1.Diagnosis & Treatment of Common Arthritis

2. Outlines Diagnosis of common arthritis OA RA Gout Spondyloarthritis Treatment of common arthritis Anti-inflammation: Steroid, Non-Steroid Anti-inflammatory drugs / Coxibs Disease-modifying: DMARDs, biologics, target therapy 3. 4. (Osteoarthritis)= = Osteoarthritis 5. generalized nodal osteoarthritis, GNOA 6. GOUT 7. Diagnosis of Gout Acute monoarthritis Abrupt onset in 24 hours Severe arthritis Small, peripheral joints. Podagra (inflammation of the first metatarsophalangeal joint) Tophi Serum uric acid Synovial MSU crystal by polarized microscope 8. 9. RA 10. Swan-neck deformity, Z-shape deformity 11. 2010 The New ACR/EULAR RA Criteria (2010) 6 RA A. 1 0 2~10 1 1~3 ( ) 2 4~10 ( ) 3 >10 ( 1 ) B. ( ) RF ACPA 0 RF ACPA 3 RF ACPA 3 C. ( ) CRP ESR 0 CRP ESR 1 D. 0 5 2 31 12. Ankylosing spondylitis 13. / 14. PE of spondylitisFinger to floor test 15. Outlines Diagnosis of common arthritis OA RA Gout Spondyloarthritis Treatment of common arthritis Anti-inflammation: Steroid, Non-Steroid Anti-inflammatory drugs / Coxibs Disease-modifying: DMARDs, biologics, target therapy 16. Side Effects of Traditional NSAID 17. New Concept of COX-2Jone Vane.Nature 1994; 367: 215 18. Effect of NSAIDs in COX-1 vs COX-2 Inhibit COX-1Phenylbutazone Piroxicam IndomethacinEqually Sulindac Ibuprofen Flurbiprofen Meclofenate DiclofenacInhibit COX-2 Nabumeton (Relifex) Etodolac (Lonine) Nimesulide (Nimed) Meloxicam (Mobic) Celecoxib (Celebrex) Etoricoxib (Arcoxia) 19. GI Tolerability Profile Etoricoxib vs. Naproxen or Ibuprofen Endoscopy Studies: Gastroduodenal Ulcers12-Week cumulative incidence rate (%) a3525RA or OA3025.27251517.021010020 15205OA7.42 b5 1.86 c1.35 b Placebo (n=207)8.12 dEtoricoxib 120 mg (n=207)Study 1Naproxen 1000 mg e (n=164)0Placebo (n=203)Etoricoxib 120 mg (n=186)Ibuprofen 2400 mg f (n=181)Study 2Although the studies were not designed to compare ulcer rates of placebo with etoricoxib, subsequent analysis revealed significant differences in Study 1 (p=0.002) and Study 2 (p=0.003). 2,3 Cumulative incidence rate of gastroduodenal ulcers 3 mm at week 12. Cumulative incidence rate from life-table analysis may not equal number of events/n 100; b p