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I. Celecoxib Medication

Celecoxib is a COX-2 selective non-steroidal anti-inflammatory drug (NSAID) used to reduce swelling and soreness.

Celecoxib medication is used to:

  • Relieve symptoms of osteoarthritis (the arthritis caused by age-related wear and tear on bones and joints)
  • Relieve symptoms of rheumatoid arthritis in adults
  • Manage acute pain in adults (like the short-term pain you can get after a dental or surgical operation)
  • Treat painful menstrual cycles
  • Reduce the number of colon and rectum growths (colorectal polyps) in patients with a disease called Familial Adenomatous Polyposis (FAP), an inherited disease in which the rectum and colon are covered with many polyps. Celecoxib medication is used along with the usual care for FAP patients such as surgery and exams of the rectum and colon

Non-steroidal Anti-inflammatory Drugs (NSAID’s): Information

The NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are a large class of medication used to treat arthritis. One of the NSAIDs is usually included in the medication regimen of an arthritis patient. NSAIDs help combat arthritis pain by interfering with the inflammatory process.

NSAIDs work primarily by preventing the formation of substances called prostaglandins. But there are two types of prostaglandins, and the body has problems when both types are inhibited.

(a) "Maintenance" prostaglandins are made regularly by the body.
They are produced by an enzyme labeled cox-1.
They play a role in maintaining normal function in several organ systems. Examples include:

  • the protective lining of the stomach
  • normal platelet function
  • kidney blood flow

(b) "Inflammatory" prostaglandins are produced by the body in response to an inflammatory stimulus.
They are produced by an enzyme labeled cox-2.
They play a role in causing inflammation and pain.

There are now three types of NSAIDs:

(1). Salicylates: The original category of NSAIDs – the salicylates includes aspirin.

(2). The Traditional NSAIDs Include:

  • Ansaid (Flurbiprofen)
  • Arthrotec (Diclofenac/Misoprostol)
  • Cataflam (Diclofenac Potassium)
  • Clinoril (Sulindac)
  • Daypro (Oxaprozin)
  • Dolobid (Diflunisal)
  • Feldene (Piroxicam)
  • Ibuprofen (Motrin, Advil)
  • Indocin (Indomethacin)
  • Ketoprofen (Orudis, Oruvail)
  • Lodine (Etodolac)
  • Meclomen (Meclofenamate Sodium)
  • Mobic (Meloxicam)
  • Nalfon (Fenoprofen)
  • Naproxen (Naprosyn, Aleve)
  • Ponstel (Mefanamic Acid)
  • Relafen (Nabumetone)
  • Tolectin (Tolmetin Sodium)
  • Voltaren ( Dicolfenac Sodium)

(3). The COX-2 Inhibitors Include:

Traditional NSAIDs - ibuprofen (Motrin, Advil), naproxen (Naprosyn, Alleve), and piroxicam (Feldene), to name a few-inhibit both cox-1 and cox-2 prostaglandins. Many of the undesirable side effects of using these non-selective NSAIDs result from inhibiting the cox-1 "maintenance" prostaglandins. The beneficial effects of the newer NSAIDs result from inhibiting, or limiting, only the cox-2 "inflammatory " prostaglandins. These specific NSAIDs are effective for treatment of musculoskeletal pain and are without many of the side effects associated with the traditional agents.

Arthritis: Information

A lot of people use the word "arthritis" to refer to all rheumatic diseases. However, the word literally means joint inflammation; that is, swelling, redness, heat, and pain caused by tissue injury or disease in the joint. Many different kinds of arthritis comprise just a portion of the rheumatic diseases. Some rheumatic diseases are described as connective tissue diseases because they affect the body's connective tissue--the supporting framework of the body and its internal organs. Others are known as autoimmune diseases because they are caused by a problem in which the immune system harms the body's own healthy tissues. Examples of some rheumatic diseases are:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Fibromyalgia
  • Systemic lupus erythematosus
  • Scleroderma
  • Juvenile rheumatoid arthritis
  • Ankylosing spondylitis
  • Gout

Osteoarthritis

Osteoarthritis is the most common type of arthritis, especially among older people. Sometimes it is called degenerative joint disease or osteoarthrosis.

Osteoarthritis is a joint disease that mostly affects the cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs--small growths called osteophytes--may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.

Some people with osteoarthritis usually have joint pain and limited movement. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. For example, rheumatoid arthritis--the second most common form of arthritis--affects other parts of the body besides the joints. It begins at a younger age than osteoarthritis, causes swelling and redness in joints, and may make people feel sick, tired, and (uncommonly) feverish.

Diagram 1: Osteoarthritis

Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It has several special features that make it different from other kinds of arthritis. For example, rheumatoid arthritis generally occurs in a symmetrical pattern, meaning that if one knee or hand is involved, the other one also is. This disease often affects the wrist joints and the finger joints closest to the hand. It can also affect other parts of the body besides the joints. In addition, people with rheumatoid arthritis may have fatigue, occasional fevers, and a general sense of not feeling well.

Rheumatoid arthritis affects people differently. For some people, it lasts only a few months or a year or two and goes away without causing any noticeable damage. While other people have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability.

How Rheumatoid Arthritis Develops and Progresses

Diagram 2: Rheumatoid Arthritis

Explanation for Diagram: The joint (the place where two bones meet) is surrounded by a capsule that protects and supports it. The joint capsule is lined with a type of tissue called synovium, which produces synovial fluid that lubricates and nourishes joint tissues. In rheumatoid arthritis, the synovium becomes inflamed, causing warmth, redness, swelling, and pain. As the disease progresses, the inflamed synovium invades and damages the cartilage and bone of the joint. Surrounding muscles, ligaments, and tendons become weakened. Rheumatoid arthritis also can cause more generalized bone loss that may lead to osteoporosis (fragile bones that are prone to fracture).

Similar to many other rheumatic diseases, rheumatoid arthritis is an autoimmune disease (auto means self), so-called because a person's immune system, which normally helps protect the body from infection and disease, attacks joint tissues for unknown reasons. White blood cells, the agents of the immune system, travel to the synovium and cause inflammation (synovitis), characterized by warmth, redness, swelling, and pain--typical symptoms of rheumatoid arthritis. During the inflammation process, the normally thin synovium becomes thick and makes the joint swollen and puffy to the touch.

When rheumatoid arthritis progresses, the inflamed synovium invade and destroy the cartilage and bone within the joint. The surrounding muscles, ligaments, and tendons that support and stabilize the joint become weak and unable to work normally. These effects lead to the pain and joint damage often seen in rheumatoid arthritis. Researchers studying rheumatoid arthritis now believe that it begins to damage bones during the first year or two that a person has the disease, one reason why early diagnosis and treatment are so important.

Side effects of NSAIDs

While NSAIDs are reasonably safe medications, it is important that you are aware of potential side effects. NSAIDs are safest when low doses are taken for brief periods. Side effects most commonly occur if you are taking large doses over a prolonged time (months or years). Some side effects are mild and go away spontaneously or after reducing the dose. Other side effects may be more serious and need medical attention.

Some common side effects include:

  • Stomach pain or heartburn -- most common side effect
  • Stomach ulcers -- as many as 5% of patients may develop a stomach ulcer while taking NSAIDs.
  • Ulcers may cause stomach pain, but some ulcers develop with no pain at all
  • Bleeding -- NSAIDs (especially aspirin) increase the tendency to bleed in general (not just from ulcers). You should not take NSAIDs before surgery. NSAIDs should be avoided if you are taking blood-thinning medications (such as Coumadin)
  • Headaches and dizziness -- may be a complication of treatment with indomethacin
  • Ringing in the ears -- may be due to treatment with salicylates, including aspirin. This can be eliminated by decreasing the dose
  • Allergic reactions -- rashes, wheezing and throat swelling rarely occur
  • Liver or kidney problems are rare side effects. These problems can be evaluated by blood tests in patients who take NSAIDs for prolonged periods. People with any kidney problems should not take NSAIDs for prolonged periods
  • Please note: The side effects listed are the most common. All possible side effects are not included. Always contact your health care provider if you have questions about your particular medication.

Uses of NSAIDs

The commonest use of these drugs is for arthritis. Paracetamol is often adequate for osteoarthritis, but NSAIDs are particularly useful in the inflammatory forms of arthritis (e.g. rheumatoid arthritis) and, sometimes, in the more severe forms of osteoarthritis.

  • Back pain and sciatica. Ibuprofen has been clearly demonstrated to be helpful, and the other NSAIDs are also helpful.
  • Sprains, strains, and rheumatism.
  • Dental pain.
  • Post-operative pain.
  • Period pain (dysmenorrhoea) and heavy periods (menorrhagia).
  • Pain from kidney stones (renal colic).
  • To help reduce temperature in someone with a fever.
  • Migraine.
  • Other painful conditions, especially where there is inflammation.
  • A recent Dutch study suggested that regular and long-term use of some NSAIDs could reduce the risk of Alzheimer's disease by as much as 80 percent. Note that this is only one study.
  • Most NSAIDs also reduce the temperature in someone with a fever.

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