Evaluation of adverse effects of long-term oral administration of carprofen, etodolac, flunixin meglumine, ketoprofen, and meloxicam in dogs

Objective - To evaluate adverse effects of long-term oral administration of carprofen, etodolac, flunixin meglumine, ketoprofen, and meloxicam in dogs. Animals - 36 adult dogs. Procedures - Values for CBC, urinalysis, serum biochemical urinalyses, and occult blood in feces were investigated before and 7, 30, 60, and 90 days after daily oral administration (n = 6 dogs/group) of lactose (1 mg/kg, control treatment), etodolac (15 mg/kg), meloxicam (0.1 mg/kg), carprofen (4 mg/kg), and ketoprofen (2 mg/kg for 4 days, followed by 1 mg/kg daily thereafter) or flunixin (1 mg/kg for 3 days, with 4-day intervals). Gastroscopy was performed before and after the end of treatment. Results - For serum γ-glutamyltransferase activity, values were significantly increased at day 30 in dogs treated with lactose, etodolac, and meloxicam within groups. Bleeding time was significantly increased in dogs treated with carprofen at 30 and 90 days, compared with baseline. At 7 days, bleeding time was significantly longer in dogs treated with meloxicam, ketoprofen, and flunixin, compared with control dogs. Clotting time increased significantly in all groups except those treated with etodolac. At day 90, clotting time was significantly shorter in flunixin-treated dogs, compared with lactose-treated dogs. Gastric lesions were detected in all dogs treated with etodolac, ketoprofen, and flunixin, and 1 of 6 treated with carprofen. Conclusions and Clinical Relevance - Carprofen induced the lowest frequency of gastrointestinal adverse effects, followed by meloxicam. Monitoring for adverse effects should be considered when nonsteroidal anti-inflammatory drugs are used to treat dogs with chronic pain.

Analgésicos Tópicos

Background and objectives: Pain treatment involves the usage of common and opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) and adjuvant analgesics. Traditionally, these drugs are administered systemically or into the neuraxis. However, when analgesics are applied through these pathways, they are associated with significant side effects, which can hinder its use. Topical administration of analgesics is an alternative. The objective of this paper is to discuss topical analgesics, the mechanisms of action and clinical efficacy. Content: This is a review paper addressing the usage of the topical local anesthetics: capsaicin, clonidine, tricyclic antidepressants, ketamine, opioids and cannabinoids, discussing mechanism of action and effectiveness. Conclusions: Topical analgesics are promising as a strategy for pain treatment, as they are associated with lower incidence of side effects. The benefit of local anesthetics, NSAID's and capsaicin is well established. However, the efficacy of clonidine, tricyclic antidepressants, ketamine, opioids and cannabinoids is still questionable. Studies have shown that the multimodal approach is an alternative, but studies are needed to confirm this hypothesis. © 2012 Elsevier Editora Ltda.

Avaliação do perfil antiinflamatório e analgésico, e dos efeitos colaterais da administração oral de meloxicam em equinos: avaliação física, laboratorial e gastroscópica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Farmacocinética pré-clínica do composto 1-(2,6-diclorofenil)indolin-2-ona (DICCIC), pró-fármaco de diclofenaco

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Remoção do ácido mefenâmico em solução aquosa com carvão ativado em pó e via oxidação com cloro

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Preditores de recidiva hemorrágica ou óbito na hemorragia digestiva alta por úlcera péptica ou lesão aguda da mucosa gastroduodenal

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparison of selective and non selective cyclo-oxygenase 2 inhibitors in experimental colitis exacerbation: role of leukotriene B4 and superoxide dismutase

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fator de crescimento do endotélio vascular e do transportador de glicose 1 em cães com ceratose actínica e carcinoma de células escamosas

Pós-graduação em Medicina Veterinária - FCAV

Interferência do parecoxibe sobre a função renal e lesão de rins submetidos ao estresse isquêmico: trabalho experimental em ratos com uso de NGAL como marcador da função renal

Pós-graduação em Anestesiologia - FMB

Gender characterization in a large series of Brazilian patients with spondyloarthritis

An increasing number of women have been diagnosed with spondyloarthritis (SpA) in recent decades. While a few studies have analyzed gender as a prognostic factor of the disease, no studies have addressed this matter with a large number of patients in South America, which is a peculiar region due to its genetic heterogeneity. The aim of the present study was to analyze the influence of gender on disease patterns in a large cohort of Brazilian patients with SpA. A prospective study was carried out involving 1,505 patients [1,090 males (72.4%) and 415 females (27.6%)] classified as SpA according to the European Spondyloarthropaties Study Group criteria who attended at 29 reference centers for rheumatology in Brazil. Clinical and demographic variables were recorded and the following disease indices were administered: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and Ankylosing Spondylitis Quality of Life (ASQoL). Ankylosing spondylitis (AS) was the most frequent disease in the group (65.4%), followed by psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), arthritis associated to inflammatory bowel disease (3.2%), and juvenile SpA (2.9%). The male-to-female ratio was 2.6:1 for the whole group and 3.6:1 for AS. The females were older (p<0.001) and reported shorter disease duration (p=0.002) than the male patients. The female gender was positively associated to peripheral SpA (p<0.001), upper limb arthritis (p<0.001), dactylitis (p=0.011), psoriasis (p<0.001), nail involvement (p<0.001), and family history of SpA (p=0.045) and negatively associated to pure axial involvement (p< 0.001), lumbar inflammatory pain (p=0.042), radiographic sacroiliitis (p<0.001), and positive HLA-B27 (p=0.001). The number of painful (p<0.001) and swollen (p=0.006) joints was significantly higher in the female gender, who also achieved higher BASDAI (p<0.001), BASFI (p=0.073, trend), MASES (p=0.019), ASQoL (p=0.014), and patient's global assessment (p=0.003) scores, whereas the use of nonsteroidal anti-inflammatory drugs (p<0.001) and biological agents (p=0.003) was less frequent in the female gender. Moreover, BASRI values were significantly lower in females (p<0.001). The female gender comprised one third of SpA patients in this large cohort and exhibited more significant peripheral involvement and less functional disability, despite higher values in disease indices.

Infrared (810 nm) Low-Level Laser Therapy in Experimental Model of Strain-Induced Skeletal Muscle Injury in Rats: Effects on Functional Outcomes

Muscle strains are among the most prevalent causes for athletes absence from sport activities. Low-level laser therapy (LLLT) has recently emerged as a potential contender to nonsteroidal anti-inflammatory drugs in muscle strain treatment. In this work we investigated effects of LLLT and diclofenac on functional outcomes in the acute stage after muscle strain injury in rats. Muscle strain was induced by overloading the tibialis anterior muscle of rats during anesthesia. The injured groups received either no treatment, or a single treatment with diclofenac 30 min prior to injury, or LLLT (810 nm, 100 mW) with doses of 1, 3, 6 or 9 J, at 1 h after injury. Functional outcome measures included a walking index and assessment of electrically induced muscle performance. All treatments (except 9 J LLLT) significantly improved the walking index 12 h postinjury compared with the untreated group. The 3 J group also showed a significantly better walking index than the drug group. All treatments significantly improved muscle performance at 6 and 12 h. LLLT dose of 3 J was as effective as the pharmacological agent in improving functional outcomes in the early phase after a muscle strain injury in rats.

Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital

OBJECTIVE: Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital. MATERIALS AND METHODS: Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients. RESULTS: Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%). The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i. e., 59% of surgeons and 25.6% of clinicians used this combination of drugs) (p = 0.014). Only 21.3% prescribe alpha blockers. CONCLUSION: Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.

Selektive und duale COX-1-, COX-2-Inhibitoren aus der Reihe der Methanone

Zusammenfassung: Prostaglandine (PG) sind wichtige biologische Entzündungsmediatoren, die aus der Arachidonsäure (AA) durch das Enzym Cyclooxygenase (COX) entstehen. Trotz einiger unerwünschter Wirkungen, sind Cyclooxygenase-Hemmer Mittel der Wahl zur Unterdrückung entzündlicher Prozesse. Von der Cyclooxygenase existieren zwei Isoenzyme: COX-1 und COX-2. Eine selektive Hemmung der COX-2 bzw. eine duale Hemmung der COX-1 und COX-2 wird als erfolgversprechendes Prinzip zur Behandlung von entzündlichen Erkrankungen diskutiert.Ziel der Arbeit war die Synthese und in vitro Testung sowie die Erstellung von Struktur-Wirkungs-Beziehungen selektiver bzw. dualer Hemmstoffe der COX-1/-2. Zusätzlich wurden die Substanzen auf inhibitorische Aktivität gegenüber der 5- und 12-Lipoxygenase untersucht.Ausgehend von der Struktur selektiver Hemmstoffe der COX-2 bzw. von dualen COX-1/ COX-2-Inhibitoren sowie von marktüblichen nichtsteroidalen Antirheumatika (NSAR), wurde das Diarylmethanon-Element als Basis gewählt. An diesem Strukturelement wurden Modifikationen vorgenommen, um selektive Hemmstoffe der COX-2 bzw. duale COX-1/ COX-2-Hemmstoffe zu erhalten.Die synthetisierten Verbindungen lassen sich in [4-(Methylsulfanyl)phenyl]- und [4-(Methylsulfonyl)phenyl](aryl)methanone, N-(Aroylphenyl)sulfonamide und -amide sowie (Hydroxyphenyl)(2-thienyl)methanone unterteilen.In der Reihe der [4-(Methylsulfanyl)phenyl](aryl)methanone sind potente Hemmstoffe sowohl der COX-1 als auch der COX-2 erhalten worden. Im Gegensatz dazu zeigen die [4-(Methylsulfonyl)phenyl](aryl)methanone gegenüber COX-1 und COX-2 keine inhibitorische Aktivität. Mit dem 2-Thienylderivat wurde ein potenter, dualer Hemmstoff beider Cyclooxygenase-Isoenzyme identifiziert, dessen Wirkstärke (bezüglich der COX-2) auf den Austausch von Phenyl gegen 2-Thienyl zurückzuführen ist.Die N-(Aroylphenyl)sulfonamide und -amide bilden die umfangreichste Gruppe bei den durchgeführten Untersuchungen, wobei besonders die regioisomeren N-(2-Aroylphenyl)sulfonamide und -amide eingehender studiert wurden. Auf der Basis der (2-Aroylphenyl)sulfonamide läßt sich für die Hemmung der COX-1 eine Struktur-Wirkungs-Beziehungen formulieren, die anhand Hilfe geeigneter Verbindungen überprüft wurde. Die Untersuchungen wurden zum Teil auch auf die 3- und 4-Regioisomeren ausgedehnt, wobei sich die erhaltenen Struktur-Wirkungs-Beziehungen bestätigten. Die Arylsulfonamide inhibieren bevorzugt die COX-1. Auch (4-Aroylphenyl)sulfonamide wurden auf mögliche inhibitorische Aktivität untersucht. Die Einbindung des Amidstickstoffs in ein Indolin- bzw. Tetrahydrochinolin-Ringsystem oder des Sulfonamids in ein 1,3-Propansultam führte in jedem Falle zu wenig aktiven Verbindungen gegenüber der COX-1. N-(2-Aroylphenyl)amide zeigten in Übereinstimmung mit der Hypothese an der COX-1 eine gute inhibitorische Aktivität.Aus der Reihe der (Hydroxyphenyl)(2-thienyl)methanone wurden die freien Alkohole, die Methylether und verschiedene Ester dargestellt und auf COX-1-Aktivität untersucht. Acetate, aber auch Phenole sind die potentesten Inhibitoren der COX-1. Als günstigte Positionen für die 2-Thienylcarbonyl-Einheit am Hydroxyphenylrest erweist sich die ortho- bzw. para-Position.

Effect of risk factors on complicated and uncomplicated ulcers in the TARGET lumiracoxib outcomes study

BACKGROUND ; AIMS: Selective cyclooxygenase-2 inhibitors were developed to reduce the gastrointestinal risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs). The Therapeutic Arthritis Research and Gastrointestinal Event Trial was the largest study to evaluate primarily the gastrointestinal safety outcomes of selective cyclooxygenase-2 inhibitors. Data from the Therapeutic Arthritis Research and Gastrointestinal Event Trial were used to identify risk factors and investigate the safety of lumiracoxib in subgroups. METHODS: Patients with osteoarthritis (age, >or=50 y) were randomized to receive lumiracoxib 400 mg once daily, naproxen 500 mg twice daily, or ibuprofen 800 mg 3 times daily for 12 months. Events were categorized by a blinded adjudication committee. The primary end point was all definite or probable ulcer complications. RESULTS: For patients taking NSAIDs, factors associated with an increased risk of ulcer complications were age 65 years or older (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.48-3.59), previous history of gastrointestinal bleed or ulcer (HR, 3.61; 95% CI, 1.86-7.00), non-Caucasian racial origin (HR, 2.10; 95% CI, 1.35-3.27), and male sex (HR, 1.70; 95% CI, 1.08-2.68). With lumiracoxib, significant risk factors were age 65 years or older (HR, 3.18; 95% CI, 1.40-7.20), male sex (HR, 2.60; 95% CI, 1.25-5.40), non-Caucasian racial origin (HR, 2.16; 95% CI, 1.02-4.59), and concomitant aspirin use (HR, 2.89; 95% CI, 1.40-5.97). Increased risks in patients age 65 years and older were increased further if other risk factors were present. Lumiracoxib maintained an advantage over NSAIDs across all subgroups except aspirin use. CONCLUSIONS: Lumiracoxib was associated with a reduced risk of ulcer complications compared with NSAIDs in all significant subgroups except aspirin users.

Anaemia may add information to standardised disease activity assessment to predict radiographic damage in rheumatoid arthritis: a prospective cohort study

OBJECTIVE: Anaemia in rheumatoid arthritis (RA) is prototypical of the chronic disease type and is often neglected in clinical practice. We studied anaemia in relation to disease activity, medications and radiographic progression. METHODS: Data were collected between 1996 and 2007 over a mean follow-up of 2.2 years. Anaemia was defined according to WHO (♀ haemoglobin<12 g/dl, ♂: haemoglobin<13 g/dl), or alternative criteria. Anaemia prevalence was studied in relation to disease parameters and pharmacological therapy. Radiographic progression was analysed in 9731 radiograph sets from 2681 patients in crude longitudinal regression models and after adjusting for potential confounding factors, including the clinical disease activity score with the 28-joint count for tender and swollen joints and erythrocyte sedimentation rate (DAS28ESR) or the clinical disease activity index (cDAI), synthetic antirheumatic drugs and antitumour necrosis factor (TNF) therapy. RESULTS: Anaemia prevalence decreased from more than 24% in years before 2001 to 15% in 2007. Erosions progressed significantly faster in patients with anaemia (p<0.001). Adjusted models showed these effects independently of clinical disease activity and other indicators of disease severity. Radiographic damage progression rates were increasing with severity of anaemia, suggesting a 'dose-response effect'. The effect of anaemia on damage progression was maintained in subgroups of patients treated with TNF blockade or corticosteroids, and without non-selective nonsteroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS: Anaemia in RA appears to capture disease processes that remain unmeasured by established disease activity measures in patients with or without TNF blockade, and may help to identify patients with more rapid erosive disease.