Coxibs and arthritis pain and inflammation
A class of medications called COX-2 inhibitors, or coxibs, were created to help relieve the pain and inflammation of osteoarthritis and rheumatoid arthritis. The coxibs are said to be less likely to irritate the stomach or gut than some of the older anti-inflammatory drugs such as aspirin or indomethacin may do.
Many people who take aspirin and other so-called NSAIDs (non-steroidal anti-inflammatory drugs) for arthritis suffer from stomach and gastrointestinal upsets caused, or made worse, by their medication. Unfortunately, this means that some people with osteoarthritis and rheumatoid arthritis, particularly those with stomach ulcers, are often unable to take NSAIDs regularly to relieve joint pain and inflammation.
Coxibs
The COX-2 inhibitors, or coxibs, for example, celecoxib (brand name Celebrex), are said to be safer on the stomach and gut than the older medications.
To understand what makes the coxibs different from the older anti-inflammatory agents, you have to understand a little about the COX (cyclo-oxygenase) enzymes. There are two COX enzymes: COX-1 and COX-2.
Put very simply, COX-1 is useful to the body and is partly responsible for maintaining the lining of the stomach. On the other hand, COX-2 is responsible for pain and inflammation in diseases such as arthritis.
NSAIDs work by blocking the effects of COX-2. Unfortunately, these older anti-inflammatory drugs are also believed to block the beneficial effects of COX-1, and so increase the risk of stomach upsets and stomach ulcers. This is why many people who take aspirin to relieve inflammation in arthritis suffer from stomach irritation and sometimes even bleeding ulcers.
By contrast, the coxibs can block the inflammatory effect of COX-2 but are believed to keep the protective COX-1 effects as well.
Effectiveness
So are the COX-2 inhibitors as effective as the older anti-inflammatories at relieving pain and inflammation in arthritis? Studies have shown that coxibs are equally as effective as some of the older agents for pain relief and relief of inflammation in osteoarthritis and rheumatoid arthritis.
Who might benefit from the coxibs?
People with osteoarthritis or rheumatoid arthritis who are at risk of gastrointestinal complications or who have a history of peptic ulcer disease are the kind of people who might benefit from a COX-2 inhibitor. Your own doctor can advise if they are right for you.
Who should avoid the coxibs?
People who are allergic to sulphonamides should avoid celecoxib, and people who have been asthmatic or had an allergic reaction to NSAIDs should not take a coxib. Also, people who are at increased risk of cardiovascular disease, such as heart attack or stroke, should not take coxibs. People should not take the coxibs in addition to other NSAIDs. Your doctor will be able to tell you whether or not coxibs are suitable for you.
Safety
Studies have shown that coxibs have much lower rates of gastric ulcer and ulcer complications associated with them than older conventional NSAIDs. However, there may be an increased risk of cardiovascular events, such as heart attack and stoke, associated with the use of celecoxib in high doses. You can discuss the risks and benefits of treatment with coxibs with your doctor, who will be able to tell you whether or not they are suitable for you.
Osteoarthritis and rheumatoid arthritis
People with osteoarthritis and rheumatoid arthritis have to deal with varying degrees of pain and inflammation and stiffness in joints.
Osteoarthritis
Osteoarthritis results from damage to cartilage, which is the soft spongy material which insulates joints. Cartilage forms a barrier between the 2 bones of a joint and stops them from grinding and scraping against each other. When the cartilage becomes thinner or damaged, extra bone forms at the edges of joints. Symptoms of osteoarthritis can be pain, swollen joints, stiffness in the morning and limited motion in joints.
Rheumatoid arthritis
In rheumatoid arthritis, the joints become inflamed. Normal joints are surrounded by a membrane (the synovium), which produces a lubricating fluid called synovial fluid. In rheumatoid arthritis, the synovium that surrounds your joints becomes inflamed and more fluid is produced which swells the capsule that contains it, causing pain. As more blood flows to the area, the joint may feel warm to the touch. Nerve endings in the area are irritated by the inflammatory reaction and produce pain. Rheumatoid arthritis can make people feel generally ill, tired and run down, making it even harder to cope with the pain.
Last Reviewed: 16 May 2005
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