World scientific research journal
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Volume-39_Issue-2_May-2025
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ASSESSMENT OF THE EFFICACY OF SELECTIVE NONSTEROIDAL
ANTI-INFLAMMATORY DRUGS IN RHEUMATOID ARTHRITIS
Solikhov B.M.
Tashkent Medical Academy
Annotation:
Objective: To evaluate the effectiveness of therapy with celecoxib
in patients with rheumatoid arthritis.
Material and methods:
The patients under observation were divided into two
groups. 25 patients in the first group were prescribed 10 mg of methotrexate as basic
anti-inflammatory therapy per week, while 25 patients in the second group were
prescribed celecoxib at a dose of 200 mg twice a day in combination with 10 mg of
methotrexate per week for basic anti-inflammatory therapy.
Results:
In the second group of patients treated with celecoxib, a significant
decrease in the number of inflamed and painful joints, ESR, C-reactive protein, VAS,
DAS-28 scales, and HAQ index was observed compared to the first group.
Conclusion:
It has been established that combined therapy with the drug
celecoxib can reduce disease activity more effectively in RA patients compared to
monotherapy with methotrexate.
Keywords
: rheumatoid arthritis, methotrexate, celecoxib.
Introduction
. Rheumatoid arthritis is an autoimmune disease of connective
tissue that causes inflammation of the synovial membrane of joints and leads to their
destruction [1,2]. In this case, the small joints of the hand and foot are most often
affected. The prevalence of rheumatoid arthritis in the population is 0.5-1% [3]. It is
twice as common in women as in men. The inflammatory process manifests itself in
the form of subjective and objective signs such as joint pain, numbness, and swelling.
Currently, there are several groups of drugs that eliminate the aforementioned clinical
symptoms of rheumatoid arthritis, leading to stable remission and improved joint
mobility. Although non-steroidal anti-inflammatory drugs are used to control the
symptoms of arthritis, they have many side effects: gastrointestinal toxicity, including
the risk of gastroduodenal ulcers, bleeding, and perforation [5,7].
Celecoxib is a selective nonsteroidal anti-inflammatory drug widely used in the
treatment of rheumatoid arthritis. At therapeutic concentrations, celecoxib does not
affect prostanoid synthesis due to the fact that it does not inhibit COX-1. As a
selective inhibitor of cyclooxygenase II (COX-2), the drug is considered low-toxic to
the gastrointestinal tract and is well tolerated by patients. The drug also does not affect
platelet aggregation and prolonged blood clotting time. The maximum concentration
in the plasma is reached 3 hours after administration. It has a high binding capacity to
plasma proteins. The half-life (T1/2) is 11 hours and is metabolized in the liver mainly
World scientific research journal
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Volume-39_Issue-2_May-2025
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by the CYP2C9 isoenzyme. According to the results of the conducted research, the
effect of the drug celecoxib on carcinogenicity, mutagenicity, and fertility is
insignificant. This drug can be administered at an average therapeutic dose (200 mg
twice a day) regardless of the diet [6, 9, 10].
Randomized studies conducted over 24 weeks showed a significant reduction in
joint pain, swelling, and numbness during celecoxib treatment compared to the
placebo group. These studies have shown that celecoxib surpasses placebo in terms
of the ACR20 index, which is a combination of clinical, laboratory, and functional
indicators in rheumatoid arthritis. Celecoxib doses of 100 mg twice a day and 200 mg
twice a day were similar in effectiveness and compared to 500 mg twice a day of
naproxen. Although 100 mg twice a day or 200 mg twice a day of celecoxib provided
the same therapeutic effect, some patients were additionally prescribed 200 mg twice
a day of celecoxib (a total of 800 mg). However, prescribing the drug at an increased
dose of 400 mg twice a day did not provide any additional benefit to patients during
the study [4.8].
The purpose
of the study is to evaluate the effectiveness of therapy with
selecoxib (seletor) in patients with rheumatoid arthritis. The evaluation of the
effectiveness of selecoxib therapy in patients with rheumatoid arthritis.
Materials and methods
. The clinical study was conducted from 2024 to 2025
at the departments of rheumatology, cardio-rheumatology, internal disease
rehabilitation, and an outpatient course of arthrological specialization of the
multidisciplinary clinic of the Tashkent Medical Academy.
Fifty patients with rheumatoid arthritis were included in the study. The study
involved patients aged 18 to 55 years. The mean age of the patients was 39.56±5.34.
The distribution of patients by age indicator was as follows: patients under the age of
20 and 20-29 years were almost equal, with the highest percentage (38.75%) being
those aged 40-55. The distribution of patients by gender: 40 (80%) were women and
10 (20%) were men. The average duration of the disease in patients was 7.5±1.3 years.
Morning stiffness was observed in 44 (73.3%) patients, edema in 24 (48%) patients,
and deformation in 12 (20%) patients.
General characteristics of patients
Index
RA
(n=50)
Gender: male, n (%)
woman, n (%)
10 (20)
40 (80)
Average age, M±m (years)
39,56
5,34
Duration of disease, M±m (years)
7,5±1,3
Signs, n (%):
Morning stiffness
Swelling
Deformation
44 (73,3)
24 (48)
12 (20)
Table 1
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138
The patients under observation were divided into two groups. Twenty-five
patients in the first group were prescribed 10 mg of methotrexate as basic anti-
inflammatory therapy per week, while 25 patients in the second group were prescribed
celecoxib at a dose of 200 mg twice a day in combination with 10 mg of methotrexate
per week for basic anti-inflammatory therapy.
The erythrocyte sedimentation rate (ESR), C-reactive protein, the Disease
Activity Score-28 scale (DAS-28), and the visual analog scale (VAS) index were
compared in the observed patients.
Results and discussion
. The distribution of patients with rheumatoid arthritis
depending on the presence of rheumatoid factor (%) was 8 (16%) seronegative
patients and 42 (84%) seropositive patients. High activity was observed in 4 (8%)
patients, moderate in 38 (76%), and low in 8 (16%) patients.
Analysis of antibodies to cyclic citrulline peptide (CCP) in patients of both
groups revealed a positive CCP in 38 patients (76%), and a negative CCP in 12
patients (24%).
Table 1 presents the dynamics of inflamed and painful joints, ESR, C-reactive
protein, VAS, DAS-28 scales, and HAQ index before and after treatment in the
observed patients.
Indicators
Observation results (Group I)
Observation results (Group II)
Before
treatment
(n=25)
After
treatment
(n=25)
Before treatment
(n=25)
After
treatment
(n=25)
6 month
6 month
Number
of
inflammatory joints
10,7±3,1
8,3±2,8
13,8±4,2
6,7±3,2*
Number of painful
joints
26,2±10,6
18,5±3,7
30,5±11,6
12,4±2,2*
ESR
38,2±6,8
15,5±6,7
37,6±7,4
11,3±5,7*
C-reactive protein
44,5±3,8
31,1±5,6
41,7±5,3
19,2±5,8*
16%
84%
Patients by RF
Seronegative
Seropozitive
16%
76%
8%
Patient disease activity
Low activity
Medium activity
High activity
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139
VAS
71,1±2,1
30,6±1,81
76,7±2,32
28,9±2,13*
DAS-28
4,84±1,7
4,15±1,4
4,89±2,0
3,89±1,2*
Index HAQ
0,96±0,6
0,68±0,06
1,08±0,3
0,56±0,09*
Table 2
* (P < 0.001) - the difference compared to the indicators before treatment is
statistically significant
According to Table 1, the reduction in the number of inflamed and painful joints,
ESR, C-reactive protein, VAS, DAS-28 scales, and HAQ index in our patients in
Group II was significant compared to Group I.
Conclusion
. As a result of the conducted research, it can be concluded that
combined therapy with the drug selecoxib can more effectively reduce disease activity
in RA patients compared to monotherapy with methotrexate. This improves the
physical condition of patients and increases their working capacity.
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