Strategic decisions for safe and potential long-term therapy of osteoarthritis with NSAIDs

I.Yu. Golovach


Pain is the most common symptom in general medical practice. Pain syndrome in osteoarthritis is characterized by a combination of pain mechanical, inflammatory, and also neuropathic origin, which gives it a persistent chronic course. Pain is also determined to be one of the risk factors and progression of osteoarthritis. The latest recommendations for osteoarthritis treatment recommend the use of non-steroidal anti-inflammatory drugs (NSAIDs) as an anesthetic and anti-inflammatory agents with long (constant or intermittent) cycles. Today, the issues of the analgesic potential of NSAIDs are inferior to their clinical safety. The problem of safety monitoring is a key aspect of the rational use of NSAIDs. The latest studies confirming gastrointestinal and cardiovascular safety of lornoxicam with long-term use are analyzed. Lornoxicam combines the optimal profile of analgesic potential and safety as regards long-term, permanent use, which makes it the drug of choice for the treatment of osteoarthritis. The favorable safety profile of lornoxicam is due to the fact that the drug is a balanced inhibitor of COX-1/COX-2 and has a relatively short half-life in comparison with other NSAIDs, which reduces the risk of its accumulation.


osteoarthritis; pain; nonsteroidal anti-inflammatory drugs; lornoxicam; safety; long-term use


Безшейко В.Г. Новые подходы к терапии при болевом синдроме: лорноксикам с позиций доказательной медицины // Укр. мед. часопис. — 2013. — 1(93). — С. 81-84.

Верткин А.Л., Наумов А.В., Семенов П.А., Шарина Н.П., Шамуилова М.М. Оценка безопасности применения лорноксикама и диклофенака натрия в общемедицинской практике // Клиническая геронтология. — 2009. — 15(2). — С. 21-26.

Головач И.Ю. Остеоартрит: современные фундаментальные и прикладные аспекты патогенеза заболевания // Боль. Суставы. Позвоночник. — 2014. — 3(15). — С. 54-58.

Головач І.Ю. Ефективність і безпечність лорноксикаму (Ксефокаму) у лікуванні ревматичних захворювань суглобів // Травма. — 2013. — 14(2). — С. 90-94.

Каратеев А.Е. Что нового? Обзор международных публикаций за 2016 г., посвященных проблемам эффективности и безопасности нестероидных противовоспалительных препаратов // Современная ревматология. — 2017. — 11(1). — С. 38-45. — doi: 10.14412/1996-7012-2017-1-38-45.

Кашеварова Н.Г., Зайцева Е.М., Смирнов А.В., Алексеева Л.И. Боль как один из факторов риска прогрессирования остеоартроза коленных суставов // Научно-практическая ревматология. — 2013. — (51)4. — С. 387-390. — doi: 10.14412/1995-4484- 2013-1249.

Коваленко В.Н., Борткевич О.П. Остеоартроз і біль: стан проблеми // Боль. Суставы. Позвоночник. — 2011. — 1. — С. 10-14.

Наумов А.В., Верткин А.Л., Шамуилова М.М., Семенов П.А., Мендель О.И., Шарина Н.П. Стратификация риска и стратегические решения фармакотерапии остеоартроза в терапевтической практике // Справочник поликлинического врача. — 2009. — 5. — С. 38-45.

Яременко О.Б., Микитенко А.М. Мультимодальный подход к лечению болевого синдрома при остеоартрозе // Укр. мед. часопис. — 2016. — 4(114). — С. 38-44.

Инструкция по медицинскому применению препарата Ксефокам.

Arfè A., Scotti L., Varas-Lorenzo C. 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.

Bannuru R.R., Schmid Ch.H., Kent D.M. et al. Comparative Effectiveness of Pharmacologic Interventions for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis // Ann. Intern. Med. — 2015. — 162(1). — Р. 46-54. — doi: 10.7326/M14-1231.

Bastick A.N., Runhaar J., Belo J.N., Bierma-Zeinstra S.M. Prognostic factors for progression of clinical osteoarthritis of the knee: a systematic review of observational studies // Arhritis Res. Ther. — 2015. — 17. — Р. 152-162. — doi: 10.1186/s13075-015-0670-x.

Berg J., Fellier H., Christoph T., Grarup J., Stimme-der D. The analgesic NSAID lornoxicam inhibits cyclooxygenase (COX)-1/-2, inducible nitric oxide synthase (iNOS), and the formation of interleukin (IL)-6 in vitro // Inflamm. Res. — 1999. — 48(7). — Р. 369-379.

Bjordal J.M., Klovning A., Ljunggren A.E. et al. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: a meta-analysis of randomised placebo-controlled trials // Eur. J. Pain. — 2007. — 11. — Р. 125-138. — doi: 10.1016/j.ejpain.2006.02.013.

Bruyere O., Cooper C., Pelletier J.P. et al. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis — From evidence-based medicine to the real-life setting // Semin. Arthritis Rheum. — 2016 Feb. — 45(4 Suppl.). — Р. 3-11. — doi: 10.1016/j.semarthrit.2015.11.010.

Dieppe P. Recommended methodology for assessing the progression of osteoarthritis of the hip and knee joints // Osteoarthritis Cartilage. — 1995. — 3. — Р. 73-77.

Fanella A., Ghisi D., Aprile P.L., Lapi F. Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications // Ther. Adv. Drug. Saf. — 2017. — 8(6). — Р. 173-182. — doi: 10.1177/2042098617690485.

Funk C.D., Fitzgerald G.A. COX-2 inhibitors and cardiovascular risk // J. Cardiovasc. Pharmacol. — 2007. — 50(5). — Р. 470-479. — doi: 10.1097/FJC.0b013e318157f72d.

Hunter D.J., Guermazi A., Roemer F. et al. Structural correlates of pain in joints with osteoarthritis // Osteoarthritis Cartilage. — 2013. — 21(9). — Р. 1170-1178. — doi: 10.1016/j.joca.2013.05.017.

Kidd B., Frenzel W. A multicenter, randomized, double blind study comparing lornoxicam with diclofenac in osteoarthritis // J. Rheumatol. — 1996. — 23(9). — Р. 1605-1611.

Kullich W., Klein G. Influence of the nonsteroidal antiinflammatory drug lornoxicami. v. on the secretion of the endogenous opiate peptides dynorphin and β-endorphin // Aktuel. Rheumatol. — 1992. — 17(4). — Р. 128-132.

Norholt S.E., Sindet-Pedersen S., Bugge C., Branebjerg P.E., Ersboll B.K., Bastian H.L. A randomized double-blind placebo-controlled, dose-response study of the analgesic effect of lornoxicam after surgical removal of mandibular third molars // J. Clin. Pharmacol. — 1995. — 35(6). — Р. 606-14.

Parada L., Marstein J.P., Danilov A. Tolerability of the COX-1/COX-2 inhibitor lornoxicam in the treatment of acute and rheumatic pain // Pain Manag. — 2016. — 6(5). — Р. 445-454. — doi: 10.2217/pmt.16.7.

Pelletier J.P., Martel-Pelletier J., Rannou F., Cooper C. Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys // Semin. Arthritis Rheum. — 2016. — 45 (4 Suppl.). — Р. 22-27. — doi: 10.1016/j. semarthrit.2015.11.009.

Radhofer-Welte S., Rabasseda X. Lornoxicam, a new potent NSAID with an improved tolerability profile // Drugs Today (Barc.). — 2000. — 36(1). — Р. 55-76.

Rose P., Steinhauser C. Comparison of Lornoxicam and Rofecoxib in Patients with Activated Osteoarthritis (COLOR Study) // Clin. Drug. Inves. — 2004. — 24(4). — Р. 227-236.

Rosenow D.E., Albrechtsen M., Stolke D. A comparison of patient-controlled analgesia with lornoxicam versusmorphine in patients undergoing lumbar disk surgery // Anesth. Analg. — 1998. — 86(5). — Р. 1045-50.

Smith S.R., Deshpande B.R., Collins J.E. et al. Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review // Osteoarthritis Cartilage. — 2016. — 24(6). — Р. 962-72. — doi: 10.1016/j.joca.2016.01. 135.

Staunstrup H., Ovesen J., Larsen U.T., Elbaek K., Larsen U., Kroner K. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain // J. Clin. Pharmacol. — 1999. — 39(8). — Р. 834-41.

Zhang W., Jones A., Doherty M. Doesparacetamol (ace-taminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials // Ann. Rheum. Dis. — 2004. — 63. — Р. 901-907. — doi: 10.1136/ard.2003.018531.



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