Clinical Review

Recent advances: Rheumatology

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7147.1810 (Published 13 June 1998) Cite this as: BMJ 1998;316:1810
  1. Peter Brooks ([email protected]), professor
  1. University of New South Wales, St Vincent's Hospital, Sydney 2010, Australia
  1. Correspondence to: Professor P Brooks, Office of the Executive Dean (Health Sciences), University of Queensland, Royal Brisbane Hospital, Hersont, Queensland 4029, Australia
  • Accepted 19 November 1997

In this review of recent advances in rheumatology I focus on treatment. This is not because our understanding of the pathogenesis or other aspects of rheumatology has progressed little but because there have been some particularly important changes in treatment (particularly of rheumatoid arthritis) that need to be communicated to a wider medical audience. Rheumatoid arthritis is usually an aggressive disease that needs to be treated forcefully if subsequent deformity and disability are to be reduced. Referring patients to a specialist rheumatology unit that can implement new treatment regimens at an early stage is therefore important.

Methods

I scanned the major rheumatology journals for articles on the treatment of rheumatoid arthritis and on advances in non-steroidal anti-inflammatory drug treatment. I also reviewed the abstracts of major rheumatology conferences that took place in 1996 and 1997.

Non-steroidal anti-inflammatory drugs

Although non-steroidal anti-inflammatory drugs are the mainstay of treatment for rheumatic diseases, they are being used less worldwide. This is particularly true in Australia, where the prescribing of these drugs has fallen by about 25%—probably as a result of an educational campaign directed at general practitioners and the public that highlighted adverse reactions to these agents.1The box lists factors in the reduced use of non-steroidal anti-inflammatory drugs.

Cyclo-oxygenase inhibitors

It is now understood that the cyclo-oxygenase enzyme system that produces prostaglandins consists of at least two basic isoforms—cyclo-oxygenase 1 and cyclo-oxygenase 2.5 The cyclo-oxygenase 1 enzyme performs “housekeeping” duties, maintaining a normal gastrointestinal mucosa and renal blood flow. Cyclo-oxygenase 2 (the inducible form) is seen in inflammation, the brain, and colon cancer cells. Description of the structure of human recombinant cyclo-oxygenase 2 and its interaction with non-steroidal anti-inflammatory drugs has enabled highly specific inhibitors to be developed.6 The effectiveness and low incidence of gastrointestinal or renal side effects of drugs such as the preferential …

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