Ivanyts'ka L. Differential Choice and Substantiation of long-term Treatment of Patients with Rheumatoid Arthritis and Osteoarthritis on the Basis of Selectiv COX -2 Inhibitors.

The thesis is devoted to the problem of treatment of patients with rheumatoid arthritis ( RA) and osteoarthritis (OA) for a long period with selective COX -2 and non-selective COX-2 inhibitors. The purpose of the investigation was increase the efficacy and safety of complex treatment of patients by long-term using of selective COX -2 inhibitor meloxicam on the basis of comparative analysis of influence of different drugs (diclofenac and flurbiprofen) on clinical manifestations RA and OA and side effects prevalence. In comparative analysis of 12-month study of selective COX-2 inhibitor meloxicam with non-selective COX-2 inhibitors diclofenac and flurbiprofen it has been shown that meloxicam is safer, posesses the same clinical effectiveness as diclofenac and overtakes flurbiprofen. Meloxicam causes gastroduodenopathy in 11,7% of patients with rheumatoid arthritis 3 months lately and in 9,7% of patients with osteoarthritis while diclofenac causes the mentioned side effects respectively in 26,6% and 33,2% of patients. Flurbiprofen provoces gastroduodenopathy in 46,6% of patients with RA and 39,9% of patients with OA. In the first place meloxicam is indicated for patients with risk factors of gastrointestinal erosion ulcers. Further selective COX-2 inhibitors are recomended, in particular meloxicam, in case of appearance of gastropathies as a result of administration of non-selective COX-2 inhibitors drugs. In case of gastrointestinal erosions ulcers development during the therapy with nonselective COX-2 inhibitors it is recommended to replace them with meloxicam. It has been proved that computer termography is of high value in guantitive appreciation of antiinflammatory effect of nonsteroidal drugs in ong-term treatment.