis refractory to multiple treatment options. She first presented at the age of 4 with swelling and contractures of both knees. Her symptoms were initially unresponsive to nonsteroidal anti-inflammatory drugs and progressed despite treatment with intraarticular and systemic glucocorticoids and methotrexate. Throughout the years, she received several biologics together with continuous administration of nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs as well as intraarticular and systemic glucocorticoids in disease flares. However, none of this options  provided a permanent remission, so various other modalities, as well as other possible diagnoses were constantly being considered. Eventually she became dependent on a daily dose of systemic glucocorticoids. In 2018, the treatment with Janus kinase inhibitor tofacitinib was initiated, which led to gradual amelioration of musculoskeletal symptoms, improvement of inflammatory markers and overall well-being, as well as to the weaning of systemic glucocorticoids. As the swelling of the wrists subsided for the first time in many years, Madelung’s deformity was noticed, first clinically, and later radiographically as well. Genetic analysis revealed short-stature homeobox gene deficiency and confirmed the diagnosis of Leri Weill syndrome. Conclusions This case report emphasizes the need for reporting refractory, complicated cases from everyday clinical practice in order to build-up the overall knowledge and share experience which is complementary to available guidelines. Individual reports of difficult to treat cases, especially when additional diagnoses are involved, can be helpful for physicians treating patients with common rheumatological diseases such as juvenile idiopathic arthritis.

scholarly journals O06 Inflammatory arthritis triggered by COVID-19

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ghazal Ansari ◽  
Frances A Borg ◽  
Gouri Koduri
Keyword(s):  
Case Report ◽  
Sore Throat ◽  
Inflammatory Arthritis ◽  
Morning Stiffness ◽  
Good Prognosis ◽  
Knee Joints ◽  
Mediastinal Lymphadenopathy ◽  
Severe Illness ◽  
Initial Symptoms ◽  
Systemic Examination

Abstract Case report - Introduction COVID-19 is an infectious disease caused by a newly discovered β-coronavirus, named Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), resulted in a recent pandemic of COVID-19. As a novel pathogen, the nature and degree of risk of COVID-19 to individuals with rheumatic diseases were unknown, as was its ability to induce musculoskeletal and autoimmune disease. Concerns were related to the chronic autoimmune or inflammatory disease and immune suppressive medications to treat it. The consequences of this infection are currently not fully understood, including the autoimmune sequelae.  Here we present two cases of inflammatory arthritis with a temporal link to COVID-19.  Case report - Case description: Case 1 A 37-year-old Caucasian male was referred to Rheumatology with severe joint pains. He developed flu-like symptoms in early April 2020, with myalgia, fever, sore throat, anosmia, and fatigue. SARS-CoV-2 PCR swab was positive. He recovered from these initial symptoms, however 4 weeks later, he developed pain and swelling in his hands, feet, ankles, and knee joints with early morning stiffness. On examination, there was marked synovitis of hands, wrists, knees, and ankle joints. Systemic examination was otherwise normal. Case 2 A 70-year-old lady developed sore throat and cough started in late March 2020. 3 weeks later, she became generally unwell with lethargy and fatigue. Her cough gradually improved, but she continued to experience breathlessness on minimal exertion. In early May 2020, she developed excruciating pain in her hands, wrists, and right knee joints with morning stiffness.  On examination she had synovitis in the wrists, small joints of the hands and right knee. Systemic examination otherwise was unremarkable. Given the severe inflammatory arthritis, both patients were commenced on oral prednisolone with remarkable improvement 4 weeks later. Case report - Discussion We present 2 cases of acute inflammatory arthritis, which were suspected to have been triggered by COVID-19 viral infection without any musculoskeletal complications with good prognosis. COVID-19 is a new disease and our understanding of it is continuing to grow. The initial concern was that COVID-19 -19 infection may lead to severe illness in immunocompromised patients, including those and with rheumatic conditions. However, this was not seen in large numbers. To our knowledge, COVID-19-related inflammatory arthritis has not previously been reported in the literature. Our current understanding of the COVID-19 pathogenic mechanisms is limited. However, it is likely that the disease may evolve in overlapping phases. Case report - Key learning points In both cases, it was suggested that COVID-19 19 may be a triggering factor for inflammatory arthritis with good prognosis and settled with steroid therapy.  It was suggested that arthritis may occur in patients with COVID-19, in previously fit and well patients without any underlying co-morbidities and autoimmune rheumatic disease and warrants urgent Rheumatology review. However, all COVID-19 suspected cases should be investigated on an individual basis to exclude other diagnosis to avoid missing other common reversible illnesses. O06 Table 1:Investigations at Baseline and 4 weeks Case 1   Case 2  Baseline4 weeks Baseline4 weeks CRP (&lt;5) mg/L18227694ESR (2-28mm/hour)3 90 Hb (130-180 g/L)14315293114Wbc (4.0-11.0)109/L8.05.311.812.1Neutrophil (1.7-7.5)109/L5.793.289.2910.20Lymphocyte (1.0-4.5) 109/L1.391.381.241.14CK (&lt;200) U/L90 22 ANANegative Negative ENA 0.2 0.3 ANCANegative ND  RF (0-14) U/mL&lt;10 428 CCP (0.4-6.9) U/mL0.8 51 ImmunoglobulinsNormal  IgG,17.9 ComplementsND Normal CXR Bil Hilar enlargement Diffuse widespread air space opacities CT Chest Significant mediastinal Lymphadenopathy with no specific features Multifocal GGO, patchy consolidation, likely recovery stage of COVID-19   

scholarly journals Cannabis and Canabidinoids on the Inflammatory Bowel Diseases: Going Beyond Misuse

2020 ◽  
Vol 21 (8) ◽  
pp. 2940
Author(s):  
Antonelly Cassio Alves de Carvalho ◽  
Gabriela Achete de Souza ◽  
Samylla Vaz de Marqui ◽  
Élen Landgraf Guiguer ◽  
Adriano Cressoni Araújo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Inflammatory Bowel Diseases ◽  
Literature Search ◽  
Cannabis Sativa ◽  
Antioxidant Properties ◽  
Number Of Patients ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Anti Inflammatory

Inflammatory bowel diseases (IBD) are characterized by a chronic and recurrent gastrointestinal condition, including mainly ulcerative colitis (UC) and Crohn’s disease (CD). Cannabis sativa (CS) is widely used for medicinal, recreational, and religious purposes. The most studied compound of CS is tetrahydrocannabinol (THC) and cannabidiol (CBD). Besides many relevant therapeutic roles such as anti-inflammatory and antioxidant properties, there is still much controversy about the consumption of this plant since the misuse can lead to serious health problems. Because of these reasons, the aim of this review is to investigate the effects of CS on the treatment of UC and CD. The literature search was performed in PubMed/Medline, PMC, EMBASE, and Cochrane databases. The use of CS leads to the improvement of UC and CD scores and quality of life. The medical use of CS is on the rise. Although the literature shows relevant antioxidant and anti-inflammatory effects that could improve UC and CD scores, it is still not possible to establish a treatment criterion since the studies have no standardization regarding the variety and part of the plant that is used, route of administration and doses. Therefore, we suggest caution in the use of CS in the therapeutic approach of IBD until clinical trials with standardization and a relevant number of patients are performed.

scholarly journals The Rate of Prescribing Gastrointestinal Prophylaxis with Either a Proton Pump Inhibitor Or an H2-Receptor Antagonist in Nova Scotia Seniors Starting Nonsteroidal Anti-Inflammatory Drug Therapy

2010 ◽  
Vol 24 (8) ◽  
pp. 481-488 ◽  
Author(s):  
Bogdan Superceanu ◽  
Sander Veldhuyzen van Zanten ◽  
Chris Skedgel ◽  
Michael Shepherd ◽  
Ingrid Sketris
Keyword(s):  
Nova Scotia ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Nonselective Nsaid ◽  
H2 Receptor Antagonist ◽  
Number Of Patients ◽  
Increased Risk ◽  
Gastroprotective Agent ◽  
Anti Inflammatory ◽  
One Year

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used agents that can cause serious gastrointestinal (GI) side effects. For patients at increased risk of NSAID-related GI complications, prophylaxis with either a nonselective NSAID plus gastroprotective agent (GPA) or, alternatively, therapy with a cyclooxygenase-2 selective inhibitor with or without a GPA such as a proton pump inhibitor (PPI), is recommended.AIM: To describe the rate, timing and duration of GI prophylaxis in Nova Scotia seniors receiving nonselective NSAIDs.METHODS: The Nova Scotia Seniors’ Pharmacare Program beneficiaries for the years 1998 to 2002 were studied. A cohort of incident NSAID and GPA users was selected from all nonselective NSAID users (no prescribed NSAID dispensed 12 months before the index month and no GPA dispensed two months before the index prescription). Monthly coprescribing rates were calculated by dividing the number of patients in the cohort using GPAs by the number of NSAID users. GI prophylactic coprescribing was defined as the coprescribing rate present at the first month (index month) of prescribing an NSAID.RESULTS: The cohort consisted of 12,906 patients. Seventy-five per cent of the nonselective NSAID prescriptions dispensed were for up to two months duration, with only 2.3% longer than one year. GI prophylaxis was given to only 3.8% of patients starting NSAIDs who were not on a GPA in the two months before starting NSAIDs. Of this 3.8%, 92.7% of the patients received H2-receptor antagonists (H2RAs), and 7% received PPIs. The rate of H2RA coprescribing increased with the number of consecutive months on an NSAID from 3.5% in the first month to 24.1% at 48 months. For PPIs, the coprescribing rate increased from 0.3% to 1.9% of all NSAID users in the cohort. The rate of gastroprophylaxis coprescribing for patients receiving NSAIDs did not rise with increasing age.CONCLUSION: In Nova Scotian seniors using nonselective NSAIDs, the rate of GI prophylaxis was low. Most patients received H2RAs as GPAs despite evidence that they offer insufficient protection.

scholarly journals Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications

2017 ◽  
Vol 8 (6) ◽  
pp. 173-182 ◽  
Author(s):  
Andrea Fanelli ◽  
Daniela Ghisi ◽  
Pierangelo Lora Aprile ◽  
Francesco Lapi
Keyword(s):  
Term Treatment ◽  
Cyclooxygenase 2 ◽  
Thrombotic Risk ◽  
Long Term Treatment ◽  
Pressure Development ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
High Doses ◽  
The Right ◽  
Meta Analyses

Observational studies and meta-analyses have shown that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), especially when prescribed at high doses for long periods of time, can potentially increase the risk of cardiovascular diseases. The increased thrombotic risk related to the use of NSAIDs is mainly due to their cyclooxygenase 2 selectivity. The dosage use, the formulation selected and the duration of the therapy are other factors that can significantly impact on the cardiovascular risk. In order to minimize the risk, prescription of the right drug based on the patient’s features and the different safety profiles of several NSAIDs that are available on the market is key for their appropriate administration. Despite the baseline cardiovascular and gastrointestinal risk of each patient, monitoring of patients is suggested for increases in blood pressure, development of edema, deterioration of renal function, or gastrointestinal bleeding during long-term treatment with NSAIDs.

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