Jornal Médico – Ana Barbosa: “osteoarthritis quality of life: the role of NSAIDs and the importance of gastroprotection in the treatment of patients with osteoarthritis”

Ana Barbosa: “Quality of Life in Osteoarthritis: The Role of NSAIDs and the Importance of Gastroprotection in the Treatment of Osteoarthritis Patients”

Read an article by Ana Barbosa, basic and household medication (FGM) specialist at the Dark Health Center of the Alto Minho Local Health Department, about the methods adopted and the impression of FGM practitioners on lowering morbidity in patients with persistent illnesses. Diseases, specifically osteoarthritis, are a pattern that can enhance resulting from the enhance in common life expectancy.

Illness is one of the most typical causes for session in major care, with a powerful bodily, psychological and socioeconomic impression and liable for vital consumption of well being care assets. Given the enhance in common life expectancy and the consequent growing old of the inhabitants, this scourge is predicted to extend in the coming years resulting from extra frequent pathologies equivalent to osteoarthritis (OA) in outdated age.

Osteoarthritis is one of the most typical persistent illnesses at this time, and each its prevalence and incidence are rising with rising life expectancy. It exhibits a progressive evolution with a loss of performance and quality of life with a powerful psychological and socio-financial impression. Primary care performs a key role in the prognosis and comply with-up of these patients. Its administration is advanced and the therapeutic strategy ought to be multidisciplinary, combining pharmacological and non-pharmacological interventions.

Nonsteroidal anti-inflammatory medicine (NSAIDs) are amongst the most generally used medicine worldwide and are the first-line medicine for the administration of ache and irritation in osteoarthritis exacerbations.

The threat of gastrointestinal (GI) problems related with NSAID use is estimated to be 4-5 instances greater than in the inhabitants not taking these medicine, and is even greater in the aged and/or these with a historical past of peptic ulcer illness. . There are many threat components for the growth of GI problems throughout NSAID treatment, equivalent to: age > 65 years, related pathologies, or concomitant remedy with different medicine that enhance this threat (a traditional instance is the use of acetylsalicylic acid for cardiovascular prophylaxis). In Portugal, about 800,000 folks take NSAIDs day-after-day. These medicine account for 7.6% of the whole price of medicine in our nation, surpassed solely by psychotropic and antihypertensive medicine.

A research performed in 9 hospital facilities in Portugal in 2006 confirmed 291 higher gastrointestinal occasions related with ASA/NSAIDs consumption amongst 280 patients. These admissions accounted for 20% of all higher gastrointestinal admissions. According to the similar research, the annual incidence of higher gastrointestinal bleeding related with ASA/NSAID consumption was 11.6 per 100,000 inhabitants.

Gastrointestinal signs may be acute (hours to days), depend upon dose and pharmacologic efficiency, and differ in medical severity from dyspepsia to gastrointestinal bleeding. GI signs, equivalent to gastroesophageal reflux illness, could precede gastrointestinal illness, however greater than half of NSAID customers with extreme peptic ulcer problems haven’t any prior GI signs, and many patients with GI signs could not have GI accidents. Thus, GI signs should not dependable predictors of the onset of GI harm.

General and household medication is a complete specialty that focuses on the simultaneous administration of acute and persistent issues. Therapeutic administration is an more and more vital problem in the medical observe of the household doctor. The aged inhabitants, typically with polymedical and different comorbidities, is a day by day problem for the household doctor. Worsening of osteoarticular pathology is the most frequent motive for session of major care, particularly in older age teams. Due to its traits, the treatment of these patients deserves particular consideration. On the different hand, ache reduction is a common proper that ought to be assured in each doctor’s medical observe.

The growth of methods to cut back the antagonistic results of NSAIDs is acknowledged as a key software in the administration of these patients. These methods embody cautious evaluation in keeping with particular person threat, eradication of Helicobacter pylori, use of brokers with higher security profiles and gastric safety, ideally proton pump inhibitors (PPIs), which have been proven to be efficient methods in lowering morbidity. Gastric ulcer threat related with NSAIDs.

Most medical tips and suggestions advocate concurrent use of proton pump inhibitors throughout NSAID administration to cut back GI unwanted side effects, particularly in at-threat patients. Despite this suggestion, roughly 50% of at-threat patients don’t obtain gastroprotection. Meanwhile, 15-30% of patients don’t adhere to their PPI co-prescription, the predominant causes being forgetfulness and low depth of GI complaints.

Educating and informing healthcare professionals about this problem and investing in enhancing the well being literacy of our customers is a key half of the path in the direction of sufficient treatment of osteoarthritis and, because of this, enhancing the quality of life of our customers.

Bibliography

  • Mäntyselkä P, Kumpusalo E, Ahonen R, Kumpusalo A, Kauhanen J, Viinamaki H, et al. Pain as a motive for visiting a health care provider: a research in Finnish major well being care. Pain 2001;89:175–80.
  • Jones RBNCL, Gass D, Grol R, Mant D, Silagy C. The nature of major care. London: Oxford University Press; 2003.
  • Conagan PG. Rheumatol Int. 2012;32:1491–502.
  • Scarpignato C & Hunt R. Gastroenterol Clin North Am. 2010;39:433–64.
  • NICE Guidelines (web page 16);
  • Conagan PG. Rheumatol Int. 2012;32:1491–502. ;
  • Bhala N, et al; Coxib and conventional NSAID Trialists’ (CNT) collaboration. Lancet 2013;382:769–79.;
  • Warlé-van Herwaarden M, et al.;
  • Scarpignato C, et al. International NSAID Consensus Group. BMC Med. 2015;13:55.;
  • Bannuru RR, et al. Osteoarthritis Cartilage 2019;27:1578–89.;
  • Bruyere O, et al. Semin arthritis rheum. 2019;49:337–50.;
  • Pham Ok & Hirschberg R, Global security of coxibs and NSAIDs. Current subjects in medicinal chemistry 2005, 5, 465-473;
  • Van de Laar, M., Schöfl, R., Prevoo, M., and Jastorff, J., Predictive worth of gastrointestinal signs and affected person threat components for nsaid-associated peptic ulcer illness? Analysis utilizing naproxen knowledge from part 3 randomized medical trials. Poster introduced at the Dutch Pain Congress on October 29, 2021.
  • Davis A & Robson J. Br J Gen Pract. 2016;66:172–3.;
  • Moore RA, et al. Pain Pract 2014;14:378–95.;
  • Goldstein JL, et al. Clin Gastroenterol Hepatol. 2006;4:1337–45.;
  • Sostres C, Carrera-Lasfuentes P, Lanas A. Curr Med Res Opin. 2017;33:1815–20.
  • Goldstein JL, et al. Clin Gastroenterol Hepatol. 2006;4:1337–45
  • Sheiman and others. Esomeprazole Ulcer Prevention in At-Risk Patients Using Nonselective NSAIDs and COX-2 Inhibitors. Am J Gastroenterol 2006; 101: 701-10.;
  • Graham et al. Ulcer prevention throughout lengthy-time period use of nonsteroidal anti-inflammatory medicine: outcomes of a double-blind, randomized, multicenter, lively, placebo-managed trial. Arch Intern Med 2002; 162:169–75.;
  • Hawkey et al. Omeprazole in contrast with misoprostol for nonsteroidal anti-inflammatory drug-related ulcers. Omeprazole and Misoprostol for the Management of NSAID-Induced Ulcers (OMNIUM) Study Group. N Engl J Med 1998; 338: 727–34
  • Duarte PEREIRA1, Elizabeth RAMOS, Jaime Branco, Osteoarthritis. Acta Med port. Jan-Fev 2015;28(1):99-106.
  • Cardoso M. NSAIDs in gastrointestinal illnesses – knowledge from Portugal. Oral communication at the XXI National Congress of Gastroenterology and Digestive Endoscopy, 2001 Endonews 2003; 5: 14-15.
  • Alves A, Furtado C. 2003-2004. Analysis of price progress in the generic drug market. Medicines and Health Products Observatory, 2005 (Infarmed).
  • Wilcox CM, Allison J, Benzuly Ok, et al. Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin. Clin Gastroenterol Hepatol 2006;4:1082-1089.

.

Leave a Comment

Your email address will not be published.