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WHAT IS AN ANTI-INFLAMMATORY?

1978; Oxford University Press; Volume: 17; Issue: 1 Linguagem: Inglês

10.1093/rheumatology/17.1.1

1462-0332

E. C. Huskisson,

Urticaria and Related Conditions

THE successful marketing of a new drug, like that of a new variety of soap powder, presumably depends in part upon the description of the product.Housewives want to know if it's biological and physicians want to know if it's anti-inflammatory.Considerable discussion has taken place at recent symposia on new drugs as to whether their anti-inflammatory activity had been adequately demonstrated.Does it matter?It certainly does, since in inflammatory conditions like rheumatoid arthritis, a drug like aspirin with anti-inflammatory activity is very much more effective than even the most potent analgesics like pethidine (Fremont-Smith and Bayles, 1965).To call an antiinflammatory an analgesic is worse than calling Stork margarine.It seemed that the elegant demonstration of the value of proximal interphalangeal joint circumference to measure the anti-inflammatory effect of aspirin had made life easy (Boardman and Hart, 1967).But the rapid reduction of joint size produced by aspirin is not achieved by newer drugs such as propionic acid derivatives.The failure of ibuprofen to reduce joint size led a group of misguided reviewers to suggest that it was analgesic but not anti-inflammatory (Huskisson et al, 1971).This is surely wrong.Ibuprofen has potent anti-inflammatory activity in animal models.In rheumatoid arthritis, it reduces the duration of morning stiffness, and morning stiffness is a particular feature of inflammatory disease-a cardinal sign which seems to have been overlooked by Celsus.Alas, we have no adequate measures of the inflammatory response in man.Dolor, pain, may be due to other things.Tumor, swelling is inadequate.Though propionic acid derivatives like fenoprofen reduce joint size slowly over the course of months, this obviously does not parallel and cannot be said to measure the anti-inflammatory effect.Similarly calor, heat, is reduced only slowly by anti-inflammatory drugs though they make the patient better very quickly.With sophisticated techniques thermography might still prove to be a useful marker of anti-inflammatory drugs.Rubor is seldom present.So for the moment, rigor or stiffness is the mainstay of our assessment of inflammation.The situation is further complicated by the fact that the non-steroidal antiinflammatory drugs are also simple analgesics, though the time course and effective doses are in some cases different.Aspirin in small doses is a simple analgesic: 600 mg produces relief of pain which begins within 30 minutes of taking the drug and lasts for about 6 hours.Further doses have the same effect, no more and no less.Aspirin in larger doses (at least 3.6 g daily) is an anti-inflammatory and several days are required to achieve maximum symptomatic relief.