USE OF CORTICOSTEROIDS AND NSAIDS IN RA

MONA YADAVGROUP 3

CORTICOSTEROIDS

• Corticosteroids are also called steroids. These drugs can help reduce inflammation in RA. They may also help reduce the pain

and damage caused by inflammation.

CORTICOSTEROIDS

• glucocorticoids :-• A) hormones :- hydrocortisone ( cortisol)• B) synthetic :- • Prednisolone• Prednisone • Methylprednisolone• Dexamethasone• Betamethasone• Triamcinolone

CORTICOSTEROIDS

• 1 ) Prednisone :- is an immunosuppressant for the treatment of autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity. Prednisone stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

• dose :- Immediate-release: ≤10 mg/day PO added (DMARDs)• Delayed-release: 5 mg/day PO initially, maintenance: lowest

dosage that maintains clinical response; may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis

CORTICOSTEROIDS

• 2) Methylprednisolone :- decreases inflammation by suppressing the migration of polymorphonuclear leukocytes (PMNs) and reversing increased capillary permeability.

• dose :- 40 mg/day PO divided q6-24hr.

• 3) SIDE EFFECT OF CORTICOSTEROIDS:- • Hyperglycemia - due to increased gluconeogenesis• Steroid-induced osteoporosis: reduced bone density• Adrenal insufficiency (if used for long time and stopped suddenly)

NON- STEROIDAL ANTI- INFLAMMATORY DRUGS

NSAIDs are the most commonly used RA drugs.• NSAIDs interfere with prostaglandin synthesis through

inhibition of the enzyme cyclooxygenase (COX), thus reducing swelling and pain.

• TYPES :-• a) acetic acid derivatives• b) Carboxylic acid derivatives • c) Proprionic acid derivatives

NSAIDS

• drugs :- Ibuprofen • Naproxen• Diclofenac• Ketoprofen• Celecoxib• Aspirin

• 1 ) Ibuprofen is indicated for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

• dose - 400mg po q6-8hr , not exceed 3000 mg/day

NSAIDS

• 2) Naproxen :- This agent inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which is responsible for prostaglandin synthesis.

• dose - 500-1000 mg/day PO divided q12hr; may increase to 1500 mg/day if tolerated well for limited time.

• 3) Diclofenac :- is one of a series of phenylacetic acids that have demonstrated anti-inflammatory and analgesic properties. It is inhibit COX, which is essential in the biosynthesis of prostaglandins.

• Diclofenac can cause hepatotoxicity; therefore, liver enzymes should be monitored in the first 8 weeks of treatment.

NSAIDS

• dose :- Diclofenac sodium: 50 mg PO q8hr or 75 mg PO q12hr.

• 4) Celecoxib is approved for the relief of signs and symptoms of RA. It primarily inhibits COX-2, which is considered an inducible isoenzyme (induced during pain and inflammatory stimuli). Inhibition of COX-1 may contribute to NSAID gastrointestinal (GI) toxicity. Administer the lowest possible dose for each patient. Use of celecoxib has been associated with an increased risk of cardiovascular toxicity.

• dose - 100-200 mg PO q12hr

NSAIDS

• side effect of nsaids: - • Stomach problems like bleeding, ulcer and stomach upset• High blood pressure• Fluid retention (causing swelling, such as around the

lower legs, feet, ankles and hands)• Rashes.