Neurologist Shubin named the most effective remedy for joint pain

Composition and release form

The medicine is available in several forms:

• pills;
• ointment;
• gel;
• candles;
• children's oral suspension.

The active substance is ibuprofen.

Auxiliary components in the tablets: potato starch, magnesium stearate, beeswax, sucrose.

Additional gel ingredients: ethanol, lavender oil, water.

Excipients in the ointment: macrogol.

Additional components of candles: solid fat.

Place of etoricoxib in the treatment of acute pain. Karateev A.E.

Oksana Mikhailovna Drapkina , professor, doctor of medical sciences:

– We move on to the next section. The next section will be devoted to rheumatology. Our symposium dedicated to rheumatology will be opened by Professor Andrey Evgenievich Karateev. Acute pain. Today we will talk about this. Things are improving all the time, and Etoricoxib appears. What is this? Like this? Tell me, please.

Andrey Evgenievich Karateev , professor, doctor of medical sciences:

- With great pleasure. For you, Oksana Mikhailovna, I will tell you with great pleasure. When a new medicine appears, we first look at what we need it for. For me, a new medicine is a tool that allows you to influence an old problem in a new way. And, of course, pain treatment is a problem that worries probably all specialists, because when we see a patient in front of us, we, first of all, try to make him feel good. We are trying to make sure his suffering ends. And one of the patient’s main complaints, the main complaint is pain. If we look at the statistics, they are inexorable. After all, pain is not just an unpleasant symptom, it is a serious threat to the patient’s life.

Here is a very recent large American study. Femoral neck fracture. A common problem, unfortunately, for elderly patients. And now, despite the well-developed medicine of this country, 10 percent of patients die. 340 thousand break their hips every year, and 10 percent die. 34 thousand patients. Why is this happening? In the first place are cardiovascular complications and pulmonary complications. What are they connected to? Impaired motor activity, use of narcotic opioids that cause respiratory depression, and cardiovascular pathologies. In fact, all these factors are connected by one factor. It is a pain. Movement disorders, cardiovascular risk. Why is this happening? We know this well. Pain, especially chronic pain, and acute pain is a release of catecholamines, an increased risk of thrombosis, depression, and arterial hypertension. And all this is ultimately realized, unfortunately, in an increase in cardiovascular risk, in cardiovascular accidents.

Here, look. A very interesting study and very visual. Chronic back pain. What we used to call osteochondrosis. Lumbodynia. It would seem that this is not a fatal disease. Yes, people suffer. Yes, people suffer. Yes, they are receiving active therapy. But there is no damage to the heart, lungs, or spleen. There is no organ pathology. The patient should not die from this pathology. But the statistics are inexorable. Here's an Australian study. One and a half thousand women, elderly, suffering from back pain. There is no life-threatening pathology, no oncology, no tuberculosis, no fractures. This is functional suffering. Australian scientists observed them for 5 years. It turned out that those women who experienced back pain every day, their risk of death from a cardiovascular accident was 2 times higher than their friends in misfortune, who experienced pain less often, that is, they were better treated for pain. We see that, in fact, there is clear evidence that pain is a problem that we need to be very active in combating. It plays a role not only as a factor that worsens the quality of life of patients, but also as a factor that significantly affects the patient’s survival. This is, in general, a fundamental question today.

There is another aspect to the problem of pain treatment. The fact is that the patient, by and large, does not care what his diagnosis is. He came to us to get help so that his suffering would end. And from the patient’s point of view, if we, and we must think about this today, help him effectively and quickly... And the easiest way to gain the patient’s favor is to relieve his symptoms, to make sure that the patient does not experience suffering. Now, if we do this quickly and efficiently, we are good doctors. If we get carried away with diagnostics, then, unfortunately, from the patient’s point of view, we will not be very good specialists. This is the harsh truth of life, and we must remember this.

But look what happens in real life. This is a very instructive study. The famous American epidemiologist Gore conducted a study. This is the British healthcare system. year 2012. They rate how doctors in the UK prescribe, a very good, clear healthcare system, how they prescribe painkillers. Patients with osteoarthritis and patients with chronic back pain. NSAIDs, Paracetamol, opioids. For us, this seems crazy - strong opioids for osteoarthritis, but nevertheless. In the UK this is possible. Look what happens. During the first month of discontinuation of therapy, if the doctor prescribes a medicine, there is a 90 percent chance that he will cancel it. Because of complications, because of ineffectiveness, because of side effects, he cancels it. Replace the drug with another 50 percent. Therapy is intensified by 10 percent. That is, a month passes, from the patients’ point of view, in two thirds of cases the therapy is ineffective. It's like throwing. The doctor does not know what to prescribe, how to use medications, old, well-known drugs. But there is no single scheme. We must understand another aspect of the problem. After all, pain is a very complex, multifactorial process. Many pathological mechanisms influence the development of this phenomenon. If we see, say, even acute pain, we always understand: there is an element of inflammation. Release of inflammatory mediators, which leads to swelling, damage and activation of nociceptors. This is one moment. There is a biomechanical disorder. After all, of course, a damaged organ cannot work as well as a whole one. This is a big problem. Muscle spasm occurs. Protective muscle spasm. Damage to the ligamentous apparatus occurs. Well, and, of course, the effect on the peripheral and central nervous system. Central sensitization, insufficiency of the antinociceptive system, and finally, a destructive behavioral reaction. All this influences the appearance of this complex phenomenon of chronic or acute pain that is interesting for treatment.

When we talk about the treatment of pain, I have already shown that inflammation occupies a very important place in its pathogenesis. We must always remember this, and therefore it is quite obvious that in the initial treatment of pain we must use those drugs that suppress inflammation, the release of inflammatory mediators, primarily prostaglandins. These are the good old non-steroidal anti-inflammatory drugs. There are a lot of them on our market, 18 pieces. And if you ask the question which of them is the best, I will give you a clear answer: there is no such drug. There can be no perfect remedy. Otherwise we would only use it. That's why we need new tools. And when we get a new drug, Etoricoxib, we think: what’s good about it, how does it differ from the old NSAIDs that we’ve been using for a long time? This is a medicine that belongs to the selective COX-2 inhibitors. That is, it has virtually no effect on the structural enzyme COX-1, and we know that its suppression is responsible for the risk of complications from the gastrointestinal tract. This medicine, which is absorbed very quickly, has linear pharmacodynamics, that is, a clear dependence of the effect on the dose. I'll now show you what it looks like in real life.

Here is a large study that shows how the dose of Etoricoxib affects its clinical effect. Or rather, here the authors of the study went from the opposite. They looked at how often therapy was discontinued due to ineffectiveness when the dose was increased. Look, there is a linear relationship between how a patient discontinues therapy depending on the dose. The higher the dose, the fewer withdrawals. This is the use of Etoricoxib for osteoarthritis. Chronic pain. Look, the small dose of this medicine is 30 mg. It turns out to be as effective as a huge dose of Ibuprofen - 2400 mg. Amazing effect. Well, of course, the effect is much higher than placebo. These are two double-blind controlled studies - more than 1000 patients.

And now we have in our hands a new tool for influencing pain, especially acute pain. This is Etoricoxib 120 mg. Can you imagine if 30 mg is more effective for chronic pain than 2400 mg of Ibuprofen, what 120 mg of Etoricoxib in one tablet can do? A medicine that is given once a day. In fact, this is a very powerful weapon. There is clear evidence that Etoricoxib at this dosage can have a very serious and powerful analgesic effect. This is a very interesting study that demonstrates the potential of a new analgesic. 588 patients who experienced a very unpleasant procedure - the removal of two or more teeth. Dentistry. They receive Etoricoxib at a dose of 90 or 120 mg once. Or, during the first 24 hours after tooth extraction, they receive Ibuprofen, an old, reliable analgesic, 600 mg 4 times a day. Or a medicine that contains a narcotic opioid, Codeine 60 mg. Let me remind you that those medications that we, unfortunately, cannot even prescribe now, such as Nurofen Plus, contained only 8 mg of codeine. There are 60 mg of Codeine and 600 mg of Paracetamol. Also up to 4 times a day. And the patients were observed throughout the day. It turned out that a single dose of 90 or 120 mg of Etoricoxib gives the same effect as a four-time dose of Ibuprofen - 2400 mg per day. And the effect is even better than taking Codeine with Paracetamol four times. This is an amazing effect. Of course, you see that with the placebo it was much worse, much worse. This is a very important thing, and we should always look at the full range of studies in which the drug was studied. The so-called meta-analysis. Clark and his colleagues, not so long ago, 3 years ago, conducted a meta-analysis of the use of Etoricoxib for acute pain. We know that placebos also work for pain. But look, according to these data, an improvement of 50 percent in patients on placebo was observed in only 10 percent, and in 64 percent on Etoricoxib. A very striking effect.

And here is a study by the famous British epidemiologist Murr. This is also a meta-analysis. In total, there are 45 thousand patients, 350 randomized controlled trials, and the NNT index is evaluated. This is how many patients need to be treated to achieve a given effect. They took a 50 percent improvement here as significant pain relief. It turns out that Etoricoxib at a dose of 120 mg is by far the most effective analgesic in comparison with the same Codeine, Ibuprofen, Celecoxib or Diclofenac. This is real life. These are clinical studies that clearly show the merits of a new drug. Of course, we know that NSAIDs, and Oksana Mikhailovna remembers very well; we discussed the topic of complications associated with these medications a lot. We know that NSAIDs are not all roses, but also thorns, these are serious complications. Previously, we talked more about NSAID gastropathy, now we have a time when we talk more about cardiovascular complications, because these complications occur with approximately the same frequency, as we often know. And we must always take them into account. Especially when we are treating elderly patients. A very important point is that if we are talking about the treatment of acute pain, we are still more interested in the problem of gastrointestinal risk, because cardiovascular complications are the prerogative of chronic pain treatment and long-term use of NSAIDs.

And this is what happens. This is a large Finnish population-based study that demonstrates the relationship between the timing of NSAID use and the risk of gastrointestinal bleeding. It turns out that the maximum risk of complications occurs in the first two weeks. In the first days after starting to take NSAIDs. This is when the risk is higher than, say, when the patient takes NSAIDs for six months. A very significant thing that you should always consider in your practice. That is, the first days are the worst in terms of prescribing medication, when we expect a serious side effect, especially if the patient has an increased risk of complications. So, Etoricoxib is a medicine that was specially created as a means to prevent the development of gastrointestinal complications. This is a medicine that has a low gastrointestinal risk. This is confirmed by the entire mass of research that has been actively carried out all over the world to study this issue.

Here, look. Here is data from a meta-analysis of ten randomized trials comparing etoricoxib with traditional NSAIDs. The risk of gastrointestinal complications, dangerous complications, primarily bleeding, is 2 times less. These are not just endoscopic ulcers, but these are serious complications. But, nevertheless, endoscopic ulcers are a very visual thing. We can always clearly assess, using gastroscopy, how NSAIDs affect the development of gastrointestinal pathology.

And now, 2 large studies are being conducted. In total, you see, there are almost 1400 patients here who are receiving the maximum dose of Etoricoxib of 120 mg compared to Ibuprofen or Naproxen - rather mild NSAIDs. What turns out to be? After 12 weeks of taking the maximum dose of Etoricoxib, the incidence of ulcers was 2.4 times lower compared to traditional NSAIDs. This is a very clear, clear effect, demonstrating that the new drug has good gastrointestinal tolerability.

Well, and, of course, the risk of cardiovascular accidents. Today I will not talk for long about the topic of heart complications, especially in the presence of Oksana Mikhailovna. She is a huge expert in this matter compared to me. But, nevertheless, we all understand perfectly well that if we talk about selective COX-2 inhibitors, we first of all think about cardiovascular risk. And, of course, Etoricoxib underwent rigorous testing in terms of such complications. What do short-term studies show, treatment of acute pain? Studies last up to three months. They clearly show that Etoricoxib has no greater risk of cardiovascular events than placebo. You see a meta-analysis of a number of studies. There are a total of 4,500 patients here. But you know, now the world community has a rather strict attitude towards medicines, there is no presumption of innocence, and we always look at a new medicine very carefully, first of all, in terms of what its shortcomings are, and only then we think about its advantages. This, of course, is the call of the times, we must always remember this. And therefore, the safety of drugs is now subject to the most severe assessment. And, of course, when we talk about cardiovascular risk, the short-term studies of Etoricoxib did not satisfy anyone. And to prove that this drug is at least as good in terms of cardiovascular risk as good old Diclofenac, the world's largest study of painkillers was conducted. This is the Medal study. What is its essence? For about three years, an average of one and a half years, 34,700 patients with rheumatoid arthritis and osteoarthritis, that is, diseases characterized by chronic pain, took 60 or 90 mg of Etoricoxib or 150 mg of Diclofenac every day. Moreover, this study simulated real clinical practice. If patients had an increased cardiovascular risk, they should have received Aspirin, in the opinion of the doctor, of course. Although, of course, the doctors did not know what medicine. Double-blind study: neither patients nor doctors knew what was prescribed. But if there was an increased cardiovascular risk, then the doctor could prescribe Aspirin, and if there was an increased gastrointestinal risk, proton pump inhibitors were prescribed as an effective means for preventing complications from the gastrointestinal tract. What happened? For the gastrointestinal tract, as expected, the overall number of complications was lower with Etoricoxib. Although I must note, an interesting fact is that the number of gastrointestinal bleedings was equal when using Etoricoxib and Diclofenac. But this is a fact that still requires some understanding. But overall gastrointestinal tolerability, of course, was significantly better when using Etoricoxib in both dosages. And cancellations due to complicated ulcers occurred less frequently. We are, of course, more concerned about cardiovascular risk. What happened here? But it turned out that the number of myocardial infarctions and ischemic strokes was absolutely equal in patients who received Etoricoxib or who received Diclofenac. A very sad, but very compelling argument in favor of Etoricoxib... How can I put it mildly? Evil tongues say that everything in research can be faked. There is only one thing that cannot be faked – the death of a patient. So, the number of deaths of patients from cardiovascular accidents was absolutely the same on Etoricoxib and on Diclofenac. That is, in all parameters of cardiovascular safety, Etoricoxib was not inferior to a traditional NSAID, a non-selective COX-2 inhibitor.

Thus, today we have in our hands a new effective tool for combating acute and chronic pain. This is Etoricoxib, a highly selective COX-2 inhibitor, an effective analgesic with a powerful anti-inflammatory effect that has a long-lasting effect. We always talk about compliance, about patient adherence to therapy, and a medicine that can give a daily effect with a single use is very cool, this is very good. And this is the medicine that initially has, this is its advantage, its main property, good tolerability from the gastrointestinal tract and a low risk of complications, serious complications.

In conclusion, I want to say that, of course, NSAIDs are not the only light in the window when treating pain. This is only the first step with which we begin treatment. Then we layer it on top, like a baby pyramid, we layer other drugs that give an analgesic effect or potentiate the effect of other analgesics. We are not talking about this today, this is a separate topic, very interesting. But we start with NSAIDs. This is the first step. We always prescribe a medicine taking into account risk factors, and select the ideal drug for a specific patient and for a specific clinical problem. Thank you very much for your attention. If you have any questions, I will be happy to answer.

When to take medicine

The medicine in tablet form is effective for the following conditions:

• inflammatory processes in the spine and joints;
• moderate pain of various origins (menstrual, headache, toothache, pain after surgery);
• fever caused by a cold infection.

Gel and ointment should be used in the following cases: osteoarthritis, arthritis, gout and other diseases of the musculoskeletal system.

Suppositories and syrup are usually prescribed to children to reduce body temperature, for various childhood infections and to reduce pain (in the head, throat, ear).

Neurologist Shubin named the most effective remedy for joint pain

Ibuprofen is the most effective remedy for arthrosis, says neurologist Dmitry Shubin. On the air of the program “Live Healthy!” the specialist compared several medications and gave advice to viewers.

Pain due to arthrosis is a fairly common problem among both middle-aged and elderly people. Knowing full well about the numerous complaints of Russians, Elena Malysheva decided to devote an entire episode of her own program on Channel One to this problem. She was joined by Dmitry Shubin - the co-host not only talked about the most effective drug, but also gave several recommendations on the frequency of its use.

Typically, two medications are used for joint pain: ibuprofen and paracetamol. Moreover, the first name is much stronger than the second, the doctor believes. However, even it has its contraindications, for example pregnancy and breastfeeding.

Ibuprofen is certainly useful in the fight against arthrosis, but it is very important for the patient not to overdo the dosage - largely due to a number of “side effects,” Shubin warned viewers. Among them are detrimental effects on the heart and increased blood pressure.

According to Shubin and Malysheva, it is worth taking ibuprofen from three to five days - this course is the most optimal, especially for acute pain.

“Increasing blood pressure and increasing the risk of heart attacks and strokes. Therefore, five days is the limit. Then we need to figure it out and look for other ways,” Malysheva warned the Russians.

FBA "Economics Today" / Boris Grishin

Arthrosis usually begins to appear between the ages of 40 and 50 years. Typically, in a 40-year-old patient, the disease is asymptomatic and begins to manifest itself only years later in the form of increasing pain and swelling. According to statistics, women most often suffer from joint problems.

Arthrosis occurs not only in Russia, but throughout the world. In the United States alone, the disease affects approximately 7% of the total population. In European countries the figures barely exceed 5%. Clinical criteria for arthrosis most often include night pain, as well as discomfort after exercise, which subsides only in a state of complete rest. In advanced cases, arthrosis can practically immobilize a person and permanently deprive him of the ability to use self-care skills.

Earlier, cardiologist Anna Korenevich told whether it is possible to sleep on your side. This pose will not harm a person at all, even if he experiences problems with the heart and blood vessels, TV channel 360 reports.

How to take Ibuprofen

Pills

Adults and children over 14 years of age can be given no more than 4 tablets per day. Depending on the condition, the dose can be adjusted and increased to 6 tablets (the dose is divided into several doses). When improvement is noted, the dose should be reduced to the original. The first tablet should be taken in the morning before meals with a glass of water. Then take 1 tablet after meals.

Without consulting a doctor, tablets can be used for no more than 5 days.

Candles

The suppositories are placed rectally. For pain and fever, the dose is determined taking into account the age and body weight of the baby. You can use no more than 10 mg per 1 kg at a time. Candles can be lit up to 4 times per day. The optimal duration of use is 3 days. If suppositories are used as an analgesic, they can be administered for 5 days.

If after the allotted time the fever has not disappeared, then you should consult your pediatrician.

Gel

You can use a 5-9 cm strip of gel at a time. Using smooth, light movements, rub the gel into the problem area until the composition is completely absorbed. It is allowed to use the gel no more than 4 times per day, with repeated use no earlier than after 4 hours.

The duration of the treatment course can be 15-20 days.

Ointment

The scheme for using the ointment is in all respects similar to applying the gel. The drug is rubbed into the problem area of ​​the skin 3-4 times a day. Can be used within 15-20 days.

Children's suspension

Ibuprofen in the form of a suspension can be given to a child no more than 3 times a day. If your child is under one year old, you should definitely consult a specialist before use. If the fever appears as a result of vaccination, then the suspension is given 2 times a day. There should be a break of at least 6 hours between doses.

IBUPROFEN-CHEMOPHARM

Interaction

Concomitant use of ibuprofen with acetylsalicylic acid and other NSAIDs is not recommended.
When administered simultaneously, ibuprofen reduces the anti-inflammatory and antiplatelet effects of ASA (an increase in the incidence of acute coronary insufficiency in patients receiving small doses of ASA as an antiplatelet agent is possible after starting ibuprofen).

When prescribed with anticoagulant and thrombolytic drugs (alteplase, streptokinase, urokinase), the risk of bleeding simultaneously increases.

Concomitant use with serotonin reuptake inhibitors (citalopram, fluoxetine, paroxetine, sertraline) increases the risk of developing serious gastrointestinal bleeding. Cefamandole, cefaperazone, cefotetan, valproic acid, plicachycin increase the incidence of hypoprothrombinemia.

Cyclosporine and gold preparations enhance the effect of ibuprofen on the synthesis of prostaglandins in the kidneys, which is manifested by increased nephrotoxicity. Ibuprofen increases the plasma concentration of cyclosporine and the likelihood of developing its hepatotoxic effects.

Drugs that block tubular secretion reduce excretion and increase plasma concentrations of ibuprofen.

Inducers of microsomal oxidation (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, increasing the risk of developing severe hepatotoxic intoxications.

Microsomal oxidation inhibitors reduce the risk of hepatotoxicity.

Reduces the hypotensive activity of vasodilators (including slow calcium channel blockers (SCBC), angiotensin-converting enzyme (ACE) inhibitors), natriuretic and diuretic activity - furosemide and hydrochlorothiazide.

Reduces the effectiveness of uricosuric drugs, enhances the effect of indirect anticoagulants, antiplatelet agents, fibrinolytics (increasing the risk of hemorrhagic complications), enhances the ulcerogenic effect with bleeding of mineralocorticosteroids (MCS) and glucocorticosteroids (GCS), colchicine, estrogens, ethanol.

Enhances the effect of oral hypoglycemic drugs (including sulfonylurea derivatives) and insulin.

Antacids and cholestyramine reduce the absorption of ibuprofen.

Increases the blood concentration of digoxin, lithium and methotrexate.

Caffeine enhances the analgesic effect.

Myelotoxic drugs increase the manifestations of hematotoxicity of the drug.

Contraindications and adverse reactions

Contraindications for all forms of medications include:

• stomach ulcers;
• problems with liver function;
• bearing a child (3rd trimester);
• internal bleeding;
• progressive kidney disease;
• chronic intestinal diseases;
• hypersensitivity to the constituent components.

It should be taken with caution for the following conditions and problems: liver cirrhosis, gastritis, stomach ulcers, problems with the cardiovascular system, liver and kidneys.

Children under 12 months can be given medicine only as prescribed by a doctor and under his supervision.

When using suppositories and tablets, the following adverse reactions may occur;

• irritation and dryness in the mouth;
• dyspnea;
• blurred vision;
• headache;
• confused thinking;
• disturbed sleep;
• high blood pressure;
• excessive sweating.

In all countries of the world, including the Russian Federation, there is a steady increase in the incidence of rheumatic diseases among adults and children [1]. These diseases are characterized by a complex autoimmune pathogenesis and interconnected inflammatory reactions [2]. There is a wide range of drugs that are used to treat rheumatic diseases in children and adults. For this purpose, drugs of different chemical classes with different pharmacological mechanisms of action are used, the common property of which is to suppress the development of inflammation [3, 4]. One of the most commonly used medications in rheumatology practice are nonsteroidal anti-inflammatory drugs (NSAIDs).

NSAIDs have been used in medicine since 1883, when the German chemist Felix Hoffmann created a new class of drugs that have been used in medical practice for the symptomatic treatment of inflammatory processes for more than 100 years [5]. Around the world, up to 30 million people use NSAIDs every day, and more than 300 million annually [4, 5].

The NSAID group includes more than 50 substances of different chemical structures, which are united not only by similarity in structure, but also by common mechanisms of action.

Despite the long-term use of NSAIDs, their mechanism of action was discovered only in 1971. English pharmacologist John Vane demonstrated the effect of these drugs on prostaglandins - biologically active substances that are released from cells under the influence of various physiological and pathological stimuli. NSAIDs inhibit the activity of enzymes responsible for the synthesis of prostaglandins. The drugs have a unique combination of anti-inflammatory, analgesic and antipyretic effects [6]. NSAIDs are used by doctors of almost all specialties as an effective symptomatic remedy for infectious diseases, traumatic injuries, and pain of various localizations.

The analgesic effect of NSAIDs is more pronounced for pain of low and moderate intensity, which is localized in the muscles, joints, and tendons.

The antipyretic effect is realized only during fever; NSAIDs do not affect normal body temperature. The anti-inflammatory effect is associated with the suppression of predominantly exudation. In terms of anti-inflammatory activity, all NSAIDs are inferior to glucocorticoids [3, 5].

As noted above, rheumatic diseases in children are characterized by an increase in incidence and a tendency to an earlier onset. In pediatric rheumatological practice, NSAIDs are used for reactive arthropathy, juvenile rheumatoid arthritis, spondyloarthritis, acute rheumatic fever, etc. [7]. A peculiarity of the use of this group of drugs in the treatment of inflammatory joint diseases in children is their long-term (weeks and months) use in high doses [8]. The need to use NSAIDs arises at the onset of the disease, during differential diagnosis, at the stage of selecting basic antirheumatic therapy, and during exacerbations of the disease [9].

However, despite the undoubted clinical effectiveness, the use of various NSAIDs has clear indications and certain limitations. A pediatric rheumatologist often encounters a situation where a patient with arthritis is prescribed an NSAID that is approved for use at an older age or by adult patients. The task of a rheumatologist is to select the most effective and safe drug for children.

An effective drug that has proven itself in clinical trials is ibuprofen. The drug is approved for use from the age of 3 months [10–12]. A review of the available literature data on the use of ibuprofen in the treatment of inflammatory joint diseases in children shows the effectiveness and safety of the drug.

The beginning of the use of ibuprofen in clinical practice dates back to 1973 [13], but the drug began to be used in pediatric practice later. One of the first long-term, multicenter, open-label studies of the effectiveness of ibuprofen monotherapy in juvenile idiopathic arthritis was conducted in Australia [14]. It included 46 patients with oligo- and polyarticular variants of the disease aged from 18 months to 13 years. The average age of patients at the time of inclusion in the study was 6.8 years. The joint syndrome in most patients was polyarticular in nature with a predominant lesion of the lower extremities. Ibuprofen was prescribed at an initial daily dose of 10 mg/kg body weight. Depending on the characteristics of the course of the disease, the dose of the drug was increased in some patients to 40 mg/kg body weight per day. The liquid form of the drug ensured dosing accuracy for small patients. During the study, indicators of laboratory disease activity, joint syndrome activity, and undesirable effects of therapy were assessed monthly. The maximum duration of observation of patients was 9 months.

This study demonstrated that ibuprofen had good analgesic and anti-inflammatory effects.

In the majority (39 children) of patients, after a month of taking the drug, not only clinical improvement was noted, but also a decrease in laboratory indicators of disease activity. In 10 patients, drug remission of the disease was noted after completion of the study. The vast majority of patients tolerated long-term ibuprofen well. Undesirable effects of treatment were noted in 7 patients and in most cases were transient in nature. Serious adverse events (dyspeptic disorders) were noted in 2 patients and required discontinuation of treatment.

The drug was not sufficiently effective in only 2 patients, and they required adjustment of antirheumatic therapy. Seven patients were excluded from the study due to irregular drug use. Most patients continued treatment after 9 months of ibuprofen.

Another study assessed the comparative effectiveness and safety of ibuprofen and acetylsalicylic acid in 92 patients suffering from various types of juvenile chronic arthritis [15]. Patients were randomly divided into two groups. Patients of the first group received ibuprofen at a daily dose of 30–40 mg/kg body weight, the second group received acetylsalicylic acid at a dose of 60–80 mg/kg body weight per day. The duration of therapy was 12 weeks. The study found that the drugs had a comparable effect on joint indices and laboratory indicators of disease activity. However, more than half of the patients treated with acetylsalicylic acid were forced to interrupt therapy due to the development of gastropathy. There were no complaints of dyspeptic disorders among patients of the first group.

After completing the first phase of the study, 84 patients continued therapy with ibuprofen at a daily dose of 30, 40 and 50 mg/kg body weight. After completion of this stage, it turned out that the clinical effectiveness of the drug was comparable in all groups and no significant difference in the development of undesirable effects of treatment was identified.

Subsequently, a number of studies were published that also showed the high effectiveness of ibuprofen in juvenile arthritis [16, 17]. Subsequent studies were largely devoted to assessing the safety of the drug in children.

The side effects of NSAIDs are the subject of extensive debate and the subject of numerous experimental and scientific studies. One of the main negative properties of the studied group of drugs is an adverse effect on the mucous membrane of the gastrointestinal tract and hepatotoxicity. A comparative assessment of the safety of various NSAIDs showed that the incidence of gastropathy and increased transaminase activity in children treated with ibuprofen is minimal [10–12, 18].

When using ibuprofen, it must be remembered that the development of the anti-inflammatory effect lags behind the analgesic and antipyretic effects. Pain relief occurs already in the first hours after administration, while the anti-inflammatory effect develops only on the 7-10th day of continuous regular use of the drug. The maximum concentration in the blood is reached 1–2 hours after ingestion. Ibuprofen is quickly metabolized and eliminated from the body. The half-life is 1.8–2.5 hours, due to which the analgesic and antipyretic effects last up to 8 hours.

For long-term use, ibuprofen is taken after meals. To ensure a quick analgesic and antipyretic effect, it is prescribed 30 minutes before meals or 2 hours after meals, washed down with 1/2 glass of water.

Treatment with ibuprofen should be started with the lowest dose; if well tolerated, the dose can be increased after 2–3 days [20]. However, it must be remembered that long-term (several weeks) use of the drug should be avoided.

Thus, analysis of the results of clinical studies indicates the high effectiveness and safety of ibuprofen in the treatment of inflammatory joint diseases in children. As an undeniable advantage of the drug, it is necessary to note its good tolerability and rare development of undesirable effects. In the Russian Federation, ibuprofen is available in the form of a suspension (Nurofen for Children, Reckitt Benckiser, UK). The suspension provides an accurate dosage of the drug and is approved for use from the age of 3 months [21]. All of the above may allow us to consider Nurofen for Children one of the drugs of choice for initial treatment of inflammatory joint diseases in children.