Silas S, Clegg DO.
Bulletin on the Rheumatic Diseases, 1999;48:1-4

NSAIDs have been the most commonly used medication for the treatment of pain and inflammation. The recent introduction of cyclooxygenase-2 inhibitors holds the promise of providing even better pain and inflammation treatment. Results from studies indicate that celecoxib and rofecoxib, cyclooxygenase-2 inhibitors, are as efficacious as conventional NSAIDs in controlling pain and inflammation in patients with osteoarthritis and rheumatoid arthritis. As well, the GI toxicity profile of these two COX-2 NSAIDs is no different that placebo. However, trials with COX-2 NSAIDs have not used large populations and have not lasted for a great length of time. Still to be determined are the effectiveness and toxicity of COX-2 NSAIDs with chronic use and the renal and neurologic effects of COX-2 inhibition. As well, those most likely to benefit from COX-2s - older patients, those taking anticoagulants and those with prior GI bleeding - have not been included in the studies. It is still unclear as to the exact function of COX-1 and COX-2. COX-1 may play an important part in fighting inflammation and COX-2 may have a positive effect on gastric mucosa during gastric healing. This may mean that patients with ulcers would have to discontinue taking COX-2 inhibitors.

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