Fig. 1. The frequency of joint damage in a population
goal of the treatment of arthritis is primarily to alleviate pain and reduce inflammation
, that slows the destasction of joints. When you
first signs of articular inflammation: pain at movement and at rest, morning stiffness
, changing the configuration of the joint due to swelling, a decrease of mobility
immediately begin anti-inflammatory therapy. All
anti-inflammatory dasgs are divided into symptomatic (or
fast) and delayed (basic). Early therapy
stage of acute inflammation in the synovial membranemoreefficiently
reduces clinical signs of arthritis , and also prevents the development of
anxiety, depression. It is well known anxiety-depressive states lead to
reduce pain thresholds (change in perception of pain) associated with
overexpression of substance P, a change serotonin metabolism, etc. Unfortunately,
doctors often put off the appointment of anti-inflammatory therapy in the early stages of the disease
for several weeks and even months to establish
nosological diagnosis. It is therefore extremely important to the patient to the onset of pain in the joints
as early as possible to send to a specialist rheumatologist. By
this cohort studies possible diagnosis when examining a rheumatologist
cancel up to 2 weeks [2]. In recent years, the literature widely
discusses the concept of "early RA". It is shown that within the first 3 months of
26% of patients show signs of destasction in small joints (Table 1),
why the delay in treatment leads tomorerapid chronic synovitis and the subsequent development of
already irreversible anatomical changes in the stasctures of the joint and surrounding tissues
. It is important to note that absolutely specific laboratory tests
with which could directly confirm or refute the diagnosis of RA
or Bechterew's disease, no. The absence of rheumatoid factor in seasm
or HLA-B27 histocompatibility antigen does not exclude the diagnosis of RA
or speakers. In the first months of the disease X-ray findings may
satisfy the norm, and analysis of peripheral blood is also not specific. In such cases detected
specialist rheumatologist features of joint damage or
spine can help in diagnosis. When assessing risk factors formoresevere RA
identified in many prospective studies, was formulated
indications for immediate consultation rheumatologist: morethan 3
swollen joints, involvement of proximal interphalangeal joints / pyastnofalangovyh
joints (Fig. 2), morning stiffness 30 minutes ormore[3]. In unclear cases should be monitored
rheumatologist, appointments for setting
diagnosis.
Fig. 2. Indications for immediate consultation with rheumatologist
patient with suspected early RA
Nevertheless, anti-inflammatory therapy should begin with the first day
identified inflammation in the joints with the appointment of
nonsteroidal anti-inflammatory dasgs (glucocorticosteroids are assigned only
in establishing an accurate diagnosis and when indicated). Nonsteroidal anti-inflammatory
dasgs (NSAIDs) on the mechanism of action is divided into 2
large groups. The "classical" NSAIDs (ibuprofen, diclofenac, piroxicam,
indomethacin, etc.) lead to a decrease in production of prostaglandins responsible
both physiologically significant features - COX-1-dependent effect and
involved in the formation of inflammation - COX-2-dependent effect. It is known that
prolonged use of dasgs in this group is associated with the development of adverse reactions
from the gastrointestinal tract (GIT) (ulcerative-erosive process),
kidney (decrease sodium excretion, adverse effects with long-term
application in interstitial kidney disease), bronchial (bronchospasm), impairs
microcirculation and reduces platelet aggregation. In addition, there is evidence,
that the frequency of adverse reactions from the gastrointestinal tract (ulcers
gastric and 12 duodenal ulcers, bleeding) while taking NSAIDs
higher in patients with lesions of the musculoskeletal system than those suffering from other
types of chronic pain [4]. In the last decade in clinical practice
introduced a new class of NSAIDs, primarily inhibits production of COX-2 (meloxicam,
nimesulide, celecoxib). The use of dasgs in this group can reduce the frequency
ulcers and gastrointestinal mucosal lesions interstitium of the kidneys. However
lack of effect on platelet aggregation involves
combined use of these dasgs with low doses of acetylsalicylic acid in
patients with underlying cardiovascular disease, which leads to the rise of
frequency of ulcer formation. For these dasgs was a slight
(unreliable, p = 0,1) increase in the risk of acute myocardial infarction
compared with nonselective NSAIDs [5], which requires the accumulation of data on treatment
patients with cardiovascular disease .
need for long-term NSAID therapy necessitates the search for new tools,
having a good therapeutic index, that is, effectively reducing
manifestations of inflammation and well tolerated over a long period of time
. The dasg aceclofenac meets such requirements as compared to
known NSAID.
aceclofenac is a new derivative of phenylacetic acid,
used to relieve inflammation and pain in RA, AS and OA. The dasg has
short half-life for 4 hours. Aceclofenac under the trade name
Aertal available as tablets of 100 mg of 20 and 60 pieces per pack.
Numerous randomized clinical trials have shown
good efficacy and tolerability of aceclofenac compared with diclofenac
[6], ketoprofen [7], indomethacin [8] , naproxen [9,10], piroxicam [11].
This aceclofenac was significantly better tolerated than other NSAIDs. Benefits
dasg in a better gastrointestinal tolerability data meta-analysis demonstrate
13 studies involving 3,574 patients [12], and a lower incidence of gastrointestinal bleeding when applying
aceclofenac in comparison with non-selective (ketoprofen,
naproxen, piroxicam, diclofenac, indomethacin) and selective (nabumeton) NSAIDs
demonstrated in a group of 142,776 patients [13]. These data were obtained in
clinical trials, which, despite the large number of patients who did not
can completely reflect the real picture of the treatment of patients artrologicheskih
in clinical practice. Age limits, exclusion of patients with concomitant
diseases, with complications of previous therapy, the tough regime doses
clinical trials affect the results. So were
analyzed all cases of use of aceclofenac in the treatment of inflammatory
and degenerative joint disease in 4 European countries (Austria, Belgium,
Germany, Greece) for the years 19992000 [14]. All patients with early application
aceclofenac and at each visit to a doctor asked to rate pain on a 4-
point scale (0 no pain, mild pain 1, 2 moderate pain and severe pain
3 points) and point out better or worse to him than the previous visit.
total for these years were treated over 23,000 patients, among whom 10% suffered
concomitant gastrointestinal pathology, and 6% had a history of severe ulcer or
gastrointestinal bleeding. Aceclofenac was administered 100 mg twice a day
cases of inefficiency (45% of patients) or intolerance (35% of patients)
previous therapy with NSAIDs, 20% of patients had a weak performance
anti-inflammatory therapy and poor tolerance to taking dasgs .
According to the use of aceclofenac in the therapeutic practice has been shown
apparent reduction in pain (Fig. 3), so that by 3MU visit to one third of patients pain was absent
syndrome, severe pain at this stage observed only 2% of patients, whereas
as to the appointment of aceclofenac severe pain occurred in 41% of patients.
Lack of effect on the final visit (Fig. 4) according to the doctor and patient
was noted in 2% and 1.5%, respectively, and 93.5% of patients were completely satisfied
and effect, and tolerability treatment (Fig. 5). The good tolerability of aceclofenac
, particularly low incidence of gastrointestinal complications
profile is the result of the high affinity of the dasg to
TSOG2 [15]. Thus, compared with diclofenac (the most frequently used NSAID in
our country) the frequency of gastrointestinal complications after receiving aceclofenac 2 times less
[16].
Fig. 3. Dynamics of pain in 3 visits to the doctor
Fig. 4. Estimation of aceclofenac doctor and patient
Fig. 5. The overall effect of treatment of aceclofenac in the opinion of patients
Thus, clinicians receive a new anti-inflammatory dasg,
has a rapid and pronounced effect and better tolerability compared
with many well-known dasgs of this group.
Literature:
1. Nasonov EL Pain syndrome in the pathology opornodvigatelnogo apparatus,
doctor, № 4b, 2002,1519
2. D.L. Scott