Category:Anti-inflammatories: Difference between revisions

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The older anti-inflammatory medicines retain specific clinical niches. [[wikipedia:Colchicine|Colchicine]], extracted from the autumn crocus ''[[wikipedia:Colchicum autumnale|Colchicum autumnale]]'' by the French chemists [[wikipedia:Pierre Joseph Pelletier|Pelletier]] and [[wikipedia:Joseph Bienaimé Caventou|Caventou]] in 1820, has been used for [[wikipedia:Gout|gout]] for more than two centuries and is now used additionally for [[wikipedia:Familial Mediterranean fever|familial Mediterranean fever]] (since the 1972 discovery by Goldfinger that low-dose colchicine prevents both the febrile attacks and the secondary amyloidosis), for [[wikipedia:Pericarditis|recurrent pericarditis]] (CORP and CORE trials), and for [[wikipedia:Atherosclerosis|atherosclerotic cardiovascular disease]] (LoDoCo and LoDoCo2 trials in stable coronary disease).<ref name="lodoco2">Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, The SHK, Xu XF, Ireland MA, Lenderink T, et al. Colchicine in patients with chronic coronary disease. ''New England Journal of Medicine''. 2020 Nov 5;383(19):1838-1847. PMID 32865380.</ref> Dapsone, originally an antimycobacterial introduced for leprosy in 1908 by Fromm and Wittmann, is now used in dermatology for the bullous and neutrophilic dermatoses (dermatitis herpetiformis, pyoderma gangrenosum). The [[:Category:5-aminosalicylates|5-aminosalicylates]] (sulfasalazine, mesalamine in various delivery formulations, balsalazide) are the foundational anti-inflammatory medicines for ulcerative colitis and milder Crohn's disease.

The clinical use of anti-inflammatory medicines has been progressively refined toward "treat-to-target" frameworks similar to those developed in [[:Category:Antihypertensives|hypertension]] and [[:Category:Antihyperglycemic_agents|diabetes]] management. The composite disease-activity indices (DAS28 in rheumatoid arthritis, BASDAI in ankylosing spondylitis, PASI in psoriasis, the Mayo score in ulcerative colitis) define a measurable target that justifies escalation of therapy until the target is reached. The pharmacological cost of long-term anti-inflammatory therapy includes immunosuppression with associated infection risk (including the reactivation of latent tuberculosis and hepatitis B that has shaped contemporary biologic prescribing), demyelinating disease (TNF inhibitors), heart-failure exacerbation (TNF inhibitors), ~~drug~~-induced lupus, paradoxical psoriasis and uveitis (TNF inhibitors), thrombotic events (Janus kinase inhibitors), and the specific class effects of the corticosteroids (described under [[:Category:Corticosteroids|corticosteroids]]) when those are used as adjunctive anti-inflammatory therapy.

The clinical use of anti-inflammatory medicines has been progressively refined toward "treat-to-target" frameworks similar to those developed in [[:Category:Antihypertensives|hypertension]] and [[:Category:Antihyperglycemic_agents|diabetes]] management. The composite disease-activity indices (DAS28 in rheumatoid arthritis, BASDAI in ankylosing spondylitis, PASI in psoriasis, the Mayo score in ulcerative colitis) define a measurable target that justifies escalation of therapy until the target is reached. The pharmacological cost of long-term anti-inflammatory therapy includes immunosuppression with associated infection risk (including the reactivation of latent tuberculosis and hepatitis B that has shaped contemporary biologic prescribing), demyelinating disease (TNF inhibitors), heart-failure exacerbation (TNF inhibitors), medicine-induced lupus, paradoxical psoriasis and uveitis (TNF inhibitors), thrombotic events (Janus kinase inhibitors), and the specific class effects of the corticosteroids (described under [[:Category:Corticosteroids|corticosteroids]]) when those are used as adjunctive anti-inflammatory therapy.

== Classes indexed ==

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