Choice of a nonsteroidal anti-inflammatory drug in ankylosing spondylitis
https://doi.org/10.14412/1996-7012-2014-4-86-89
Abstract
Ankylosing spondylitis (AS) is a chronic systemic disease with predominant axial skeleton injury, peripheral articular and entheseal involvements, and extra-skeletal manifestations. 8–10 years elapse since the first manifestations of AC to its diagnosis, leading to delays in adequate therapy, to the progression of structural and functional impairments in the axial skeleton and peripheral joints and to the development of complications. According to the international and Russia's Association of Rheumatologists guidelines, nonsteroidal anti-inflammatory drugs (NSAIDs) are an important component of AS therapy. It is necessary to carefully choose the safest NSAID for these patients, by taking into consideration that AS therapy should be long-term and continuous.
The trial previously performed by the authors evaluated comorbidity in 220 AS patients long receiving nimesulide. Its long-term administration was shown to cause no increase in the level of liver enzymes. Esophagogastroduodenoscopy revealed antral gastritis in 23.6% of the patients, gastric mucosal erosions in 13, and gastric ulcer disease without an exacerbation in 3.6%. It was noted that the physicians had not prescribed gastroprotectors to the patients. Nimesulide caused no blood pressure (BP) elevation even in patients who had baseline hypertension. Elevated BP occurred in 2.5% of the patients. There was no clear association of higher BP with nimesulide intake since the patients had previously used other NSAIDs, mainly diclofenac, to treat severe pain syndrome. These findings suggest that in addition to its analgesic activity, nimesulide shows good tolerability in patients with AS, which permits its long-term use, but in this case the gastrointestinal tract and BD should be carefully monitored, which will be able to prevent the possible adverse events characteristic of the entire group of NSAIDs.
About the Authors
Rimma Mikhailovna Balabanova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow Russia 115552
Russian Federation
34A, Kashirskoe Shosse, Moscow Russia 115552
M. V. Podryadnova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow Russia 115552
Russian Federation
34A, Kashirskoe Shosse, Moscow Russia 115552
References
1. Заболеваемость взрослого населения России в 2013 г. Статистические материалы, часть IV. Москва; 2014. [Zabolevaemost' vzroslogo naseleniya Rossii v 2013 g. Statisticheskie materialy, chast' IV [Incidence of adult population of Russia in 2013. Statistical materials, part IV]. Moscow; 2014.]
2. Van der Heijde D, Maksymovych WP. Spondiloarthritis: state of the art and future. Ann Rheum Dis. 2010;69:949–54. DOI: http://dx.doi.org/10.1136/ard.2009.119529.
3. Дубинина ТВ, Эрдес ШФ. Причины поздней диагностики анкилозирующего спондилита в клинической практике. Научно-практическая ревматология. 2010;48(2):43–8. [Dubinina TV, Erdes ShF. Reasons for late diagnosis of ankylosing spondylitis in clinical practice. Nauchnoprakticheskaya revmatologiya = Rheumatology Science and Practice. 2010;48(2):43–8. (In Russ.)]. DOI: рttp://dx.doi.org/10.14412/1995-4484-2010-1415.
4. Эрдес ШФ, Бочкова АГ, Дубинина ТВ и др. Ранняя диагностика анкилозирующего спондилита. Научно-практическая реаматология. 2013;51(4):365–7. [Erdes ShF, Bochkova AG, Dubinina TV, et al. Early diagnosis of ankylosing spondylitis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2013;51(4):365–7. (In Russ.]. DOI: http://dx.doi.org/10.14412/1995-4484-2013-1245.
5. Zochling J, Van der Heijde D, Burgos-Vargas R, et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2006;65:442–52. DOI: http://dx.doi.org/10.1136/ard.2005.041137.
6. D'Agostino MA, Breban M, Said-Nahal R, et al. Refractory inflammatory heel pain in spondylarthropathy: a significant response to infliximab documented by ultrasound. Arthritis Rheum. 2002;46:840–1. DOI: http://dx.doi.org/10.1002/art.513.
7. Inman RD, Davis JCJr, Van der Heijde D, et al. Efficacy and safety of golimumab in patients with ankylosing spondylitis: results of a randomized, double-blind, placebo-controlled , phase III trial. Arthritis Rheum. 2008;58:3402–12. DOI: http://dx.doi.org/10.1002/art.23969.
8. Davis JC, Van der Heijde D, Braun J, et al. Recombinant human tumor nеcrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthritis Rheum. 2003;48:3230–18. DOI: http://dx.doi.org/10.1002/art.11325.
9. Насонов ЕЛ, Насонова ВА, редакторы. Ревматология. Национальное руководство. Москва: ГЭОТАР-Медиа; 2008. 345 с. [Nasonov EL, Nasonova VA, editors. Revmatologiya. Natsional'noe rukovodstvo [Rheumatology. National Guide]. Moscow: GEOTAR-Media; 2008. 345 p.]
10. Wanders A, Van der Heijde D, Landewe R, et al. Nonsteroidal anti-inflammat ory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum. 2005;52:1756–65. DOI: http://dx.doi.org/10.1002/art.21054.
11. Sieper J, Klopsch T, Richter M, et al. Comparison of two different dosages of celecoxib with diclofenac for the treatment of active ankylosing spondylitis: results of a 12-week randomized, double-blind, controlled study. Ann Rheum Dis. 2008;67:323–9. DOI: http://dx.doi.org/10.1136/ard.2007.075309.
12. Насонова ВА, Астапенко МГ. Болезнь Бехтерева. В кн.: Клиническая ревматология. Москва: Медицина; 1989. 592 с. [Nasonova VA, Astapenko MG. Bekhterev's illness. In: Klinicheskaya revmatologiya [Clinical rheumatology]. Moscow: Meditsina; 1989. 592 p.]
13. Rainsford K. Nimesulide – a multifactorial approach to inflammation and pain: scientific and clinical consensus. Curr Med Res Opin. 2006;22:1161–70. DOI: http://dx.doi.org/10.1185/030079906X104849.
14. Rainsford K. Current status of the therapeutic uses and actions of the prefential cyclo-oxygenase-2 NSAID, nimesulide. Inflammopharmacology. 2006;14:120–37. DOI: http://dx.doi.org/10.1007/s10787-006-1505-9.
15. Pelletier JP, Martel-Pelletier J. Effects of nimesulide and naproxen on the degradation and metalloprotease synthesis of human osteoarthritis cartilage. Drugs. 1993;43 (Suppl 1):34–9. DOI: http://dx.doi.org/10.2165/00003495-199300461-00008.
16. Conforti A, Leone R, Moretti U, et al. Adverse drug reactions related to the use of NSAIDs with a focus on nimesulide: results of spontaneous reporting from Northern Italian area. Drugs. 2001;24:1081–90.
17. Каратеев АЕ, Алексеева ЛИ, Братыгина ЕА и др. Оценка частоты развития побочных эффектов при длительном использовании нимесулида в реальной клинической практике. Русский медицинский журнал. 2009;17(21):1466–72. [Karateev AE, Alekseeva LI, Bratygina EA, et al. Assessment of frequency of development of side effects at long use of a nimesulid in real clinical practice. Russkii meditsinskii zhurnal. 2009;17(21):1466–72. (In Russ.)]
18. Traversa G, Bianchi C, Da Cas R. et al. Cohort study of hepatotoxity associated with nimesulide and other NSAIDs. BMJ. 2003;327:18–22. DOI: http://dx.doi.org/10. 1136/bmj.327.7405.18.
19. Gulmez SE, Larrey D, Pageaux G-Ph et al. Transplantation for acute liver failure in patients exposed to NSAIDs or Paracetamol (Acetaminophen). Drugs. 2013;36:135–44. DOI: 10.1007/s 40264-012-0013-7.
20. Рекомендации Российской Гастроэнтерологической Ассоциации по диагностике и лечению инфекции Helicobacter pylori у взрослых. Российский журнал гастроэнтералогии, гепатологии, колопроктологии. 2012;1:87–9. [Recommendations of the Russian Gastroenterologichesky Association about diagnostics and treatment of an infection of Helicobacter pylori at adults. Rossiiskii zhurnal gastroenteralogii, gepatologii, koloproktologii. 2012;1:87–9. (In Russ.)]
21. Tubaro E, Belogi L, Mezzadri CM. Anti-inflammatory and antiplatelet effect of Amtolmetin Guacil, a new gastroprotective njn-steroidal anti-inflammatory drug. Arzneimittelforschung. 2001;51:737–42.
22. Jajic Z, Malaise M, Nekam K, et al. Gastrointestinal safety of amtolmetin guacyl in comparison with celecoxib in patients with rheumatoid arthritis. Clin Exp Rheumatol. 2005;23(6):809–18.
23. Каратеев АЕ. На пути к созданию новой генерации нестероидных противовоспалительных препаратов: амтолметин гуацил. Современная ревматология. 2014;(2):83–9. [Karateev AE. On the way toward designing next-generation nonsteroidal anti-inflammatory drugs: amtolmetin guacil. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2014;(2):83–9. (In Russ.)]. DOI: http://dx.doi.org/10.14412/1996-7012-2014-2-83-89.
Review
For citations:
Balabanova RM, Podryadnova MV. Choice of a nonsteroidal anti-inflammatory drug in ankylosing spondylitis. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2014;8(4):86-89. (In Russ.) https://doi.org/10.14412/1996-7012-2014-4-86-89
Views:
5477
JATS XML
Email this article 
