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Celebrex relieves the pain and inflammation of osteoarthritis
and rheumatoid arthritis. It is the first of a new
class of nonsteroidal anti-inflammatory drugs (NSAIDs)
called "COX-2 inhibitors." Like older NSAIDs
such as Motrin and Naprosyn, Celebrex is believed
to fight pain and inflammation by inhibiting the effect
of a natural enzyme called COX-2. Unlike the older
medications, however, it does not interfere with a
similar substance, called COX-1, which exerts a protective
effect on the lining of the stomach. Celebrex is therefore
less likely to cause the bleeding and ulcers that
sometimes accompany sustained use of the older NSAIDs.
Celebrex has also been found to reduce the number
of colorectal polyps (growths in the wall of the lower
intestine and rectum) in people who suffer from the
condition called familial adenomatous polyposis (FAP),
an inherited tendency to develop large numbers of
colorectal polyps that eventually become cancerous.
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METOPROLOL
(brand names: Lopressor, Toprol XL) |
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Metoprolol is used to treat high blood pressure. It
also is used to prevent angina (chest pain) and heart
attacks. It works by relaxing your blood vessels so
your heart doesn't have to pump as hard. This medication
is sometimes prescribed for other uses; ask your doctor
or pharmacist for more information. Metoprolol also
is used to treat abnormal heart rhythms
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Department of Rheumatology,
Juntendo University, School of Medicine.
The early suppression of disease
activity during the first 2 years in rheumatoid arthritis
(RA) has been reported to be exclusively important
to prevent joint destruction and functional decline.
Since single disease-modifying antirheumatic drugs(DMARDs)
therapy is still disappointing, many rheumatologists
today advocated a more aggressive approach using combinations
of classic DMARDs. Many clinical trials on combination
therapy have been reported and most studies of combination
therapy focused on the efficacy of a treatment strategy.
Therefore, the possible synergistic action of combination
of drugs has not been demonstrated. Among combination
of therapy of classical DMARDs, only few trials demonstrated
the efficacy of combination therapy. The incidence
of adverse effects among 341 RA patients was investigated
by our department. The incidence of adverse effect
in combination therapy revealed 36.4% which was not
statistically different from that in monotherapy(33.6%,
p = 0.41). The recent studies on combination therapy
on classical DMARDs are not encouraging, however,
the combination therapy for patients with early RA,
drugs utilizing immunosuppressant, biologics and other
newly developed drugs will still have a chance to
expect a potent efficacy for RA.
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Service de Rhumatologie,
Institut Calot, Berck sur mer, France.
Few prospective placebo-controlled
studies have evaluated disease-modifying antirheumatic
drugs (DMARDs) in the treatment of peripheral psoriatic
arthritis. OBJECTIVE: To evaluate second-line treatments
used in clinical practice in patients with psoriatic
arthritis. METHOD: We studied a cross-section of 100
consecutive patients seen by hospital-based or office-based
rheumatologists for psoriatic arthritis. PATIENTS:
The 55 men and 45 women had a mean age of 48 years
(range, 17-79 years) and a mean disease duration of
7 years (range, 1-24 years). RESULTS: The most commonly
used DMARDs were sulfasalazine, gold, methotrexate,
and hydroxychloroquine (64, 43, 41 et 17 patients,
respectively). These drugs had been stopped because
of inefficacy in 31%, 31%, 12%, and 53% of patients,
respectively, and because of adverse events in 23%,
44%, 22%, and 41% of patients, respectively. At the
time of the study, mean treatment durations were 15,
21, 34, and 12 months, respectively, and the drugs
were still being used in 45%, 21%, 66%, and 6% of
patients. CONCLUSION: Our data confirm the value of
methotrexate and salazopyrine. Methotrexate had the
best risk/benefit ratio. Gold was often responsible
for side effects. Hydroxychloroquine was inadequately
effective and poorly tolerated.
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Centre for Rheumatic Disease,
Royal Infirmary, Glasgow, Scotland.
Longterm safety and efficacy of disease
modifying antirheumatic drugs (DMARD) have been challenging
to assess. There are few studies that have evaluated
patient outcome beyond 5 years. As patients may receive
several DMARD over the course of their disease a long
with nonsteroidal antiinflammatory drugs, corticosteroids,
and other drugs for comorbidities, it is difficult
to design and implement a trial to define a specific
drug's longterm effect. Based on the findings of several
key studies, however, it does appear that DMARD are
safe when taken longterm, and that they are more likely
to be discontinued because of inefficacy than toxicity.
Although DMARD are often discontinued because of lack
of efficacy, 12 year data suggest that DMARD can provide
benefit over this period. The toxicity profiles vary
significantly between DMARD. In addition, the time
during therapy when the majority of these adverse
effects most frequently appear is DMARD-specific.
Prospective studies are needed to further clarify
longterm safety and efficacy of the newer DMARD.
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