RESUMEN
BACKGROUND: Topical formulations of non-steroidal anti-inflammatory drugs (NSAIDs), in particular diclofenac (DI), have become popular for treating various acute and chronic painful inflammatory conditions. OBJECTIVE: To perform a literature review of (1) the use of topical NSAIDs; (2) the pharmaceutical, pharmacokinetic and pharmacodynamic properties of a medicated plaster (patch) containing diclofenac epolamine (DI-EP, Flector Tissugel, Flector patch) compared with other formulations of topical NSAIDs; and (3) evaluation of the clinical findings from studies with this novel DI-EP patch. OUTCOMES: (1) Pharmacokinetic studies involved determination of DI from DI-EP and separately epolamine (EP) and the epoxide metabolite (N-oxide-EP) in laboratory animals and humans; the latter being the major metabolite in humans. About 2% of DI is absorbed by the skin in humans and is excreted in the urine. Maximum plasma concentrations of 17.4 ng/mL DI are reached at 5.4 hours (approximate steady state conditions); the plasma elimination half-time (t(1/2)) being 26.4 hours. Low systemic levels of DI and EP are produced from DI-EP. Pronounced accumulation of DI occurs in the muscle layers and in synovial fluids of arthritic patients; (2) No significant toxicity occurs from EP nor N-oxide-EP, while that of oral DI-EP was similar to that from DI; and (3) In acute musculoskeletal conditions (sprains, tendonitis and sports injuries) and osteoarthritis DI-EP patches control pain and signs of joint or physical injury compared with placebo controls by 3-5 days with almost complete pain relief at 14 days. DI-EP was shown to have equivalent therapeutic effect to another DI diethylammonium gel formulation (Voltaren Emulgel). There were no reports of serious adverse events in the gastro-intestinal (GI) tract, kidneys or liver from DI-EP. Mild GI symptoms and skin reactions occur in 2 and 10% of patients, respectively. CONCLUSIONS: The patch delivery of DI in DI-EP affords controlled delivery of the active drug in contrast to that from application of gels or ointments of NSAIDs.
Asunto(s)
Antiinflamatorios no Esteroideos/farmacología , Antiinflamatorios no Esteroideos/farmacocinética , Diclofenaco/análogos & derivados , Dolor/tratamiento farmacológico , Administración Tópica , Antiinflamatorios no Esteroideos/efectos adversos , Enfermedades Óseas/tratamiento farmacológico , Enfermedades Óseas/metabolismo , Preparaciones de Acción Retardada/farmacocinética , Preparaciones de Acción Retardada/farmacología , Diclofenaco/efectos adversos , Diclofenaco/farmacocinética , Diclofenaco/farmacología , Humanos , Inflamación/tratamiento farmacológico , Inflamación/metabolismo , Enfermedades Musculares/tratamiento farmacológico , Enfermedades Musculares/metabolismo , Dolor/metabolismo , Piel/metabolismoAsunto(s)
Artritis Reumatoide/complicaciones , Traumatismos de los Dedos/diagnóstico , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Dedos/etiología , Articulaciones de los Dedos/patología , Humanos , Imagen por Resonancia Magnética , Rotura Espontánea , Traumatismos de los Tendones/etiologíaRESUMEN
Erosive osteoarthritis (OA) is a subcategory of OA in which destructive changes occur in the joints, probably as a result of a combination of inflammatory inciters and phenomena. The major changes occur in the distal and proximal interphalangeal joints, root joints of the thumb, and less commonly other hand and centripetal joints. A familial tendency suggests hereditary predisposition, and women more likely to be afflicted than men. Diagnosis has been enhanced by newer imaging techniques such as sonography and scintigraphy. Treatment remains chiefly palliative, although there are hints that alleviation of inflammation may be more salutary than simple analgesia.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Articulaciones de los Dedos , Osteoartritis/diagnóstico , Osteoartritis/tratamiento farmacológico , Suplementos Dietéticos , Femenino , Humanos , Masculino , Medicina AyurvédicaRESUMEN
No diagnostic laboratory test or curative treatment yet exists for Behçet's disease. However, genetic studies have identified those most at risk, and newer molecular biologic investigations further elucidate the etiology and shed light on potential triggers. This article reviews current therapies.
Asunto(s)
Síndrome de Behçet , Síndrome de Behçet/clasificación , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/epidemiología , Síndrome de Behçet/terapia , China/epidemiología , Inglaterra/epidemiología , Alemania/epidemiología , Humanos , Irak/epidemiología , Japón/epidemiología , Corea (Geográfico)/epidemiología , Prevalencia , Turquía/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Are NSAIDs doomed to fade away, to be replaced by more targeted treatments? Or, as I have long maintained, will they survive the other current approaches to the therapy of osteoarthritis and rheumatoid arthritis, despite the recent disdain for them in some academic circles? To answer these questions, one must look at the rationale behind the development of NSAIDs.
RESUMEN
Medical treatment of low back pain is at best palliative. While no drugs are specifically labeled for back pain treatment, analgesics, muscle relaxants, and corticosteroids are used in practice to augment rest and exercise programs. Invasive therapy remains contentious. This article reviews the available literature on the various pharmacologic therapies. In addition, newly postulated outcome measures for future back pain studies are discussed.