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Rheumatoid Arthritis

Pain punctuates everday life. A telephone survey found that 46% of respondents experienced severe pain at some time in their lives, with nearly half of these episodes attributed to chronic backaches and one third to "arthritis." In the United States alone, more than 75 million people have some form of recurrent or persistent rheumatoid arthritis, rumatoid Not surprisingly, people spend billions of dollars each year to purchase over-the-counter (OTC) analgesics such as acetaminophen, aspirin, ibuprofen, naproxen, and medicated creams. Rheumatologists and other

Pain management requires an integrated approach consisting of pharmacotherapy, physical and psychosocial therapies, and procedural interventions. Our purpose here is to review analgesic therapy of musculoskeletal pain, focusing on the use of acetaminophen, NSAIDs, centrally acting

Until recently, there were no published reports comparing the efficacy of an NSAID with a pure analgesic such as acetaminophen for symptomatic therapy of patients with osteoarthritis (OA). A recent study by Bradley et al, however, evaluated the effects of analgesic and anti-inflammatory

The side effects of long-term acetaminophen use are less severe than those of chronic NSAID therapy. In the absence of other hepatotoxic agents (i.e., alcohol), acetaminophen-induced liver



NSAIDs are an important component of therapy for many of the arthritides. The most frequently prescribed drugs for chronic pain are NSAIDs, which account for almost 4% of all prescriptions

Biological Effects of Nonsteroidal Anti-Inflammatory Drugs

NSAIDs exhibit antipyretic, analgesic, and anti-inflammatory properties. The primary therapeutic effect of NSAIDs is thought to result from inhibition of prostaglandin production. NSAIDs inhibit the enzyme cyclooxygenase (COX) which converts arachidonic acid into prostaglandins.  Selective COX-2 inhibitors have been shown to block prostaglandin production and acute tissue inflammation in vivo at doses that do

Etanercept (Enbrel). After twice-weekly subcutaneous injections of etanercept (recombinant human tumor necrosis factor receptor), 25 mg, at 3 months, 62% improve. Etanercept is well tolerated and is an indicated for use alone or with methotrexate for patients with active disease that is refractory to methotrexate.

Infliximab (Remicade) is given intravenously for use in refractory disease. Infliximab is an anti-tumor necrosis factor monoclonal antibody. Infliximab is given intravenously in dosages of 3 or 10 mg/kg, repeated at about four- to 12-week intervals.

Leflunomide ( Arava), which inhibits pyrimidine synthesis, is an oral drug considered as a possible alternative to methotrexate. The dosage is 100 mg PO daily for three days followed by a maintenance dosage of 10 to 20 mg daily. Leflunomide improves rheumatic arthritis but offers no clear advantages over methotrexate

In preclinical studies in dogs, etanercept (ENBREL), celocoxib ( (a highly specific COX-2 inhibitor) was compared with meloxicam and nabumetone, two selective but nonspecific COX-2 inhibitors. Gastrointestinal and renal damage did not occur with etanercept but was common in