American Fitness Professionals & Associates

When taken regularly and at high doses, traditional nonsteroidal anti-inflammatory drugs (NSAIDs) used for pain relief can cause gastrointestinal (GI) bleeding or ulcers. But a new type of NSAID, cyclooxygenase-2 inhibitors, better known as COX-2 inhibitors, has joined the old standbys and helps suppress arthritis with less stomach irritation.

Cyclooxygenases are enzymes needed for the synthesis of hormone-like substances called prostaglandins. There are two types of cyclooxygenases: the COX-2 enzyme that mediates inflammation and pain, and the COX-1 enzyme that helps maintain other physiological functions in the body. Traditional NSAIDs inhibit both enzymes. The new NSAIDs, however, block mostly the COX-2 enzyme, offering a new treatment option for people who have had difficulty tolerating the old NSAIDs.

FDA approved the first COX-2 inhibitor, Celebrex (celecoxib), in December 1998 to treat rheumatoid arthritis and osteoarthritis. Vioxx (refecoxib) became the second COX-2 inhibitor to receive approval, in May 1999, but only for the treatment of osteoarthritis, dysmenorrhea (pain with menstrual periods), and the relief of acute pain in adults, such as that caused by dental surgery.

Both drugs, taken orally, were found to substantially lower the risk of stomach and upper intestinal ulcers detected by endoscopy in clinical trials, compared with other NSAIDs. Additional studies are needed to determine whether Celebrex and Vioxx actually cause fewer serious stomach problems, including GI ulceration, bleeding and perforation. Until such studies are done, FDA is requiring the drugs’ labeling to include the standard warning about the GI risks that are associated with NSAIDs.

Two non-drug alternatives for the treatment of pain in osteoarthritis of the knee were approved by the Center for Devices and Radiological Health in 1997 for patients who have failed to respond adequately to simple analgesics, such as acetaminophen, and to conservative nonpharmacologic therapy. Hyalgan and Synvisc are viscous solutions composed of hyaluronan (hyaluronic acid, a lubricant found naturally in the joints), and are injected directly into the knee joint. Both are believed to increase the quality of synovial fluid, although the mechanism of action for these products is not well understood. The most common side effects reported from these treatments–injection site pain and knee pain and/or swelling–were found to be temporary. For patients who cannot tolerate oral medications and who are not candidates for surgical knee replacement, these treatments may be an ideal option.

Fitness expert Johnnie D. Jackow Sr. has designed thousands of specialized programs specifically for people with Arthritis and Rheumatoid arthritis conditions. If you have been diagnosed with arthritis by your physician take control over your condition and let Johnnie design a health program just for you!