Role of Nonsteroidal Antiinflammatory Drugs in the Differential Diagnosis of Neoplastic Fevers versus Fevers of Infectious Etiology

1995 ◽  
Vol 11 (5) ◽  
pp. 211-213 ◽  
Author(s):  
Parrish G Rabon ◽  
Kim M Murray
Keyword(s):  
Differential Diagnosis ◽  
English Language ◽  
Diagnostic Value ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Nsaid Therapy ◽  
Antiinflammatory Drugs ◽  
Patient Morbidity ◽  
Neoplastic Fever ◽  
Infectious Etiology

Objective: To determine the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the differential diagnosis of neoplastic fevers versus fevers of infectious etiology and to recommend a therapeutic regimen as well as a suggested treatment duration of NSAID therapy to aid in this diagnosis. Data Sources: The English-language literature was searched using MEDLINE, Index Medicus, and bibliographic reviews of relevant textbooks and review articles. Conclusions: NSAIDs have induced dramatic antipyretic effects when administered to patients with cancer whose fevers are particularly disabling and often a major contributor to patient morbidity and mortality. When a fever persists after infection has been ruled out, an NSAID test may be of diagnostic value for a neoplastic fever. Naproxen, indomethacin, and diclofenac all have been studied and demonstrated efficacy. A reduction or cessation of a neoplastic fever can be expected within 24 hours after initiation of NSAID therapy. However, NSAID therapy should be continued for three days before cessation of therapy or a change to another NSAID is considered.

Treatment Options for Rheumatoid Arthritis: Celecoxib, Leflunomide, Etanercept, and Infliximab

2000 ◽  
Vol 34 (6) ◽  
pp. 743-760 ◽  
Author(s):  
Brigitte T Luong ◽  
Barbara S Chong ◽  
Dionne M Lowder
Keyword(s):  
Rheumatoid Arthritis ◽  
English Language ◽  
Data Extraction ◽  
Treatment Options ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Safety And Efficacy ◽  
Medline Search ◽  
Pertinent Data

OBJECTIVE: To review new pharmacologic agents approved for use in the management of rheumatoid arthritis (RA). DATA SOURCES: A MEDLINE search (1966–January 2000) was conducted to identify English-language literature available on the pharmacotherapy of RA, focusing on celecoxib, leflunomide, etanercept, and infliximab. These articles, relevant abstracts, and data provided by the manufacturers were used to collect pertinent data. STUDY SELECTION: All controlled and uncontrolled trials were reviewed. DATA EXTRACTION: Agents were reviewed with regard to mechanism of action, efficacy, drug interactions, pharmacokinetics, dosing, precautions/contraindications, adverse effects, and cost. DATA SYNTHESIS: Traditional pharmacologic treatments for RA have been limited by toxicity, loss of efficacy, or both. Increasing discoveries into the mechanisms of inflammation in RA have led to the development of new agents in hopes of addressing these limitations. With the development of celecoxib, a selective cyclooxygenase-2 inhibitor, the potential exists to minimize the gastrotoxicity associated with nonsteroidal antiinflammatory drugs. Leflunomide has been shown to be equal to or less efficacious than methotrexate, and may be beneficial as a second-line disease-modifying antirheumatic drug (DMARD). The biologic response modifiers, etanercept and infliximab, are alternatives that have shown benefit alone or in combination with methotrexate. However, they should be reserved for patients who fail to respond to DMARD therapy. Further studies should be conducted to evaluate the long-term safety and efficacy of these agents as well as their role in combination therapy. CONCLUSIONS: Celecoxib, leflunomide, etanercept, and infliximab are the newest agents approved for RA. Clinical trials have shown that these agents are beneficial in the treatment of RA; however, long-term safety and efficacy data are lacking.

Assessing Physician Choice of Nonsteroidal Antiinflammatory Drugs in a Health Maintenance Organization

1993 ◽  
Vol 27 (11) ◽  
pp. 1393-1399 ◽  
Author(s):  
Barbara Kaplan ◽  
Karen B. Farris ◽  
Duane M. Kirking
Keyword(s):  
Large Population ◽  
Health Maintenance Organization ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Nsaid Therapy ◽  
Prescribing Patterns ◽  
Utilization Review ◽  
Antiinflammatory Drugs ◽  
Potential Cost ◽  
Health Maintenance ◽  
Acute Patients

OBJECTIVE: To develop a categorization scheme for grouping various nonsteroidal antiinflammatory drugs (NSAIDs) by relative safety; to develop a method to quantify the appropriateness of the initial and subsequent choices of NSAID therapy; to assess whether NSAID prescribing was consistent with the developed criteria; to examine the cost of inappropriate, acute NSAID use as defined by the established criteria. DESIGN: Retrospective drug utilization review focusing on NSAIDs. SETTING/PARTICIPANTS: Members aged age⩾18 years of a 40 000-person southeastern Michigan health maintenance organization MAIN OUTCOME MEASURES: (1) Appropriateness of therapy using a four-level safety classification system for the NSAIDs developed by a consensus process; criteria based on safety under the assumption that any particular NSAID is equally likely to be effective when dosed appropriately; (2) evaluation of progression of NSAID therapy using the NSAID Therapy Progression Formula. RESULTS: For acute patients, almost half of the prescriptions were for ibuprofen and 33 percent were for naproxen. Ibuprofen usage accounted for 16 percent of total NSAID cost and naproxen agents accounted for over 50 percent of that cost. Potential cost savings of approximately $82 000 probably would have occurred had a 50 percent interchange rate for ibuprofen been acceptable. For chronic patients, 85 percent were treated with one or two NSAIDs; treatments were of reasonable high quality when compared by safety profiles. There was low use of ibuprofen in patients who only received one NSAID. CONCLUSIONS: NSAID usage assessment in a large population was achieved by developing a classification and scoring system based on NSAID safety; in this population, prescribing patterns were generally consistent with established criteria; however, when considering cost, improvement in initial NSAID selection for acute patients was possible.

Nonsteroidal Antiinflammatory Drug-Induced Renal Dysfunction Related to Inhibition of Renal Prostaglandins

1987 ◽  
Vol 21 (12) ◽  
pp. 954-960 ◽  
Author(s):  
Richard G. D'Angio
Keyword(s):  
Renal Dysfunction ◽  
Antiinflammatory Drug ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Nonsteroidal Antiinflammatory Drug ◽  
Antiinflammatory Drugs ◽  
Drug Induced ◽  
Frequent Use ◽  
The Face ◽  
Patients At Risk

This article reviews the role of prostaglandins (PG) in maintaining renal function in the face of vasoconstrictive substances and decreased renal blood flow. Inhibition of the synthesis of renal PG by nonsteroidal antiinflammatory drugs (NSAID) may lead to the development of hemodynamically induced renal dysfunction in patients with a decreased effective plasma volume or chronic renal insufficiency. The importance of stimulation of renal PG activity to the action of diuretics and a pharmacodynamic mechanism for NSAID-induced diuretic resistance are presented. Evidence for the relative selectivity of sulindac in inhibiting systemic PG without inhibiting renal PG is also reviewed. Inhibition of renal PG synthesis has been postulated to be a contributing factor for other forms of NSAID-induced renal dysfunction (interstitial nephritis, analgesic-associated nephropathy). The relationship between renal PG inhibition by NSAID and these syndromes is briefly discussed. Considering the frequent use of NSAID, it is important that practitioners are aware of the mechanisms whereby patients may develop NSAID-induced renal dysfunction and that they are able to identify patients at risk.

Indirect role of β2-adrenergic receptors in the mechanism of analgesic action of nonsteroidal antiinflammatory drugs

2010 ◽  
Vol 38 (9) ◽  
pp. 1860-1867 ◽  
Author(s):  
Elif Cadirci ◽  
Halis Suleyman ◽  
Ahmet Hacimuftuoglu ◽  
Zekai Halici ◽  
Fatih Akcay
Keyword(s):  
Adrenergic Receptors ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Analgesic Action ◽  
Antiinflammatory Drugs

scholarly journals Imaging Studies in Otosclerosis: An Up-to-date Comprehensive Review

2020 ◽  
Author(s):  
Lucas Resende Lucinda Mangia ◽  
Luiz Otávio de Mattos Coelho ◽  
Bettina Carvalho ◽  
Adriana Kosma Pires de Oliveira ◽  
Rogerio Hamerschmidt
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Value ◽  
Imaging Studies ◽  
Superior Semicircular Canal Dehiscence ◽  
Acquired Hearing Loss ◽  
Potential Benefits ◽  
Surgical Failure ◽  
Magnetic Resonance Imaging Mri ◽  
Prognostic Prediction

Abstract Introduction Otosclerosis is a primary osteodystrophy of the otic capsule, frequently responsible for acquired hearing loss in adults. Although the diagnostic value of imaging investigations in otosclerosis is debatable, they might still be employed with different goals within the context of the disease. Objectives The present paper aims to review the most recent literature on the use of imaging studies in otosclerosis for the most varied purposes, from routine application and differential diagnosis to prognostic prediction and investigation of surgical failure. Data Synthesis The diagnosis of otosclerosis is usually clinical, but computed tomography (CT) is paramount in particular cases for the differential diagnosis. The routine use, however, is not supported by strong evidence. Even so, there is growing evidence of the role of this method in surgical planning and prediction of postoperative prognosis. In specific scenarios, for example when superior semicircular canal dehiscence (SSCD) syndrome is suspected or in surgical failure, CT is crucial indeed. Magnetic resonance imaging (MRI), however, has limited – although important – indications in the management of individuals with otosclerosis, especially in the evaluation of postoperative complications and in the follow-up of medical treatment in active ostosclerosis. Conclusion Imaging studies have a broad range of well-established indications in otosclerosis. Besides, although the routine use of CT remains controversial, the most recent papers have shed light into new potential benefits of imaging prior to surgery.

Role of Nonsteroidal Antiinflammatory Drugs in the Association Between Osteoarthritis and Cardiovascular Diseases: A Longitudinal Study

2019 ◽  
Vol 71 (11) ◽  
pp. 1835-1843 ◽  
Author(s):  
Mohammad Atiquzzaman ◽  
Mohammad E. Karim ◽  
Jacek Kopec ◽  
Hubert Wong ◽  
Aslam H. Anis
Keyword(s):  
Longitudinal Study ◽  
Cardiovascular Diseases ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs

scholarly journals A Review of Intravesical Prostatic Protrusion in the Evaluation and Treatment of Benign Prostatic Enlargement

2021 ◽  
Vol 3 (1) ◽  
pp. 13-17
Author(s):  
Balantine U. Eze ◽  
Okwudili C. Amu ◽  
Jude A. Edeh
Keyword(s):  
Treatment Option ◽  
Symptom Severity ◽  
English Language ◽  
Diagnostic Value ◽  
Benign Prostatic Obstruction ◽  
Benign Prostatic Enlargement ◽  
Non Invasive ◽  
Prostatic Enlargement ◽  
Intravesical Prostatic Protrusion

The evaluation of severity of symptoms, tracking complications, choosing effective and efficient approach to treatment, and prognosis is important in benign prostatic enlargement (BPE) patients. Measurement of intravesical prostatic protrusion (IPP) is an easy, affordable and non-invasive marker for benign prostatic obstruction with a high diagnostic value. This study aims to undertake a descriptive review of current literature for the role of IPP in the evaluation and treatment of patients with BPE. Relevant articles written in English language were retrieved from PubMed and Google Scholar. Keywords used for searching articles included intravesical prostatic Protrusion and Benign Prostatic Enlargement/ hyperplasia/ Obstruction; evaluation; and treatment. Papers published between January 1990 and October 2020 were extracted and evaluated. The analyzed studies showed that IPP can be assessed by various modalities and is important in the evaluation of symptom severity, tracking progression and complications of disease, choosing treatment option and prognostication. It is important that IPP be always assessed at the point of initial evaluation of BPE patients.

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