RESUMO
BACKGROUND: The cyclooxygenase-2 inhibitors are usually recommended as a safe alternative in patients with multiple hypersensitivity to non-steroidal antiinflammatory drugs. Nevertheless, both immediate and delayed hypersensitivity reactions have been described, and the possibility of cross-reactivity with sulphonamides. CASE REPORT: A 66-year-old patient who, after taking a celecoxib tablet, presented with latency of several hours a skin reaction. Previously, he had presented a minor reaction during treatment with etoricoxib without establishing the correlation at that time. The patient underwent an allergological study by means of skin tests with negative results and an oral challenged test with etoricoxib with positive results. Tolerance to sulfonamides was proven. CONCLUSIONS: We present a singular case of a cross-reactivity skin reaction to etoricoxib and celecoxib, suggesting the need to perform challenge tests to confirm the tolerance or not of each drug before allowing their use. On the contrary, trimethropim/sulfamethoxazole could be safely used in our patients, if needed.
INTRODUCCIÓN: Los inhibidores de la ciclooxigenasa-2 suelen indicarse en pacientes con hipersensibilidad múltiple a los antiinflamatorios no esteroides. Sin embargo, se han descrito reacciones de hipersensibilidad inmediata y retardada, además de posible reactividad cruzada con sulfonamidas. REPORTE DE CASO: Paciente masculino de 66 años, que acudió al servicio de Alergia por una reacción cutánea, luego de haber consumido un comprimido de celecoxib. Previamente, durante el tratamiento con etoricoxib, tuvo una reacción menor, sin establecer la correlación farmacológica. Se realizaron pruebas cutáneas (intraepidérmicas y epicutáneas), con resultados negativos, y un examen de exposición oral controlada con etoricoxib, con resultado positivo. Se comprobó la tolerancia a las sulfamidas. CONCLUSIONES: El caso de reacción cutánea, mediante reactividad cruzada, entre etoricoxib y celecoxib expuesto en este artículo sugiere la necesidad de realizar pruebas de provocación para confirmar la tolerancia de cada fármaco antes de su prescripción. Por el contrario, trimetropim-sulfametoxazol pueden indicarse con seguridad, si fuese necesario.
Assuntos
Inibidores de Ciclo-Oxigenase 2 , Hipersensibilidade a Drogas , Idoso , Humanos , Masculino , Anti-Inflamatórios não Esteroides , Celecoxib/efeitos adversos , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Etoricoxib/efeitos adversos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Sulfonamidas/efeitos adversos , Sulfonas/efeitos adversosRESUMO
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) and particularly selective cyclooxygenase-2 (COX-2) inhibitors such as celecoxib (Cxb) are considered promising cancer chemopreventive for colon, breast, prostate, lung, and skin cancers. However, the clinical application to the prevention is limited by concerns about safety, potential to serious toxicity (mainly for healthy individuals), efficacy and optimal treatment regimen. Cxb exhibits advantages as potent antiinflammatory and gastrointestinal tolerance compared with conventional NSAID's. Recent researches suggest that dermatological formulations of Cxb are more suitable than oral administration in the treatment of cutaneous disease, including skin cancer. To date, optimism has been growing regarding the exploration of the topical application of Cxb (in the prevention of skin cancers and treatment of cutaneous inflammation) or transdermal route reducing risks of systemic side effects. OBJECTIVE: This paper briefly summarizes our current knowledge of the development of the cutaneous formulations or delivery systems for Cxb as anti-inflammatory drug (for topical or transdermal application) as well its chemopreventive properties focused on skin cancer. CONCLUSION: New perspectives emerge from the growing knowledge, bringing innovative techniques combining the action of Cxb with other substances or agents which act in a different way, but complementary, increasing the efficacy and minimizing toxicity.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Celecoxib/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Dermatite/tratamento farmacológico , Dermatite/prevenção & controle , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/prevenção & controle , Administração Cutânea , Animais , Anti-Inflamatórios não Esteroides/administração & dosagem , Celecoxib/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Sistemas de Liberação de Medicamentos/métodos , Humanos , Camundongos , Modelos Animais , RatosRESUMO
Aspirin-exacerbated respiratory disease is a chronic and treatment-resistant disease, characterized by the presence of eosinophilic rhinosinusitis, nasal polyposis, bronchial asthma, and nonsteroidal anti-inflammatory drugs hypersensitivity. Alterations in arachidonic acid metabolism may induce an imbalance between pro-inflammatory and anti-inflammatory substances, expressed as an overproduction of cysteinyl leukotrienes and an underproduction of prostaglandin E2. Although eosinophils play a key role, recent studies have shown the importance of other cells and molecules in the development of the disease like mast cells, basophils, lymphocytes, platelets, neutrophils, macrophages, epithelial respiratory cells, IL-33 and thymic stromal lymphopoietin, making each of them promissory diagnostic and treatment targets. In this review, we summarize the most important clinical aspects of the disease, including the current topics about diagnosis and treatment, like provocation challenges and aspirin desensitization. We also discuss recent findings in the pathogenesis of the disease, as well as future trends in diagnosis and treatment, including monoclonal antibodies and a low salicylate diet as a treatment option.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Asma Induzida por Aspirina/imunologia , Asma/induzido quimicamente , Pólipos Nasais/induzido quimicamente , Doenças Respiratórias/induzido quimicamente , Rinite/induzido quimicamente , Sinusite/induzido quimicamente , Adulto , Anticorpos Monoclonais/uso terapêutico , Ácido Araquidônico/metabolismo , Asma/terapia , Asma Induzida por Aspirina/diagnóstico , Asma Induzida por Aspirina/epidemiologia , Asma Induzida por Aspirina/terapia , Cisteína/metabolismo , Citocinas/metabolismo , Dessensibilização Imunológica/métodos , Dinoprostona/metabolismo , Progressão da Doença , Síndrome de Hipersensibilidade a Medicamentos , Eosinófilos/metabolismo , Feminino , Humanos , Leucotrienos/metabolismo , Masculino , Mastócitos/metabolismo , Pólipos Nasais/terapia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/terapia , Rinite/terapia , Sinusite/terapia , Linfopoietina do Estroma do TimoRESUMO
INTRODUCCIÓN: el dolor cervical es considerado como uno de los síntomas más relevantes del de espalda, con una incidencia del 10 % de la población adulta, lo cual influye en la calidad de vida de las personas. OBJETIVO: comparar la eficacia de la acupuntura y del tratamiento medicamentoso para el alivio de la cervicalgia no traumática. MÉTODOS: estudio comparativo, abierto y aleatorizado en 100 pacientes de ambos sexos mayores de 18 años, seleccionados aleatoriamente en el municipio Marianao. Se conformaron dos grupos de 50 pacientes cada uno; al grupo A se le aplicó tratamiento con acupuntura y al grupo B terapia con analgésicos y antiinflamatorios no esteroideos. La evaluación comparativa de los resultados se realizó por la prueba de Mc Gill modificada, al quinto día y al final del tratamiento. Para el análisis y el procesamiento de los datos se utilizó la prueba de chi cuadrado. RESULTADOS: no hubo diferencias significativas para el alivio del dolor a favor de alguno de los tratamientos aplicados, aunque los pacientes tratados con acupuntura refirieron la mejora del dolor cervical, además de un menor tiempo de tratamiento. CONCLUSIÓN: ambos tratamientos son igualmente eficaces para el alivio de la cervicalgia, pero el acupuntural deviene en una terapia electiva a considerar por la rapidez en el alivio del dolor.
INTRODUCTION: the high incidence of cervical pain at the consultations of health areas has motivated this study, which was carried out during year in patients with neck pain diagnosis. 10 % of the population suffers cervical pain in a specific moment of their lives; it represents an important factor for their professional lives. OBJECTIVE: to compare the acupuncture efficacy and the medical treatment for relieving non-traumatic neck pain. METHODS: a comparative, open and randomized study was conducted in 100 patients of both sexes older than 18 years. They were randomly selected in Marianao municipality. Two groups of 50 patients each were formed; group A had acupuncture treatment and group B therapy had analgesics and nonsteroidal antiinflammatory drugs. The result comparative evaluation was performed by Mc Gill modified test, on the fifth day and at the end of treatment. For data processing and analyzing, chi square test was used. RESULTS: there was no significant difference for pain relief in any of the treatments applied, although patients treated with acupuncture reported improvement neck pain, and a shorter treatment time. CONCLUSIONS: both treatments are equally effective for neck pain relief, but acupuncture therapy is an option to consider due to fast pain relief.
Assuntos
Humanos , Masculino , Feminino , Qualidade de Vida , Analgesia por Acupuntura/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Estatística como Assunto/métodos , Cervicalgia/terapiaRESUMO
Aquí exponemos un modelo que explica por qué, en el sistema nervioso central, los anti-inflamatorios no esteroideos, para ejercer su acción analgésica, deben interactuar con los opioides endógenos y los canabinoides endógenos. La sustancia gris del acueducto de Silvio es una estructura clave del llamado "sistema descendente de control nociceptivo". La activación de este sistema disminuye el flujo de mensajes nociceptivos hacia la corteza cerebral y, por lo tanto, el dolor. En la sustancia gris el ácido araquidónico es el elemento donde los opioides endógenos, los analgésicos opioides y los no-opioides (anti-inflamatorios no esteroideos) convergen para inducir analgesia. Las enzimas degradantes de los endocanabinoides son el punto donde estos y los analgésicos no-opioides convergen para inducir analgesia. Parece ventajoso el hecho de que los analgésicos que se compran libremente en la farmacia pueden aprovechar para su acción los mecanismos endógenos que todos nosotros poseemos
Here we present a model that explains why, in the central nervous system, the nonsteroidal antiinflammatory drugs, in order to induce analgesia, must interact with the endogenous opioids and the endocannabinoids. The periaqueductal gray matter is a key structure in the socalled "descending pain control system". Activations of this system diminishes the flow of nociceptive signals towards the cerebral cortex and, therefore, pain perception. In the periaqueductal gray matter, arachidonic acid is the elements where endogenous opioids analgesics and nonopioid analgesics converge to induce analgasia. The endocannabinoid metabolizing enzyme are the point at which endocannabinoids and nonsteroidal antinflammatory drugs converge to induce analgesia. There seems to be some advantage in that analgesics that can be bought over the counter can use for their action some endogenous mechanisms that we all possess
Assuntos
Humanos , Anti-Inflamatórios , Analgésicos Opioides/farmacologia , Canabinoides , Córtex Cerebral , Neurônios Aferentes , Manejo da Dor , Sistema Nervoso Central/anatomia & histologia , EndocanabinoidesRESUMO
T cells are involved in the pathogenesis of rheumatoid arthritis (RA). CD6 is a co-stimulatory molecule, predominantly expressed on lymphocytes, that has been linked to autoreactive responses. The purpose of this study was to evaluate the safety, immunogenicity and preliminary efficacy of itolizumab, a humanized anti-CD6 monoclonal antibody, in patients with active rheumatoid arthritis. Fifteen patients were enrolled in a phase I, open-label, dose-finding study. Five cohorts of patients received a weekly antibody monotherapy with a dose-range from 0.1 to 0.8 mg/kg. Itolizumab showed a good safety profile, with no severe or serious adverse events reported so far. No signs or symptoms associated with immunosuppression were observed in the study. Objective clinical responses were achieved in more than 80% of patients after treatment completion, and these responses tend to be sustained afterwards. This clinical study constitutes the first evidence of the safety and positive clinical effect of a monotherapy using an anti-CD6 antibody in patients with rheumatoid arthritis.
RESUMO
Estudios previos han indicado que las drogas antiinflamatorias no esteroideas (AINEs) actúan en la modificación de la respuesta inflamatoria por parte del huésped. El propósito del presente trabajo es presentar una revisión bibliográfica relacionada con el empleo de los AINEs y su efectividad comprobada sobre la enfermedad periodontal. Se desarrollarán diversos aspectos dentro de los cuales se mencionarán la etiología y patogenia de la enfermedad periodontal, características de los AINEs, su clasificación, farmacocinética, farmacodinamia (haciendo énfasis en el mecanismo como antiinflamatorio), uso terapéutico, así como diferentes estudios experimentales sobre el uso de los mismos en animales y en pacientes con enfermedad periodontal.
This review presents information about nonsteroidal antiinflammatory drugs their clinical efficacy in the periodontal disease, doing emphasis on the indications, pharmaceutical preparations, classification and adverse effects which they can produce on the basis of scientific knowledge. This report describes the use of nonsteroidal antiinflammatory drugs as an adjunct to scaling and root planning in periodontal disease.