1. Pharmacotherapy of rheumatic diseases and systemic diseases of connective tissue. Pharmacotherapy of allergic conditions

2. RHEUMATIC DISEASES Rheumatic diseases (rheumatism) are painful conditions that affect millions. These diseases cause inflammation, swelling, and pain in the joints or muscles. Rheumatic diseases (rheumatism) are painful conditions that affect millions. These diseases cause inflammation, swelling, and pain in the joints or muscles.pain Some rheumatic diseases like osteoarthritis are the result of "wear and tear" to the joints. Other rheumatic diseases, such as rheumatoid arthritis, happen when the immune system goes haywire; the immune system attacks the linings of joints, causing joint pain, swelling, and destruction. Some rheumatic diseases like osteoarthritis are the result of "wear and tear" to the joints. Other rheumatic diseases, such as rheumatoid arthritis, happen when the immune system goes haywire; the immune system attacks the linings of joints, causing joint pain, swelling, and destruction.osteoarthritisrheumatoid arthritisjoint painosteoarthritisrheumatoid arthritisjoint pain

3. Rheumatism is a medical term once frequently used to describe disorders associated with many different parts of the body. Most often, people associate rheumatism with arthritis, or with rheumatic fever, a complication of strep throat that can result in damage to the heart. However, the term rheumatism might apply to the symptoms of numerous conditions that can cause pain and/or weakness. Rheumatism is a medical term once frequently used to describe disorders associated with many different parts of the body. Most often, people associate rheumatism with arthritis, or with rheumatic fever, a complication of strep throat that can result in damage to the heart. However, the term rheumatism might apply to the symptoms of numerous conditions that can cause pain and/or weakness.arthritisstrep throatheart weaknessarthritisstrep throatheart weakness Some conditions that were once given the general label of rheumatism or called rheumatic diseases include, rheumatoid arthritis, osteoarthritis, lupus, fibromyalgia, and tendonitis. Frequently autoimmune disorders, since they remained unnamed but caused pain as well as affecting other organs, were classed as rheumatism. Illnesses like lupus were particularly susceptible to being called rheumatism. Later understanding of the actions of these illnesses show that the problem is not dysfunction of the joints, but rather immune systems that can attack joints, muscles and organs. Some conditions that were once given the general label of rheumatism or called rheumatic diseases include, rheumatoid arthritis, osteoarthritis, lupus, fibromyalgia, and tendonitis. Frequently autoimmune disorders, since they remained unnamed but caused pain as well as affecting other organs, were classed as rheumatism. Illnesses like lupus were particularly susceptible to being called rheumatism. Later understanding of the actions of these illnesses show that the problem is not dysfunction of the joints, but rather immune systems that can attack joints, muscles and organs.lupusfibromyalgiatendonitisimmune systemslupusfibromyalgiatendonitisimmune systems

4. Some forms of rheumatism are called non-articular rheumatism and may affect the soft tissues causing pain throughout the body. Conditions like tendonitis and fibromyalgia fall into this category. As well, non- articular rheumatism can be localized to specific areas in the body. Bursitis is a non-articular form of rheumatism that affects and inflames the bursa, which are special sacs that protect joints and overlapping muscles. Bursitis most frequently occurs at the site of one joint that may have been injured through overuse. BursitisbursaBursitisbursa

5. Fibromyalgia

6. Osteoarthritis OA is not a normal part of aging; it usually affects the knees, hips, lower back, neck, and fingers. The signs and symptoms of OA include: The signs and symptoms of OA include: Pain in joint Pain in joint Joint swelling Joint swelling Joint may be warm to touch Joint may be warm to touch Joint stiffness Joint stiffness Muscle weakness and joint instability Muscle weakness and joint instability Pain when walking Pain when walking Difficulty gripping objects Difficulty gripping objects Difficulty dressing or combing hair Difficulty dressing or combing hair Difficulty sitting or bending over Difficulty sitting or bending over To diagnose OA, doctor will ask the patient about medical history and symptoms and do a physical exam. Blood tests may help rule out other types of arthritis or medical problems. A joint fluid sample from an affected joint may also be examined to eliminate other medical problems. types of arthritistypes of arthritis

7. Osteoarthritis

8. Rheumatoid Arthritis RA is sometimes called a crippling disease. That's because it can result in permanent joint damage and deformity. RA is sometimes called a crippling disease. That's because it can result in permanent joint damage and deformity. joint damagejoint damage RA signs and symptoms include: Joint pain, stiffness, and swelling Joint pain, stiffness, and swelling Involvement of multiple joints (symmetrical pattern) Involvement of multiple joints (symmetrical pattern) Other organ involvement Other organ involvement Joint stiffness, especially in the morning Joint stiffness, especially in the morning Fatigue Fatigue Fevers Fevers Lumps called rheumatoid nodules Lumps called rheumatoid nodules To diagnose RA, doctor will ask about medical history and do a physical examination. Also, X-rays and blood tests will likely be taken. One blood test may be for rheumatoid factor; it is positive in 70% to 80% of those with RA. rheumatoid factorrheumatoid factor

10. Rheumatoid Arthritis

11. Lupus SLE or systemic lupus erythematosus is another autoimmune disease; the cause of SLE is unknown. Lupus signs and symptoms include: Joint pain Joint pain Fatigue Fatigue Joint stiffness Joint stiffness Rashes, including the"butterfly rash" across the cheeks Rashes, including the"butterfly rash" across the cheeks Sun sensitivity Sun sensitivity Hair loss Hair loss Discoloration of the fingers or toes when exposed to cold (called Raynaud's phenomenon) Discoloration of the fingers or toes when exposed to cold (called Raynaud's phenomenon) Internal organ involvement, such as the kidneys Internal organ involvement, such as the kidneys Blood disorders, such as anemia and blood clots Blood disorders, such as anemia and blood clots Chest pain from inflammation of the lining of the heart or lungs Chest pain from inflammation of the lining of the heart or lungs Seizures or strokes Seizures or strokes To diagnose lupus, doctor will ask about medical history, do a physical exam, and order lab tests of blood and urine samples. One blood test is the antinuclear antibody test (ANA). Most people with lupus have a positive ANA blood test.

12. Systemic lupus erythematosus

13. Ankylosing Spondylitis Ankylosing Spondylitis (AS) usually starts gradually as lower back pain. The hallmark feature of AS is the involvement of the joints at the base of the spine. This is where the spine attaches to the pelvis, also known as the sacroiliac joints. Ankylosing spondylitis is more common in young men, especially from the teenage years to age 30. AS symptoms include: Gradual pain in the lower back and buttocks Gradual pain in the lower back and buttocks Lower back pain that worsens and works its way up the spine Lower back pain that worsens and works its way up the spine Pain felt between the shoulder blades and in the neck Pain felt between the shoulder blades and in the neck Pain and stiffness in the back, especially at rest and on arising Pain and stiffness in the back, especially at rest and on arising Pain and stiffness get better after activity Pain and stiffness get better after activity Pain in the middle back and then upper back and neck (after 5-10 years) Pain in the middle back and then upper back and neck (after 5-10 years) With progression of AS, the spine may become stiffer. It may become difficult to bend for common everyday activities. To diagnose AS, doctor will ask about medical history and perform a physical exam. X-rays of the back looking at the sacroiliac joints may help in making an AS diagnosis. A positive blood test for HLA-B27 protein may help confirm a diagnosis.

14. Ankylosing Spondylitis

16. Sjogren's Syndrome Sjogren's syndrome is an inflammatory, autoimmune disease. It can occur with other autoimmune diseases such as RA and lupus, but also on its own. Although the cause of Sjogren's is unknown, it is more common in women. Sjogren's syndrome is an inflammatory, autoimmune disease. It can occur with other autoimmune diseases such as RA and lupus, but also on its own. Although the cause of Sjogren's is unknown, it is more common in women. Sjogren's signs and symptoms include: Dry eyes (the glands in eyes do not give adequate tears) Dry eyes (the glands in eyes do not give adequate tears) Eye irritation and burning Eye irritation and burning Dry mouth (the glands in mouth do not give adequate saliva) Dry mouth (the glands in mouth do not give adequate saliva) Dental decay, gum disease, thrush Dental decay, gum disease, thrush Swelling of the parotid glands on the sides of the face Swelling of the parotid glands on the sides of the face Joint pain and stiffness (rarely) Joint pain and stiffness (rarely) Internal organ diseases (rarely) Internal organ diseases (rarely) To diagnose Sjogren's syndrome, doctor will do a physical exam and ask about medical history. Blood tests and other tests may also be performed. A simple biopsy of the inner lip or other area may help confirm the diagnosis.

17. Sjogren's Syndrome Venus Williams Diagnosed With Sjogren’s Syndrome

19. Drugs used to treat arthritis: Painkillers (analgesics) - These reduce pain. They are used for many different types of arthritis and are often used together with other drugs. Painkillers (analgesics) - These reduce pain. They are used for many different types of arthritis and are often used together with other drugs. Non-steroidal anti-inflammatory drugs (NSAIDs) - These reduce inflammation of the joint as well as pain. They are used for many different types of arthritis, often along with other drugs. Non-steroidal anti-inflammatory drugs (NSAIDs) - These reduce inflammation of the joint as well as pain. They are used for many different types of arthritis, often along with other drugs. Non-steroidal anti-inflammatory drugs (NSAIDs) Non-steroidal anti-inflammatory drugs (NSAIDs) Disease-modifying anti-rheumatic drugs (DMARDs) - This group of drugs is used mainly in the treatment of rheumatoid arthritis but also in some other rheumatic diseases. They reduce pain, swelling and stiffness. Disease-modifying anti-rheumatic drugs (DMARDs) - This group of drugs is used mainly in the treatment of rheumatoid arthritis but also in some other rheumatic diseases. They reduce pain, swelling and stiffness. Disease-modifying anti-rheumatic drugs (DMARDs) Disease-modifying anti-rheumatic drugs (DMARDs) Corticosteroids (steroids) - These drugs are very effective in controlling inflammation. Corticosteroids (steroids) - These drugs are very effective in controlling inflammation. Corticosteroids (steroids) Corticosteroids (steroids)

21. NSAIDs can be very effective against inflammation, but they do not prevent tissue damage. Even when NSAIDs are controlling the inflammation, the joint or organ damage of arthritis can continue to get worse. NSAIDs only lessen pain and discomfort. They do not affect underlying disease.

22. Non steroidal anti-inflammatory drugs (NSAIDs) are examples of drugs that act on enzymes. NSAIDs inhibits the enzyme cyclo-oxygenase (COX) which catalyses a reaction in the biochemical pathway that results in the production of prostaglandins, important mediators in the inflammatory response.

23. NSAIDs. Mechanism(s) of Action

26. The more an NSAID blocks COX-1, the greater is its tendency to cause ulcers and promote bleeding. One NSAID, celecoxib (Celebrex), blocks COX-2 but has little effect on COX-1, and is therefore further classified as a selective COX-2 inhibitor. Selective COX-2 inhibitors cause less bleeding and fewer ulcers than other NSAIDs. celecoxib COX-2 inhibitorscelecoxib COX-2 inhibitors

27. NSAIDs can be classified based on their chemical structure or mechanism of action. Older NSAIDs were known long before their mechanism of action was elucidated and were for this reason classified by chemical structure or origin. Newer substances are more often classified by mechanism of action. Salicylates Aspirin (acetylsalicylic acid) Aspirin (acetylsalicylic acid) Aspirinacetylsalicylic acid Aspirinacetylsalicylic acid Diflunisal Diflunisal Diflunisal Salsalate Salsalate Salsalate

28. NSAIDs Propionic acid derivatives Ibuprofen Ibuprofen Ibuprofen Naproxen Naproxen Naproxen Fenoprofen Fenoprofen Fenoprofen Ketoprofen Ketoprofen Ketoprofen Flurbiprofen Flurbiprofen Flurbiprofen Oxaprozin Oxaprozin Oxaprozin Acetic acid derivatives Acetic acid derivatives Indomethacin Indomethacin Indomethacin Sulindac Sulindac Sulindac Etodolac Etodolac Etodolac Ketorolac Ketorolac Ketorolac Diclofenac (Safety alert by FDA) Diclofenac (Safety alert by FDA) Diclofenac Nabumetone Nabumetone Nabumetone

29. NSAIDs Enolic acid (Oxicam) derivatives Piroxicam Piroxicam Piroxicam Meloxicam Meloxicam Meloxicam Tenoxicam Tenoxicam Tenoxicam Droxicam Droxicam Droxicam Lornoxicam Lornoxicam Lornoxicam Isoxicam Isoxicam Isoxicam Fenamic acid derivatives( Fenamates ) Mefenamic acid Mefenamic acid Mefenamic acid Mefenamic acid Meclofenamic acid Meclofenamic acid Meclofenamic acid Meclofenamic acid Flufenamic acid Flufenamic acid Flufenamic acid Flufenamic acid Tolfenamic acid Tolfenamic acid Tolfenamic acid Tolfenamic acid

30. NSAIDs Selective COX-2 inhibitors (Coxibs) Celecoxib (FDA alert) Celecoxib (FDA alert) Celecoxib Rofecoxib (withdrawn from market) Rofecoxib (withdrawn from market) Rofecoxib Valdecoxib (withdrawn from market) Valdecoxib (withdrawn from market) Valdecoxib Parecoxib FDA withdrawn Parecoxib FDA withdrawn Parecoxib Lumiracoxib TGA cancelled registration Lumiracoxib TGA cancelled registration Lumiracoxib Etoricoxib FDA withdrawn Etoricoxib FDA withdrawn Etoricoxib Firocoxib used in dogs and horses Firocoxib used in dogs and horses Firocoxib Sulphonanilides Nimesulide (systemic preparations are banned by several countries for the potential risk of hepatotoxicity) Nimesulide (systemic preparations are banned by several countries for the potential risk of hepatotoxicity) Nimesulide Others Licofelone acts by inhibiting LOX (lipooxygenase) & COX and hence known as 5-LOX/COX inhibitor Licofelone acts by inhibiting LOX (lipooxygenase) & COX and hence known as 5-LOX/COX inhibitor Licofelone

31. NSAIDs are generally indicated for the symptomatic relief of the following conditions: Rheumatoid arthritis Rheumatoid arthritis Rheumatoid arthritis Rheumatoid arthritis Osteoarthritis Osteoarthritis Osteoarthritis Inflammatory arthropathies (e.g. ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome) Inflammatory arthropathies (e.g. ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome)ankylosing spondylitispsoriatic arthritisReiter's syndromeankylosing spondylitispsoriatic arthritisReiter's syndrome Acute gout Acute goutgout Dysmenorrhoea (menstrual pain) Dysmenorrhoea (menstrual pain) Dysmenorrhoeamenstrual Dysmenorrhoeamenstrual Metastatic bone pain Metastatic bone pain Metastatic Headache and migraine Headache and migraine Headachemigraine Headachemigraine Postoperative pain Postoperative pain Mild-to-moderate pain due to inflammation and tissue injury Mild-to-moderate pain due to inflammation and tissue injury Pyrexia (fever) Pyrexia (fever) Pyrexiafever Pyrexiafever Ileus Ileus Ileus Renal colic Renal colic Renal colic Renal colic They are also given to neonate infants whose ductus arteriosus is not closed within 24 hours of birth They are also given to neonate infants whose ductus arteriosus is not closed within 24 hours of birthductus arteriosusductus arteriosus Aspirin, the only NSAID able to irreversibly inhibit COX-1, is also indicated for inhibition of platelet aggregation. Aspirin, the only NSAID able to irreversibly inhibit COX-1, is also indicated for inhibition of platelet aggregation. Aspirinplatelet Aspirinplatelet

32. Complications of NSAIDs NSAIDs are safe drugs. However, they have many side effects. The side effects happen more often when they are used over long periods of time, which is common in arthritis patients. Some of the side effects can become very serious. GI Effects GI Effects NSAIDs irritate the gastrointestinal (GI) tract (the digestive system--your esophagus, stomach, and intestines). They increase the production of gastric acid, and they harm the gastric lining. NSAIDs aggravate ulcers and GI bleeding. Up to 5 percent of people who use NSAIDs for a year develop ulcers, bleeding, or tears in the GI tract. The risks are higher for older patients, patients with a history of GI problems, and patients with heart disease. Blood Effects Blood Effects NSAIDs make it harder for the platelets in your blood to clump together at the site of an injury. This can cause bleeding problems. Aspirin especially has this effect. Before you have surgery, you should stop taking aspirin for two weeks to prevent bleeding problems. Liver Effects Liver Effects NSAIDs can be toxic to your liver. You will not feel this, but elevated levels of certain liver enzymes can easily be seen in blood tests. Liver function almost always returns to normal when you stop taking NSAIDs.

33. Kidney Effects Kidney Effects NSAIDs can make it hard for your kidneys to get rid of some kinds of wastes. If you have a history of kidney problems, or if your disease may affect your kidneys, your doctor will use NSAIDs with caution. Other Effects Other Effects Some people get skin reactions and rashes from NSAIDs. Some get a combination of runny nose, polyps in the nose, and asthma. Different kinds of NSAIDs can have different side effects. Salicylates can cause problems with hearing. Other kinds of NSAIDs can cause headaches and confusion, especially in elderly patients. Many of the possible side effects depend on your health and the disease for which you are being treated. Individuals can react very differently to the same NSAIDs. You and your doctor must work together to find the type and dose of NSAID that controls your symptoms without causing unwanted side effects.