Adverse reactions in patients with rheumatic diseases. Retrospective analysis of causes of admission and out-patient attendance in a specialist centre

An audit of the use of antirheumatic drugs in a north Indian referral hospital

OBJECTIVE

This study was conducted with the aim of auditing the pattern of use of antirheumatic drugs in a tertiary care hospital in Northern India.

METHODS

The study was carried out in 1000 patients recruited sequentially from the clinic for a period of 1 year (January to December 1999). Patient data such as age, sex, income, family size, diagnosis, duration of illness, drugs prescribed/duration, adverse drug reaction were noted and used to calculate core drug use indicators and pattern of drug use.

RESULTS

The pattern of drug use was in accordance with the standard practices followed internationally. In rheumatoid arthritis the most common prescriptions were for non-steroidal antiinflammatory drugs (NSAIDs) alone, followed by the combination of NSAIDs, disease modifying agents (DMARDs) and steroids. Of the NSAIDs diclofenac was the most frequently prescribed drug, while chloroquine was the most commonly used DMARD. The most commonly seen adverse drug reactions were gastritis, Cushings syndrome and decreased visual acuity.

CONCLUSION

In conclusion, this study has demonstrated that in this clinic, the pattern of use of antirheumatic drugs follows standard guidelines.

A review of upper-gastrointestinal effects of the newer nonsteroidal antiinflammatory agents

Newer nonsteroidal antiinflammatory agents (NSAI's) such as ibuprofen, neproxen, fenoprofen, and tolmetin have broadened the therapeutic choice and increased the chances of providing optimum arthritis control, but require careful assessment of the possibilities for unwanted drug effects when long-term therapy is required. A review of the literature on the gastrointestinal effects of the promising newer NSAIs, as compared with the older agents, aspirin, indomethacin, and phenylbutazone, is presented, highlighting animal toxicology and human adverse reaction surveillance data and the evidence for various suggested pathophysiological mechanisms.

Indomethacin--aspirin interaction: a clinical appraisal

Plasma profiles of indomethacin after a 50-mg oral dose were constructed in six healthy volunteers before and after a week of aspirin treatment. Aspirin did not interfere with indomethacin plasma levels. To examine the clinical effect of concurrent indomethacin and aspirin treatment 20 patients with seropositive rheumatoid arthritis were given indomethacin 100 mg/day, aspirin soluble 4 g/day, and the two drugs taken together in random order. Analysis of the clinical indices of inflammation--articular index and mean pain score--and of the efficacy of each treatment showed no significant differences between the three treatment groups. With the proliferation in the number of anti-rheumatic drugs available, the case for giving two or more nonsteroidal anti-inflammatory drugs concurrently remains unproved.

Antirheumatic drugs: clinical pharmacological and therapeutic aspects

There are many current concepts of the pathogenesis of rheumatic diseases which incorporate immunological, infectious and hereditary factors. Rheumatic diseases may sometimes become apparent after trauma, be associated with certain diseases and may be induced by nerve damage and serum sickness. Systemic lupuserythematosus may result from the use of a variety of drugs. At present the body of evidence tends to incriminate immunological factors as well as infectious agents as principal factors in the pathogenesis of rheumatoid arthritis and systemic lupus erythematosus. Just as there is uncertainty regarding the pathogenesis of rheumatic diseases, knowledge of the mechanism of action of the various drugs used to treat these diseases is also incomplete. Recent progress indicates that inhibition of prostaglandin biosynthesis and possibly lysosomal membrane stabilization are primary modes of action of the anti-inflammatory agents. Certain antirheumatic drugs have also been shown to exert some of their therapeutic effect by interfering with the kallikrein-kinin-kininase system...