Naproxen in juvenile chronic polyarthritis.

Moran, Helen; Hanna, David B.; Ansell, B. M.; Hall, M A; Engler, C

doi:10.1136/ard.38.2.152

Cited by 24 publications

(25 citation statements)

References 3 publications

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“…Unlike adults, children with articular disease have fewer comorbidities (hypertension, diabetes, chronic congestive heart failure, chronic lung disease, renal insufficiency, smoking, and alcohol intake) that might affect the incidence or relative risk of GI injury, hospitalization, or death. Previous analyses identifying NSAID enteropathy in children have been performed with small sample sizes, single agents, or in the absence of controls, a group not taking NSAIDs (1,2,(13)(14)(15)(16)(17)(18). This analysis reviewed all patient records in a pediatric rheumatology clinic over a 3-year period and compared the incidence of gastroduodenal injury in children taking NSAIDs with those not taking NSAIDs.…”

Section: Discussionmentioning

confidence: 99%

Nonsteroidal antiinflammatory drug‐induced gastroduodenal injury in children

Dowd

Cimaz

Fink

1995

Arthritis & Rheumatism

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Objective. To determine the incidence of abdominal pain and gastroduodenal injury in children with arthritis taking nonsteroidal antiinflammatory drugs (NSAIDs).Methods. A retrospective review of the records of all children (570 patients) receiving followup care in an academic rheumatology clinic between 1991 and 1993 was performed.Results. There were 344 patients who used NSAIDs during the study period. Abdominal pain was recorded in 27.9% of patients taking NSAIDs and 14.6% of patients not taking NSAIDs. Abdominal pain in 47 patients (49%) taking NSAIDs and 14 patients (42%) not taking NSAIDs was evaluated radiographically and/or endoscopically. Among those patients evaluated, gastric or duodenal injury was found in 16 (34.0%) who were taking NSAIDs and 1 (7.1%) who were not. This represented a relative risk for gastroduodenal injury of 4.8 for patients taking NSAIDs (P = 0.09). The incidence of injury did not change when analyses were controlled for prednisone or slow-acting antirheumatic drug use. None of the children were hospitalized or died as a result of gastroduodenal injury during the 3-year period.Conclusion. We conclude that NSAID use in children with arthritis frequently leads to gastroduodenal injury, with an estimated incidence and relative risk that are comparable to the rates found in adults with arthritis taking NSAIDs, but that hospitalization or death as a result of this injury is uncommon. There are no consistent data on the incidence or risk of gastroduodenal injury in pediatric patients taking nonsteroidal antiinflammatory drugs (NSAIDs). It has long been assumed that gastroduodenal injury in children taking NSAIDs is rare. A recent prospective study included 17 NSAID-treated juvenile arthritis patients referred to a gastroenterology clinic for endoscopic evaluation of abdominal pain , hematemesis, stools with occult blood, and/or iron deficiency anemia. A 23% incidence of gastric or duodenal ulcers and a 47% incidence of gastritis or duodenitis was found (1). However, a similar study in which 13 children with rheumatologic conditions who were taking NSAIDs underwent endoscopy for dyspepsia, abdominal pain, or vomiting showed no ulcers and only a single duodenal erosion (2).Risk and incidence figures for gastrointestinal (GI) complications in adults taking NSAIDs vary, depending on the study design and outcome measurements. Meta-analyses and reviews of these data show on average a 3-fold increased risk for severe GI complications (ulcers, GI hemorrhage, perforation, and death) in adults taking NSAIDs, with greater risks for those over the age of 60 (3-10). The incidence of ulceration, as determined by endoscopy, in adults taking NSAIDs ranges from 14% to 31% (4). The cost of managing the GI complications that result from NSAID use in adult arthritis patients was estimated to be 3.9 billion dollars per year in 1988, elevating the cost of treating arthritis by 45% (1 1).In this study, we retrospectively reviewed the records of all patients seen in an academic pediatric rheumatology clinic ov...

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Section: Discussionmentioning

confidence: 99%

Nonsteroidal antiinflammatory drug‐induced gastroduodenal injury in children

Dowd

Cimaz

Fink

1995

Arthritis & Rheumatism

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“…GI AE have been observed in a number of clinical trials in children with JRA using NSAID 4,[9][10][11][15][16][17][18][19][20][21][22][23] . A number of clinical trials and observational studies have also been conducted to determine the prevalence of GI complications of NSAID therapies over time, in a real-world clinical setting.…”

Section: Rheumatologymentioning

confidence: 99%

A Prospective Study Comparing Celecoxib with Naproxen in Children with Juvenile Rheumatoid Arthritis

Foeldvari¹,

Szer²,

Zemel³

et al. 2009

J Rheumatol

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“…It has been found to be as effective as aspirin in this disease (K vein et al 1984;Moran et al 1979). Naproxen is recommended by various authorities as one of the first-choice NSAIDs in the early management of juvenile arthritis, at a dose of 10 to 20 mg/kg/day in 2 divided doses.…”

Section: 2 Propionic Acid Derivativesmentioning

confidence: 97%

Clinical Pharmacokinetics of Drugs Used in Juvenile Arthritis

Skeith

Jamali

1991

Clinical Pharmacokinetics

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Juvenile arthritis is defined as the occurrence of objective evidence of arthritis for a minimum of 6 weeks, in a child 16 years of age or younger. With a reported incidence of 9 to 19.6 per 100,000 children, juvenile arthritis is considered to be a rare disease. There is no known cure; however, up to 75% of patients will undergo remission by late adolescence. Drugs used in the treatment of juvenile arthritis are divided into 2 major classes: (a) the nonsteroidal anti-inflammatory drugs (NSAIDs) including salicylates, naproxen, ibuprofen, fenoprofen, ketoprofen, flurbiprofen, indomethacin, sulindac, tolmetin and diclofenac, and (b) disease modifying agents which encompass drugs such as antimalarial agents, gold, methotrexate, penicillamine and sulfasalazine. In almost all the reports dealing with the pharmacokinetics of NSAIDs, the level of disease activity has not been noted. The level of activity is important since, during a flare, the plasma albumin may fall to the point that it causes a substantial and clinically significant increase in the unbound serum concentration of highly bound drugs. The relationship between the concentration of these drugs in the systemic circulation and their efficacy is not clear. However, for many of them, therapeutic drug monitoring is recommended as a means of reducing the possibility of toxic reactions. Further pharmacokinetic and -dynamic evaluations are needed for many of these drugs in juvenile arthritis.

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Naproxen in juvenile chronic polyarthritis.

Cited by 24 publications

References 3 publications

Nonsteroidal antiinflammatory drug‐induced gastroduodenal injury in children

Nonsteroidal antiinflammatory drug‐induced gastroduodenal injury in children

A Prospective Study Comparing Celecoxib with Naproxen in Children with Juvenile Rheumatoid Arthritis

Clinical Pharmacokinetics of Drugs Used in Juvenile Arthritis

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