Off-label Use of Secukinumab: A Potential Therapeutic Option for SAPHO Syndrome

We read the recent article by Wang et al with great interest.1 The authors described a cohort of 4 patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome who showed substantial improvement in skin lesions, clinical conditions, and whole-body magnetic resonance imaging before and after treatment with secukinumab without concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), nonsteroidal antiinflammatory drugs (NSAIDs), or other biologics, and suggested a potential benefit of secukinumab in the treatment of SAPHO syndrome. However, there are some details that need further clarification.

Nonsteroidal antiinflammatory drugs versus tramadol in pain management following transsphenoidal surgery for pituitary adenomas: a randomized, double-blind, noninferiority trial

OBJECTIVE Opioid-minimizing or nonopioid therapy using nonsteroidal antiinflammatory drugs (NSAIDs) or tramadol has been encouraged for pain management. This study aimed to examine the noninferiority of NSAIDs to tramadol for pain management following transsphenoidal surgery for pituitary adenomas in terms of analgesic efficacy, adverse events, and rescue opioid use. METHODS This was a randomized, single-center, double-blind noninferiority trial. Patients 18–70 years old with planned transsphenoidal surgery for pituitary adenomas were randomly assigned (in a 1-to-1 ratio) to receive NSAIDs (parecoxib injection and subsequent loxoprofen tablets) or tramadol (tramadol injection and subsequent tramadol tablets). The primary outcome was pain score assessed by a visual analog scale (VAS) for 24 hours following surgery; the secondary outcomes were VAS scores for 48 and 72 hours. Other prespecified outcomes included nausea, vomiting, dizziness, upset stomach, skin rash, peptic ulcer, gastrointestinal bleeding, and pethidine use to control breakthrough pain. Noninferiority of NSAIDs to tramadol was established if the upper limit of the 95% confidence interval (CI) of the VAS score difference was < 1 point and the rate difference of adverse events and pethidine use < 5%. The superiority of NSAIDs was assessed when noninferiority was verified. All analyses were performed on an intention-to-treat basis. RESULTS Two hundred two patients were enrolled between November 1, 2020, and May 31, 2021 (101 in the NSAIDs group, 101 in the tramadol group). Baseline characteristics between groups were well balanced. Mean VAS scores for 24 hours following transsphenoidal surgery were 2.6 ± 1.8 in the NSAIDs group and 3.5 ± 2.1 in the tramadol group (−0.9 difference, 95% CI −1.5 to −0.4; p value for noninferiority < 0.001, p value for superiority < 0.001). Noninferiority and superiority were also achieved for both secondary outcomes. VAS scores improved over time in both groups. Incidences of nausea (39.6% vs 61.4%, p = 0.002), vomiting (3.0% vs 42.6%, p < 0.001), and dizziness (12.9% vs 47.5%, p < 0.001) were significantly lower, while incidence of upset stomach (9.9% vs 2.0%, p = 0.017) was slightly higher in the NSAIDs group compared with the tramadol group. The percentage of opioid use was 4.0% in the NSAIDs group and 15.8% in the tramadol group (−11.8% difference, 95% CI −19.9% to −3.7%; p value for noninferiority < 0.001, p value for superiority = 0.005). CONCLUSIONS NSAIDs significantly reduced acute pain following transsphenoidal surgery, caused few adverse events, and limited opioid use compared with tramadol.

Odontological Drugs and Their Action on Some Biological Organisms

Odontology is the study of teeth, of theirs diseases and treatment of these. Many odontological drugs are commonly used in dental practice. Antibiotics are indicated for the treatment of odontogenic infections, oral non-odontogenic infections, as prophylaxis against focal infection, and as prophylaxis against local infection and spread to neighboring tissues and organs. In addition to antibiotic, antifungals (drugs for classes azoles, imidazoles and polyenes), antiviral such as antimicrobial mouthwashes and nucleases inhibitors are also indicated for the treatment. These drugs prescription is almost invariably associated with the prescription of Nonsteroidal Antiinflammatory Drugs (NSAIDs), topical corticoids, local anaesthesic for odontological pain and/or Sodium Fluoride for dental caries. Odontalogical drugs act on several levels of metabolism either of microorganisms’ constitutive material (e.g. wall, membrane, cytoplasm and nuclear materials for antibiotics, antivirals, antifungals and oxidizing substances) to destroys them or of humans system cells (receptors, enzymes, hormones for painful, inflammation, local anaesthesic and dental building drugs) to inhibit or stimulate them for the best functioning.

Drug-induced liver injury associated with the use of nonsteroidal antiinflammatory drugs

Nonsteroidal antiinflammatory drugs (NSAIDs) are effective drugs used widely in clinical practice. NSAIDs are reversible inhibitors of cyclo-oxygenase, mainly used for the symptomatic relief of pain, whether rheumatologic, traumatic, infectious or episodic. However, the appointment of NSAIDs must be considered risk factors for side effects.Drug-induced liver injury associated with the use of NSAIDs does not have any specific manifestations and covers the symptoms that occur in a variety of liver lesions, from asymptomatic increase in transaminases to the development of fulminant liver failure. The need for early diagnosis, a difficult differential diagnostic search, and the absence of specific laboratory tests make this pathology quite difficult for a practicing physician. Treatment is based on the abolition of NSAIDs, which caused liver damage, and the appointment of symptomatic therapy. Preventive measures are reduced to compliance with the dose, multiplicity, ways of drug administration, the absence of polypragmasia, careful collection of medical history, analysis of risk factors before prescribing a drug and monitoring the patient in the dynamics.

A Simple Test for the Most Common Cause or Aggravating Factor of the Neck, Shoulder, or Upper Extremity Pain

Background: Shoulder pain and neck pain affect respectively 25% and 43% of the population. The aim of this clinical study is to assess the proportion, correct diagnosis, and treatment of hypertension (HTN) in patients with pain in the neck, shoulder, and upper extremity. Methods: 300 patients with complaints of neck, shoulder, or upper extremity pain without trauma or infection were studied from January 2015 to December 2017. After taking the history and examination, the blood pressure of these patients was recorded. Laboratory tests, x-ray, and magnetic resonance imaging (MRI) of the neck and affected shoulder joint were requested. Antihypertensive and symptomatic treatments were prescribed for patients with HTN. In the next visits, new history and examination, including the range of motion (ROM) of neck, shoulder, and upper extremity, blood pressure, and the results of laboratory tests, and images were checked. The final data were analyzed using chi-square test in SPSS software. Results: The Prevalence of HTN in patients in the age groups of 20-30, 31-60, and above 60 years were 21%, 44%, and 56 %, respectively. Neck, shoulder, and upper extremity pain and motion improved significantly after antihypertensive and symptomatic treatment in patients with HTN. Conclusion: HTN is the most common cause of neck, shoulder, and upper extremity pain in the adults and older patients referring to a physician. Thus, checking blood pressure by a physician or specialist is recommended for adults or older patients with neck, shoulder, or upper extremity pain. Antihypertensive and symptomatic treatments must be prescribed for nonsteroidal antiinflammatory drugs (NSAIDs), and acetaminophen-codeine and corticosteroids should be prohibited for the patients with HTN.