Current treatment for OA is relatively limited. Because there are currently no pharmacological agents capable of retarding or preventing disease, treatment is predominantly focused on relief of pain, and maintenance of quality of life and functional independence. Pharmacological Therapy COX-2 Inhibitors Non-steroidal Anti-inflammatory Agents Analgesic Agents Several studies have shown acetaminophen to be superior to placebo and equivalent to nonsteroidal anti-inflammatory agents (NSAIDs) for the short-term management of OA pain. At present, acetaminophen (up to symptoms hands first symptoms rheumatoid arthritis 4,000 mg/daily) is the recommended initial analgesic of choice for symptomatic OA. (ACR Guidelines-Guidelines for Medical Management of OA of the knee) However, many patients eventually require NSAIDs or more potent analgesics to control pain. COX-2 Inhibitors Cyclooxygenase-2 (COX-2) inhibitors are a class of nonsteriodal anti-inflammatory agents (NSAIDs) that recently received Food and Drug Administration (FDA) approval. These specific COX-2 inhibitors appear to be as effective as current non-selective NSAIDs in treating the pain and inflammation of arthritis. Their constant velocity joint first symptoms rheumatoid arthritis theoretical advantage, however, is that they will cause significantly less toxicity than conventional NSAIDs, particularly in the GI tract. This theoretical enhanced safety profile will be a significant advantage in the management of all patients but especially those at high risk for peptic ulcers. Nonsteroidal anti-inflammatory drugs (NSAIDs) exert their anti-inflammatory effect primarily by inhibiting an enzyme called cyclooxygenase (COX), also known as prostaglandin (PG) synthase. COX catalyzes the conversion of the substrate molecule, arachidonic acid, to prostanoids. Prostanoids consist of first symptoms rheumatoid arthritis first symptoms rheumatoid arthritis prostaglandins E, D and F2a, prostacyclin and thromboxane. The major inflammatory vasoactive prostanoids are PGE2 and prostacyclin. Thromboxane is critical for platelet clotting, while PGD2 is involved in allergic reactions and PGF2a in uterine contraction. Non-steroidal Anti-inflammatory Agents The mechanism by which NSAIDs exert their anti-inflammatory and analgesic effects is via inhibition of the prostaglandin-generating enzyme, cyclooxygenase (COX) (see image above). In addition to their inflammatory potential, prostaglandins also contribute to important homeostatic functions, such as maintenance of the gastric lining, testicle pain first symptoms rheumatoid arthritis renal blood flow,
