Dutch study suggests that COX-2 inhibiting NSAIDs should also always be prescribed with gastroprotective drugs

In clinical practice conventional (classic) NSAIDs are usually prescribed together with proton-pump-inhibtors (PPI) as concomitant gastroprotective agent (GPA). In patients not at risk for gstro-intestinal problems the COX-2 inhibtors group within the NSAIDs are not necessarily prescribed with concomitant GPA. I.e. when the COX-2 blocking agents were introduced, the reduced risk for gastro-intestinal bleedings was an important factor for drug registration by the authorities as well as in marketing for the pharmaceutical companies. However, from the classic NSAIDs the risk of gastrointestinal bleeding is well known as side-effect, especially when not (continuously) taking PPI. For the COX-2 inhibitors data on gastrointestinal complications when not or not continuously taking PPI were relatively lacking. A Dutch study was performed (and published today in Arthritis and Rheumatism) on the effect of adherence to a gastroprotective drug regimen with COX-2 blocker use. The investigatrs concluded that BOTH for classic NSAIDs as well as for COX-2 blockers the risk of developing gastrointetinal complications rises remarkably when PPIs are not taken as concomitant medication on a daily base.

Further analysis found that for every 10% decrease in GPA adherence, there was a 9% increase in the risk of gastrointestinal complications. “Our findings show that with every three day reduction of GPA coverage per 30 days of COX-2 inhibitor use, the risk of upper GI events increases 9%,” concludes Dr. Valkhoff.

Clinical research on Sjögren’s Syndrome continues, also in the Netherlands

Fatigue remains a major symptom encountered in Sjögren’s Syndrome, and this phenomenon has already been documented in quite a number of studies. A recent Dutch study (published in this month’s Annals of the Rheumatic Diseases) adds to that series and suggests that fatigue in patients with Sjögren’s syndrome might be reduced by targeting both physical activity and physical activity cognitions.

Find a link to the abstract here.

Basic research on Sjögren’s Syndrome continues, also in the Netherlands

A recently published thesis by Nienke Roescher from the University of Amsterdam further contributes to the difficult and ongoing search on how to tackle the disease Sjögrenś sydnrome. Although as a rheumatologist I am more into clinical research, the evolving knowledge obtained from basic (laboratory) research is of invaluable importance in guiding the way to find a cure for this disease.

Nienke Roescher concluded her thesis as follows:

The research presented herein summarizes the current knowledge on cytokines and their presence in SS, it identifies immunological targets in mice with an SS-like disease and shows that local gene therapy can be successful for the treatment of the inflammatory salivary gland component of a SS-like disorder in mice. The chance for success of this approach depends on proper timing and should be aimed at the right target.

American College of Rheumatology classification criteria for Sjögren’s syndrome: A data-driven, expert consensus approach in the Sjögren’s International Collaborative Clinical Alliance Cohort – Shiboski – 2012 – Arthritis Care & Research – Wiley Online Library

American College of Rheumatology classification criteria for Sjögren's syndrome: A data-driven, expert consensus approach in the Sjögren's International Collaborative Clinical Alliance Cohort – Shiboski – 2012 – Arthritis Care & Research – Wiley Online Library.

(thanks @AmiDauhoo for notifying me)