Richard Wernick, MD; Stephen M. Campbell, MD
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Current Author Addresses: Dr. Wernick: Providence Portland Medical Center, 4805 NE Glisan, Portland, OR 97213.
Dr. Campbell: Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97202.
Wernick R, Campbell SM. Update in Rheumatology. Ann Intern Med. 2000;132:125-133. doi: 10.7326/0003-4819-132-2-200001180-00007
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Published: Ann Intern Med. 2000;132(2):125-133.
Our search of recent general medical and rheumatology journals for this Update focused on studies that used reasonably valid methods and yielded practical and clinically relevant results. We selected key articles in four subject areas: nonsteroidal anti-inflammatory drugs (NSAIDs), particularly their ability to inhibit cyclooxygenase-2 (COX-2) selectively; vaccination against Lyme disease; new biological treatments for rheumatoid arthritis; and prevention and management of back pain.
One of the two isoforms of COX, known as COX-1, is expressed in most tissues and promotes formation of the prostaglandins needed for normal physiology. Inhibiting COX-1 suppresses the formation of beneficial prostaglandins and may lead to ulceration of the mucosa of the upper gastrointestinal tract as well as acute renal insufficiency. The other form of the enzyme, COX-2, is evoked by inflammatory cytokines and leads to the production of prostaglandins that mediate inflammation, as in rheumatoid joints. This form is also expressed in the brain, kidneys, ovaries, and bone (1). To combat inflammation, ideally only COX-2 should be inhibited; unfortunately, all traditional prostaglandin inhibitors, until the release of celecoxib 1 year ago, suppressed both forms of COX.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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