NON-STEROIDAL ANTI–INFLAMMATORY DRUGS IN THE TREATMENT OF RHEUMATOLOGICAL PATIENTS WITH COMORBIDITY

Zhdan V.M., Babanina M. Yu., Kitura Ye. M., Tkachenko M.V., Rybalchenko Ye. V., Savuliak T.M.

LITERATURE REVIEWS

Scentific article

. The results of the analysis of the importance of the main groups of chronic diseases show that rheumatic diseases have the greatest contribution to reducing efficiency, deteriorating the general condition of the patient, and increasing the number of visits to the general practitioner. Pain is the most common symptom of rheumatological patients. Non-steroidal anti-inflammatory drugs are the most popular agent of analgesic therapy in medical practice due to the combination of efficacy, safety, availability, and simplicity of use. The aim of the study was to search and analyze literature data on the use of nonsteroidal anti-inflammatory drugs in rheumatological patients with comorbidity. Non-steroidal anti-inflammatory drugs quickly and effectively overcome acute pain syndromes and play the role of not only symptom-modifying but also pathogenetic therapy in the treatment of some chronic diseases (including rheumatological), slowing the progression of the pathological process. The variety of effects of certain nonsteroidal antiinflammatory drugs on cartilaginous tissue metabolism is directly relevant to clinical practice, as any drugs that inhibit proteoglycan synthesis and impair chondrocyte repair can potentially accelerate cartilage degradation. Responses to treatment and toxic effects vary significantly at the individual level. Variability of efficacy between patients may be due to a number of factors, such as the mechanism of action of NSAIDs (predominant blockade of prostaglandins or other inflammatory mediators), the half-life, protein binding, and pharmacodynamic features. Although there is no strong correlation between the effectiveness of NSAIDs and the halflife/plasma concentration: lower levels of albumin in synovial fluid cause slightly fewer NSAIDs in the joints, but the concentration of NSAIDs in the joint cavity may be stable over time. Given the presence of comorbidities in rheumatology patients, it is extremely important to evaluate the possible side effects of NSAIDs. First of all, it is recommended to assess the condition of the gastrointestinal tract and cardiovascular and excretory systems. It is important to remember that allergic reactions, hematological disorders (cytopenia), neurological disorders, etc. can occur sometimes during medication management. Non-steroidal anti-inflammatory drugs are an important component of the treatment of many rheumatic diseases, however, as with other drugs, they need to assess the benefit-risk balance. The use of nonsteroidal anti-inflammatory drugs is indicated for all persons with rheumatic diseases that are accompanied by pain and are associated with inflammatory or degenerative lesions of the musculoskeletal system. The duration of treatment with nonsteroidal anti-inflammatory drugs should be determined individually. The choice of a particular nonsteroidal anti-inflammatory drug determines primarily its safety in specific clinical conditions.

nonsteroidal anti-inflammatory drugs, rheumatic diseases.

1. Perruccio AV, Power JD, Badley EM. The relative impact of 13 chronic conditions across three different outcomes. J. Epidemiol. Community Health. 2007;61(12):1056–1061.
2. Nasonov EL. Dostizheniya revmatologii v XXI veke. Nauchno-prakticheskaya revmatologiya. 2014;52(2):133–140. [in Russian].
3. Duenas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. Journal of Pain Research. Dove Medical Press Ltd. 2016 Jun;9:457–67. Available from: https:// doi.org/10.2147/ jpr.s105892.
4. Kovalenko VM, redaktor. Vnutrishnia medytsyna. Pidruchnyk dlia studentiv. 3-e vydannia knyhy «Dokazova medytsyna», pereroblene i dopovnene. Kyiv: MORION; 2019. 960 s. [in Ukrainian].
5. Antipov MH, Petrusenko YuIe. Porivnialna kharakterystyka efektyvnosti ta bezpechnosti nesteroidnykh protyzapalnykh zasobiv, inhibitoriv TsOH‑1 ta TsOH‑2. Materialy nauk.-prakt. konf., prysv. 175 richchiu z dnia narodzhennia vydatnoho imunoloha ta mikrobioloha, laureata Nobelivskoi premii Illi Illicha Mechnykova ta Dniu Farmatsevta Suchasni problemy farmakolohii, kosmetolohii ta aromolohii; 2020 Ver. 18; Odesa. Odesa: Mizhnarodnyi humanitarnyi universytet; 2020. s. 99–105. [in Ukrainian].
6. Zhuravleva MV, Kukes VG, Prokofev AB Serebrova SYu, Gorodeczkaya GI, Berdnikova NG. Ratsionalnoe primenenie NPVP – balans effektivnosti i bezopasnosti (obzor literaturyi). Mezhdunarodnyiy zhurnal prikladnyih i fundamentalnyih issledovaniy. 2016;6:687– 696. [in Russian].
7. NPZP u likuvanni bolovykh syndromiv: na pershomu mistsi – pytannia bezpeky. Medychna hazeta «Zdorovia Ukrainy 21 storichchia». 2021;3(496);52. [in Ukrainian].
8. Nesteroidni protyzapalni preparaty – efektyvnist chy bezpeka? Medychna hazeta «Zdorovia Ukrainy 21 storichchia». Tematychnyi nomer «Kardiolohiia, Revmatolohiia, Kardiokhirurhiia». 2020;2(69):34. [in Ukrainian].
9. Solomon DH, Husni ME, Libby RA, Yeomans ND, Lincoff AM, Lϋscher TF, et al. The risk of major NCAID toxicity with celecoxib, ibuprofen or naproxen: a secondary analysis of the PRECISION trial. Am J Med 2017;130:1415–22.
10. Holovach IIu. Vybir nesteroidnykh protyzapalnykh preparativ u patsiientiv revmatolohichnoho profiliu. Medychna hazeta «Zdorovia Ukrainy 21 storichchia». Tematychnyi nomer «Kardiolohiia, Revmatolohiia, Kardiokhirurhiia». 2018;4(59):43–44. [in Ukrainian].
11. Karateev AE, Gontarenko NV, Tsurgan AV. Nesteroidnyie protivovospalitelnyie preparatyi: chto novogo v mezhdunarodnyih publikatsiyah za 2015 g.? Sovremennaya revmatologiya. 2016;10(1):52–55. DOI: https://doi.org/10.14412/1996–7012–2016–1–52– 55. [in Russian].
12. Suchasni mozhlyvosti optymalnoho likuvannia suhlobovoho boliu. Medychna hazeta «Zdorovia Ukrainy 21 storichchia». 2021;5(498):52–54. [in Ukrainian].
13. Dyklofenak dlia iniektsii iz metoiu kupiruvannia bolovykh syndromiv u praktytsi simeinoho likaria. Medychna hazeta «Zdorovia Ukrainy 21 storichchia». 2021;3(496):64. [in Ukrainian].
14. Nissen SE, Yeomans ND, Solomon DH, Lüscher TF, Libby P, Husni ME, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med 2016;375:2519–2529.
15. Arfè A, Scotti L, Varas-Lorenzo C, Nicotra F, Zambon A, Kollhorst B, et al. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study. BMJ. 2016;354: i4857. DOI: 10.1136/bmj.i4857.
16. Ivanov DD. Vybir efektyvnoho i bezpechnoho zneboliuvalnoho preparatu u khvorykh iz porushenniamy funktsii nyrok. Medychna hazeta «Zdorovia Ukrainy 21 storichchia». Tematychnyi nomer «Urolohiia. Nefrolohiia. Androlohiia». 2020;2(19):4. [in Ukrainian].
17. Kovic SV, Vujovic KS, Srebro D, Medić B, Ilic-Mostic T. Prevention of Renal Complications Induced by Non-Steroidal AntiInflammatory Drugs. Current medicinal chemistry. 2016;23(19):1953–64.
18. Shchokina KH, Semeniv DV, Drohovoz SM, Bielik HV, Kutsenko TO. Porivnialne doslidzhennia nefrotropnykh vlastyvostei suchasnykh nesteroidnykh protyzapalnykh preparativ. Ukrainian Biopharmaceutical Journal. 2020;1(62): C. 61–66. [in Ukrainian].
19. Lucas GNC, Leitão ACC, Alencar RL, Xavier RMF, Daher EF, Silva Junior GBD. Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs. Brazilian Journal of Nephrology. 2019;41(1):124–130.
20. Kovalenko VM, Holovach IIu, Bortkevych OP, Rekalov DH, Smiian SI. Osteoartryt / Osteoartroz. Klinichna nastanova. Kyiv; 2020. 92 s. [in Ukrainian].
21. Kovalenko VM, Shuba NM, redaktor. Natsionalnyi pidruchnyk z revmatolohii. Kyiv: MORION; 2013. 671 s. [in Ukrainian].
22. da Costa BR, Reichenbach S, Keller N, L Nartey, S Wandel, P Jüni, et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet. 2016;387:2093–2105.
23. Kapeltsova OA, Dolynna OV, Shkolina NV, Marchuk OV. Efektyvnist poiednannia fizioterapevtychnykh metodiv z mistsevymy formamy nesteroidnykh protyzapalnykh preparativ u kompleksnomu likuvanni bolovoho syndromu v revmatolohii». Mizhdystsyplinarnyi naukovo-praktychnyi zhurnal «Medytsyna boliu» (Pain Medicine Journal). 2018;3(1):49–55. [in Ukrainian].
24. Shuba NM, Voronova TD, Kokunov Yu O. NPZP‑ryzyky ta vybir bezpechnoi terapii. Ukrainskyi revmatolohichnyi zhurnal. 2018;1(71):16–21. [in Ukrainian].
25. Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med. 2016 Jun 30;374(26):2563–74.
26. Pasiieshvili LM, redaktor. Zakhvoriuvannia skeletno-miazovoi systemy yak mizhdystsyplinarna problema: navchalnyi posibnyk. Lviv: Mahnoliia 2006; 2021. 412 s. [in Ukrainian].
27. Khyts AR. Dytiacha revmatolohiia: osoblyvosti likuvannia yuvenilnoho idiopatychnoho artrytu ta systemnoho chervonoho vovchaku u svitli suchasnykh reform okhorony zdorovia. Ukrainskyi medychnyi chasopys. 2020;6(140)-XI/XII:10–13. [in Ukrainian].
28. Khyts AR. Menedzhment bolovoho syndromu v osib pokhyloho viku: fokus na nesteroidni protyzapalni preparaty. Ukrainskyi medychnyi chasopys. 2020;6(140)-XI/XII:27–30. [in Ukrainian].
29. Bortkevych OP, Korendovych VV, Yaretska HV. Perspektyvy indyvidualizatsii likuvannia nesteroidnymy protyzapalnymy preparatamy v revmatolohii. Medychna hazeta «Zdorovia Ukrainy 21 storichchia». Tematychnyi nomer «Kardiolohiia, Revmatolohiia, Kardiokhirurhiia». 2017 Kvit;2(51):66–68. [in Ukrainian].
30. Chan FK, Ching JY, Tse YK, K Lam, Grace L H Wong, Siew C Ng, et al. Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothtombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN): an industry-independent, double-blind, double-dummy, randomized trial. Lancet. 2017;389:2375–82.
31. Farmakoterapiia boliu v nyzhnii chastyni spiny. Medychna hazeta «Zdorovia Ukrainy 21 storichchia». 2021;3(496):58–59. [in Ukrainian].
32. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J.Am. Geriatr. Soc. 2009;57(8):1331–1346. DOI: 10.1111/j.1532–5415.2009.02376.x.

«Bulletin of problems biology and medicine» Issue 2 Part 1 (164), 2022 year, 18-32 pages, index UDK 616.72–002.77:615.276–08

10.29254/2077-4214-2022-2-1-164-18-32