Answer: By preferentially inhibiting COX-2, newer NSAIDs are able to reduce inflammation with less impact on the remaining prostaglandins and therefore fewer side effects. Two points should be emphasized. The side effects of NSAIDs remain by and large toxicities for the entire class of compounds. COX-2 NSAIDs may preferentially inhibit COX-2, but there is much [...]

Answer: Recently two subtypes of COX have been described. The traditionally recognized enzyme, designated COX-1, seems to be most involved with normal cellular processes, often described as housekeeping functions. COX-2 seems to be involved more specifically in the synthesis of inflammatory mediators. It is normally not easily detectable in tissue and is thought to be [...]

Answer: All NSAIDs work by inhibiting cyclooxygenase (COX). This enzyme forms an important step in the production of many proinflammatory mediators, including prostaglandins. Without COX there are fewer circulating prostaglandins and therefore less inflammation and pain. As with most mediators in the body, prostaglandins do not have a unique function. They are important in regulating [...]

Answer: Still’s disease is the eponym assigned to systemic-onset juvenile arthritis. It has been reported in adults as a seronegative polyarthropathy associated with sudden-onset high fever and chills, with evanescent rash on the trunk and extremities. Bony erosions are uncommon, although fusion of the carpal bones may occur. Reference: Reginato AJ: Adult onset Still’s disease. [...]

Answer: The classic rheumatoid nodule has a central area of necrosis surrounded by a rim of palisading fibroblasts that, in turn, is surrounded by a collagenous capsule with perivascular collections of chronic inflammatory cells. Rheumatoid nodules occur in 20-35% of patients with RA and can be found at the elbow, wrist, soles, Achilles tendon, head, [...]

Answer: Signs and symptoms of RA subside in approximately 70% of women during pregnancy. No data suggest that RA has a detrimental effect on the fetus. However, arthritis should be assessed before pregnancy, if possible, because anesthesia and intubation can be problematic and even dangerous when cervical spine disease is present. Delivery also can be [...]

Answer: Class I No restrictions, able to perform normal activities Class II Moderate restriction, but able to perform normal activities Class III Marked restriction, inability to perform most duties of the patient’s usual occupation or self-care Class IV Incapacitation or confinement to a wheelchair Reference: Hochberg MC (ed). Rheumatology, 3rd ed. St. Louis, Mosby, 2003