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NSAID Use in Osteoarthritis
Osteoarthritis, also known as OA, is the most common joint disorder in the United States affecting one third of adults greater than age sixty-five (Uroza et al., 2017). Osteoarthritis is often misdiagnosed as it can mimic the signs of natural aging such as pain, muscle weakness, and restricted range of motion. Risks factors for OA include obesity, prior injury, age, race, and genetics (Uroza et al., 2017). Treatment for OA should always begin with non-pharmacological treatment including weight loss, exercise, and appropriate physical therapy. According to Uroza et al. (2017) the goal of treatment for OA includes maintaining function, preventing further joint damage, and diminishing pain. First line pharmacological therapy for osteoarthritis is acetaminophen, or Tylenol, for its analgesic properties. Acetaminophen acts by exerting action in the central nervous system inhibiting central cyclooxygenase (COX) resulting in decreased prostaglandin synthesis (Uroza et al., 2017). Although acetaminophen helps with pain it does not have any anti-inflammatory properties. The second line therapy treatment for OA is nonsteroidal anti-inflammatory drugs (NSAIDs), which are broken into classes based on their chemical structure.
Celecoxib, or Celebrex, is a COX-2 selective inhibitor which produces anti-inflammatory and analgesic effects with no harm on the gastrointestinal (GI) tract. As discussed by Sally, celecoxib does have an increased risk of cardiovascular issues such as increased risk of stroke and myocardial infarctions (Uroza et al., 2017). A study completed by Shin (2018) found that celecoxib users are at a greater risk of experiencing cardiovascular and renal events in relation to patients who use traditional NSAIDs. Higher risk of cardiovascular events was seen in patients receiving high doses of celecoxib, and those taking the medication long term. Renal events may occur with use of celecoxib due to the medication inhibiting the protective prostaglandins within the kidneys. These prostaglandins are primarily responsible for maintaining blood perfusion via vasodilation of the afferent arteriole. COX-2 inhibitors, such as celecoxib, can lead to decreased renal perfusion and compromised kidney function.
Education on the proper use of celecoxib is important for Sally to understand. Prior to prescribing any medication it is important for Sally and her provider to discuss the risk and benefits of taking celecoxib. Sallys medical history and current medication list should be reviewed by the provider and assessed for any medications that may be contraindicated. Celecoxib should always be taken as directed by the provider, and doses should not be adjusted without speaking to the provider. Celecoxib can be taken with or without food, and if necessary, capsules can be opened. For patients suffering from osteoarthritis, such as Sally, the dosing should begin at 200 milligrams once a day or 100 milligrams two times a day (Mayo Clinic, 2021). Providers may increase the dose of this medication depending on a patients symptoms, but dosing should never exceed 400 milligrams per day. Sally should be aware to monitor for any unwanted side effects and call her provider if she experiences any adverse effects. Although celecoxib is a COX-2 inhibitor and dose not usually effect the GI system, Sally should be aware to monitor for bleeding and alert her provider if bleeding occurs.
Ibuprofen and celecoxib are similar in the fact that they are both classified as NSAIDs and inhibit COX-2. However, Ibuprofen also inhibits COX-1, which is found in the GI tract as well as the kidneys. Due to this Ibuprofen brings an increased risk of GI bleeding and can lead to GI discomfort, like Sally has been experiencing. Another difference between the two medications is their length of action. Ibuprofen is a short acting NSAID whereas celecoxib is considered intermediate acting. Use of either medication requires patients to monitor their renal and hepatic function, and those with cardiovascular conditions should be cautious.
Mayo Clinic. (2021). Celecoxib. https://www.mayoclinic.org/drugs-supplements/celecoxib-oral-route/side-effects/drg-20068925 (Links to an external site.)
Shin, S. (2018). Safety of celecoxib versus traditional nonsteroidal anti-inflammatory drugs in older patients with arthritis. Journal of Pain Research. 2018(11), 3211-3219. https://doi.org/10.2147/JPR.S186000 (Links to an external site.)
Uroza, S., McCluggage, L & Mest, C. (2017). Osteoarthritis and Gout. In V. Arcangelo, A. Peterson, V. Wilbur & J. Reinhold (Eds.). Pharmacotherapeutics for Advanced Practice: A Practical Approach (4th ed., pp. 591-610). Wolters Kluwer.
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