Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis / Comparação da eficácia de tenoxicam administrado por via oral e intra-articular a pacientes com osteoartrite de joelhos

ABSTRACTBACKGROUND AND OBJECTIVES:Tenoxicam is widely used in osteoarthritis treatment and we aimedto compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthri-tis treatment.METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing andcomparing the findings of 60 patients who were clinically and radiologically diagnosed with kneedegenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in thestudy were divided into two groups. The first group (tenoxicam IA, n = 30) included patientfindings of those subjected to intra-articular injection of 20 mg tenoxicam to the knee oncea week for three weeks and the second group (oral tenoxicam, n = 30) included patients whowere administered 20 mg oral tenoxicam once a day for three weeks. All patients were clini-cally evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatmentaccording to specified criteria.RESULTS AND CONCLUSIONS: Twenty two of 60 patients included in the study were male and 38were female. In both groups significant improvements were detected in all of the observedparameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physicalactivity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week,1st month and 3rd month with respect to pre-treatment values. Besides, a better complianceto treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed.Intra-articular tenoxicam administration could be thought as an alternative treatment methodin patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemicgastrointestinal system side effects and those who have difficulties in adapting to treatment.

RESUMOJUSTIFICATIVA E OBJETIVOS: Tenoxicam é amplamente usado no tratamento da osteoartrite (OA)e o nosso objetivo foi comparar a eficácia de tenoxicam administrado por via oral (VO) e intra-articular (IA) no tratamento da OA.MÉTODOS: Este estudo foi conduzido entre 2011 e 2012 por meio de análise retrospectiva ecomparação dos resultados de 60 pacientes que foram clínica e radiologicamente diagnosticadoscom OA degenerativa de joelhos na Policlínica de Tratamento da Dor do Hospital Estadual deBünyan. Os 60 pacientes incluídos no estudo foram alocados em dois grupos. O primeiro grupo(tenoxicam IA, n = 30) incluiu resultados de pacientes submetidos à injeção nos joelhos porvia IA de 20 mg de tenoxicam uma vez por semana durante três semanas e o segundo grupo(tenoxicam VO, n = 30) incluiu pacientes que receberam 20 mg de tenoxicam por VO uma vezpor dia durante três semanas. Todos os pacientes foram avaliados clinicamente na fase basalpré-tratamento e em uma semana, um mês e três meses pós-tratamento, de acordo com oscritérios especificados.RESULTADOS E CONCLUSÕES: Dos 60 pacientes, 22 eram do sexo masculino e 38 do sexo feminino.Em ambos os grupos, melhorias significativas foram detectadas em todos os parâmetros da escalavisual analógica, do índice Western Ontario and MacMaster (Womac --- dor, atividade física erigidez dos joelhos) e do índice de Lequesne nas avaliações feitas em uma semana, um mês etrês meses e comparadas aos valores basais. Além disso, uma melhor adesão ao tratamento etolerabilidade ao sistema gastrointestinal no grupo tenoxicam IA também foram observadas. Aadministração de tenoxicam IA pode ser considerada como um método opcional de tratamentoem pacientes com OA de joelhos que não podem usar tenoxicam por VO, especialmente porcausa dos efeitos colaterais sobre o sistema gastrintestinal, e naqueles com dificuldades de adaptação ao tratamento.

Evaluation of piroxicam-β-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgery

The preemptive analgesic efficacy and adverse effects of preoperatively administered piroxicam-β-cyclodextrin for post-endoscopic sinus surgery pain was determined in a prospective, double-blind, randomized, clinical study. Seventy-five American Society of Anesthesiologists status I-II patients, aged 18-65 years, were divided into three groups with similar demographic characteristics: group 1 received 20 mg piroxicam-β-cyclodextrin, group 2 received 40 mg piroxicam-β-cyclodextrin and group 3 received placebo orally before induction of general anesthesia. A blinded observer recorded the incidence and severity of pain at admission to the post-anesthesia care unit (PACU), at 15, 30, and 45 min in the PACU, and 1, 2, 4, 6, and 24 h postoperatively. All patients received patient-controlled morphine analgesia during the postoperative period and consumption was recorded for 24 h. During the PACU period, mean visual analogue scale values were significantly lower in groups 1 and 2 compared to group 3 (P < 0.05). During the postoperative period, morphine consumption was 3.03 ± 2.54, 2.7 ± 2.8, and 5.56 ± 3.12 mg for each group, respectively (P < 0.05). As a side effect, bleeding was observed in groups 1 and 3, nausea and vomiting in all groups, and edema only in group 3. However, no significant differences were detected in any of the parameters analyzed, which also included epigastric pain, constipation/diarrhea and headache. Similar hematological test results were obtained for all groups. Preemptive administration of piroxicam-β-cyclodextrin effectively reduced analgesic consumption, and 40 mg of the drug was more effective than 20 mg piroxicam-β-cyclodextrin without side effects during the postoperative period.

Effect of piroxicam and zinc on morphological and histochemical changes in mice liver

To observe the morphological and histochemical findings, produced by piroxicam and zinc in mice liver and correlate with serum hepatic enzyme. For this experimental study 30 adult mice [25 -30 grams] were obtained from animal house of Jinnah Postgraduate Medical Center, and divided into three groups i.e. A, B and C. Group A served as control and received normal diet, Group B received piroxicam 0.3 mg /Kg body weight intraperitoneally and Group C 1mg/Kg body weight of zinc intraperitoneally and piroxicam in the same dose as group B. After completion of study [6 weeks] animals were scarified and their livers were removed and after processing paraffin section were made and stained with Haematoxylin and Eosin for histological and histochemical examinations and correlate with serum hepatic enzyme level. Haematoxylin and Eosin stained section of group A indicated the normal histology and morphometry, the group B showed distorted hepatic lobular architecture. Central vein and sinusoids was dilated and congested, kupfer cell prominent and pyknotic cells and mono nuclear infiltration were seen. Group C showed altered histological findings comparable to group A. The Histochemical findings of group B showed depletion in glycogen content marked fibrosis of reticulin fibres and increased deposition of calcium phosphate crystals. In group C effect of zinc improve glycogen content and reticulin fiber deposition and decreased deposition of alkaline phosphatase crystals. The serum enzyme level of Alkaline Phosphatase and Serum Gulutamin Phosphatase significantly increased in group B animals and less significantly increase in group C as compared to group B animals. It was concluded that piroxicam in therapeutic dose, was toxic and produced hepatic injury and zinc along with piroxicam improved the hepatic damage

Piroxicam-induced hepatic and renal histopathological changes in mice

Piroxicam is a non-steroidal anti-inflammatory drug widely used in rheumatic diseases. The aim of this study was to investigate Piroxicam-induced histopathological changes in livers and kidneys of male albino mice. Animals were classified into a control group and 4 treated groups. Piroxicam was injected intraperitoneally using 0.3 mg/kg every day for four weeks. Each week a group of mice was sacrificed. Liver and kidneys were obtained for histological and histochemical examination. Animals were classified into a control group and 4 treated groups. Piroxicam was injected intraperitoneally using 0.3 mg/kg every day for four weeks. Each week a group of mice was sacrificed. Liver and kidneys were obtained for histological and histochemical examination. Liver sections appeared with inflammatory cellular infiltration, vacuolated hepatocytes, dilated sinusoids, and increased number of Kupffer cells. Kidney sections appeared with some cellular inflammations. The glomeruli were shrunk resulting in widening of the urinary space. Oedema and vacuolations were noticed in the tubular cells. There was a positive correlation between these pathological changes and the increased treatment periods. Histochemical staining revealed that glycogen and protein contents had decreased in the hepatocytes. This depletion worsened gradually in liver cells after two, three, and four weeks. Similar depletion of the glycogen content was observed in kidney tissue. However, protein content appeared to be slightly decreased in the kidney tubules and glomeruli. Incensement of coarse chromatin in the nuclei of hepatocytes, Kupffer cells and most inflammatory cells were detected by Fuelgen method. Kidney tissues appeared with a severe decrease in coarse chromatin in the nuclei. Liver sections appeared with inflammatory cellular infiltration, vacuolated hepatocytes, dilated sinusoids, and increased number of Kupffer cells. Kidney sections appeared with some cellular inflammations. The glomeruli were shrunk resulting in widening of the urinary space. Oedema and vacuolations were noticed in the tubular cells. There was a positive correlation between these pathological changes and the increased treatment periods. Histochemical staining revealed that glycogen and protein contents had decreased in the hepatocytes. This depletion worsened gradually in liver cells after two, three, and four weeks. Similar depletion of the glycogen content was observed in kidney tissue. However, protein content appeared to be slightly decreased in the kidney tubules and glomeruli. Incensement of coarse chromatin in the nuclei of hepatocytes, Kupffer cells and most inflammatory cells were detected by Fuelgen method. Kidney tissues appeared with a severe decrease in coarse chromatin in the nuclei. Piroxicam has a time-dependent toxic effect on both liver and kidney tissues

Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin®) when compared with 20 mg piroxicam alone (Feldene®) in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo) Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol). Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group). Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.

Comparison of endoscopic gastric mucosa features after administration of piroxicam to meloxicam and their correlation with dyspepsia symptoms in elderly patient with knee osteoarthritis.

AIM: to know the effect of piroxicam (COX-1 and COX-2 inhibitor NSAID) and meloxicam (selective COX-2 inhibitor NSAID) against the gastric mucosa. METHODS: a random, double-blind-parallel study and repeat measurement against 20 elderly-patients with knee-OA was conducted. Patients were divided into 2 equal groups, every group got piroxicam 20 mg/day or meloxicam 15 mg/day for 3 weeks. On the second group, sukralfat 2 x 1 g/day were given. To examine the difference before and after treatment, we used Wilcoxon signed rank test, to examine the difference within those groups we used Mann-whitney U test, to examine the correlation between endoscopic score and dyspepsia, we used the Spearman correlation test with significant correlation interpretation by Guilford rules. RESULTS: one of piroxicam group was resigned, so that there was 19 person left to complete this study. Piroxicam has caused elevation of endoscopic score in 78% subject compared to the beginning of study, and 22% of the subject has developed ulcers. Alteration of endoscopic feature after administration of this piroxicam was statistically significant (p< 0,05). Mild dyspepsia symptoms after piroxicam administration were positive on 67% subjects (p< 0,05). After administration of meloxicam, 40% subjects have elevated endoscopic score compared to beginning of the study (p< 0,05). Mild dyspepsia symptoms after meloxicam administration were positive on 40% subjects (p> 0,05). Meloxicam has less elevation of endoscopic score compared to the piroxicam (p< 0,05). By statistics, both of groups showed no difference in dyspepsia symptoms (p> 0,05). There was no significant correlation between elevation of endoscopic score and dyspepsia on both of groups. Nevertheless, it tends to have weak positive correlation (piroxicam group r= 0,306, p> 0,05, meloxicam group r= 0,330, p> 0,05). CONCLUSION: on this study, we conclude that the administration of either piroxicam or meloxicam in elderly-patient with knee-OA has caused the gastric mucosa impairment. The impairment after meloxicam administration is milder than piroxicam. There is no significant difference of dyspepsia symptoms in both of groups. There is correlation between endoscopic gastric mucosa features with the dyspepsia symptoms.

Estudo morfométrico do efeito do Tenoxicam e do seu diluente no endotélio venoso, em coelhos / Morphometric study on the effect of tenoxicam and its diluent in the venous endothelium, in rabbits

Com o objetivo de avaliar pela morfometria o efeito do tenoxicam e do seu diluente no endotélio venoso, foram utilizados 48 coelhos (Oryctolagus cuniculus), brancos, da linhagem Nova Zelândia, machos, com idade acima de 10 semanas, com peso variando entre 2.350 e 3.500 gramas, divididos em dois grupos, denominados Experimento e Controle, que foram observados nos tempos de 6, 12 e 24 horas. Administrou-se nas venae auriculares dextra e sinistra, diluente ou tenoxicam/diluente no Grupo Experimento e cloreto de sódio a 0,9 por cento no Grupo Controle. Näo se constatou diferença estatisticamente significante entre o peso dos animais do Grupo Experimento e do Grupo Controle, antes da realizaçäo do procedimento. Pode-se observar que após a administraçäo do tenoxicam com o seu diluente ou do diluente isolado, os diâmetros dos núcleos das células endoteliais apresentaram significativamente menor dimensäo, quando comparados aos do grupo Controle, em que foi injetado cloreto de sódio a 0,9 por cento. Os resultados encontrados permitem concluir que o tenoxicam com o seu diluente comercial ou o diluente isolado reduzem o diâmetro dos núcleos das células endoteliais das venae em que foram injetados os fármacos.

Estudo histopatológico do efeito do tenoxicam e do seu diluente no endotélio venoso, em coelhos / Histopathologic study on the effect of tenoxicam and its diluent in the venous endothelium, in rabbits

Com o objetivo de avaliar pela histopatologia o efeito do tenoxicam e do seu diluente no endotélio venoso, foram utilizados 48 coelhos (Oryctolagus cuniculus), rancos, da linhagem Nova Zelândia, machos, com idade acima de 10 semanas, com peso variando entre 2350 e 3500 gramas, divididos em dois grupos, denominados Experimento e Controle, que foram observados nos tempos de 6, 12 e 24 horas. Administrou-se nas venae auriculares dextra e sinistra, diluente ou tenoxicam/diluente no Grupo Experimento e cloreto de sódio a 0,9 por cento no Grupo Controle. Não se observou diferença estatisticamente significante entre o peso dos animais do Grupo Experimento e do Grupo Controle, antes da realização do procedimento. No que se refere à presença ou ausência de trombose, observamos que: após administração do diluente no Grupo Experimento, 19,4 por cento das venae apresentaram trombos; após administração do tenoxicam com o diluente no Grupo Experimento, a incidência de trombose foi também de 19,4 por cento; no Grupo Controle, em que foi injetado cloreto de sódio a 0,9 por cento, nenhuma das venae apresentou trombos. Os resultados observados permitem concluir que o tenoxicam com o seu diluente comercial ou o seu diluente isolado podem acarretar trombose nas venae em que foram injetados.

Hepatitis colestásica por piroxicam: caso clínico / Cholestatic hepatitis associated to piroxicam use: report of one case

Most nonsteroidal antiinflammatory drugs can produce hepatotoxicity. We report a 22 years old female who presented with an acute cholestatic hepatitis after a prolonged period of piroxicam use. Hepatitis was attributed to this drug since all markers for hepatitis virus (A, B, C, E, Epstein Barr, Cytomegalovirus and Herpex Simplex) were negative, autoimmune markers were negative, serum iron and ceruloplasmin were normal, there was a temporal relationship between the administration of piroxicam and the hepatitis, the histological picture was compatible with this etiology and the patient had a favorable evolution after the discontinuance of the drug. This type of hepatotoxicity is not common but it must be born in mind when patients must receive nonsteroidal antiinflammatory drugs for prolonged periods

Quantitative histological and histochemical analysis of protective effects of prostaglandin-E2, ranitidine and sucralfate against piroxicam-induced gastric mucosal injury

Four groups of white albino rats received piroxicam through an orogastric tube in a daily dose of 1.8 mg/kg BW/day for five consecutive days were included in this study. In three of these groups, whether prostaglandin-E2 [PG-E2], ranitidine or sucralfate was administered in fixed dose 30 minutes prior to piroxicam injection. The fourth group received piroxicam only and an additional fifth group received saline only serving as normal controls. All animals were sacrificed 24 hours after the last injection and sections of a strip of the gastric corpus were stained for histological [H and E combined PAS-alcian blue] and histochemical [succinic dehydrogenase, alkaline phosphatase] evaluation. Gastric mucosal damage was assessed using a prespecified criteria for quantitative estimation of percentage injury across the depth of the mucosa. Only negligible proportions of injury were observed in the control animals, whereas extensive destruction involving 85% of the mucosa down to the chief cell area was detected in the group of rats which had received piroxicam alone. Variable degrees of protection were observed in the other three groups of animals. PG-E2 reduced gastric injury by about 75%, ranitidine by 45% and sucralfate by 37%. Moreover, injury beyond the upper gastric pit cells was scarce among the PG-E2 protected rats and the microvasculature of the mucosa was left intact. The histochemical findings confirmed those of the histological study. These results indicated that PG-E2 is far superior to the other drugs for cytoprotection against gastric injury induced by the non- steroidal anti-inflammatory drugs both ranitidine and sucralfate provide only modest protective effects

Acción del piroxicam en ratones hembras CEPA C57BL/6 con melanoma B16F1 / Action of the piroxicam in the females mices of C57BL/6 with inoculated melanoma B16F1

El melanoma maligno es un cáncer cutáneo grave, cuya frecuencia ha aumentado rápidamente en los últimos años. Debido al éxito limitado de la quimioterapia en el tratamiento del melanoma nos propusimos demostrar la acción del piroxicam, un analgésico no esteroide, sobre el melanoma B16F1, tumor experimental ampliamente utilizado en el estudio de células cancerosas, para lo cual nos planteamos la hipótesis de que el piroxicam administrado a ratones hembras de la cepa C57BL/6 inoculados con melanoma B16F1 ejerce una acción antitumoral. Se utilizaron 33 hembras de la cepa C57BL/6 distribuidos en dos grupos, un grupo tratado durante un mes con una dosis diaria de piroxicam de 8mg/kg y un grupo control el cual recibió una solución de agua destilada más el vehículo de la droga utilizada. Los resultados obtenidos se analizaron mediante la prueba "t" de Student. Se demostró que el Piroxicam no inhibió el desarrollo del melanoma B16F1; por el contrario aumentó el crecimiento diario del tumor primario "in situ" y las dimensiones del tumor primario "in situ" y las dimensiones del tumor primario disecado, debido probablemente al efecto inhibidor de las prostaglandinas sobre la replicación celular del melanoma B16F1. Concluimos con estos resultados que el piroxicam estimula el desarrollo del melanoma B16F1 en ratones de la cepa C57BL/6

study of hepatotoxic effect of tiaprofenic acid and piroxicam in normal and adjuvant-induced arthritic rats

Hepatotoxicity is now a recognized adverse or NSAIDs therapy in any patient, especially individuals suspected to be at risk as elderly patients or those suffering from rheumatic or arthritic conditions. So, this study was performed to investigate the hepatic effect of chronic administration of two members of NSAIDs; namely, tiaprofenic acid and piroxicam, in normal and adjuvant induced arthritic rats. The animals received the tested drugs in doses of 10 mg/kg and 1 mg/kg, respectively, orally for 21 days. Serum levels of GPT, GOT and alkaline phosphatase were measured, and also histopathological examination of the liver was done after 10, 12 days of administration and one month later after drugs withdrawal to study the reversibility of their hepatic effect. It was observed that serum transaminases in normal rats receiving tiaprofenic acid were elevated one time normal, whereas in the case of piroxicam, the elevation was more and reached about 1.5 times normal. Histopathological changes revealed vascular changes and fatty degeneration of the liver cells. This effect was reversed, and healing occurred after one month from cessation of the drugs. Meanwhile, in arthritic rats, there was a marked elevation in serum transaminases 2 times normal in tiaprofenic acid and 3 times normal in the case of piroxicam. Moreover, the histopathological examination revealed more damage of the liver with areas of necrosis and fibrosis which more prominent with piroxicam. Some of these changes persist after the drugs were withdrawn for one month

Dermatosis por medicamentos: relación de 169 casos revisados en 3 años / Dermatosis induced by drugs: relation of 169 cases revised in 3 years

Se comunica la frecuencias de farmacodermias en el Instituto Dermatológico Guanajuatense de Irapuato, Gto. La incidencia fue de 2.2 por ciento en relación con otras dermatosis. Los medicamentos responsables con más frecuencia fueron el piroxicam, corticoesteroides y dimetilpirazolona. Se encontraron 11 formas clínicas diferentes; las más comunes: fotosensibilización, dermatosis acneiformes, urticaria y eritema pigmentado fijo

Fotodermatitis al piroxican / Photosensitivity by piroxicam

El número de reacciones a la fotosensibilización ha aumentado en los últimos años. De los 16 casos estudiados que presentaron fotodermatitis posterior a la medicación con piroxicam, el mayor porcentaje pertenecía al sexo femenino, con antecedentes familiares de alergia a los medicamentos en un 25%. La localización de lesiones de eritema-pápula-vesícula se registraron en zonas expuestas al sol predominantemente en verano. En todos los casos se inicia la sintomatología durante las primeras tomas, con una duración mayor de 10 días a pesar de la medicación, y sin exposición solar. Se debe agregar la familia de los oxicams a la lista de los medicamentos potencialmente fotosensibilizantes

Efectos estructurales e histoquímicos del piroxicam: modificaciones estructurales e histoquímicas en hígados de ratas producidas por la administración de piroxicam / Structural and histochemical effects of piroxicam: structural and histochemical modifications in rats' livers produced by piroxicam administration

El objetivo del presente trabajo fue evaluar los cambios producidos por la administración de piroxicam (Pir) en el tejido hepático de ratas hembras alimentadas normalmente, mediante estudios histológicos e histoquímicos. Se tomaron muestras de hígado de animales tratados con Pir durante uno a cuatro días consecutivos, en dosis de 5, 10 ó 20 mg/Kg. peso corporal, las cuales fueron procesadas según el método histológico de rutina e histoquímico del P.A.S. Con la dosis de 20 mg/Kg, peso corporal se observaron diversas modificaciones estructurales, según el número de dosis y el tiempo de administración de la droga, tales como hiperplasia de células de Kupffer, dilatación de los capilares sinusoidales, infiltrado inflamatorio periportal, tumefacción turbia y necrosis focal centrolobulillar. En los animales que recibieron las dosis más elevadas de Pir, el método del P.A.S. demostró una reacción negativa levemente positiva para el glucógeno de los hepatocitos, lo cual corrobora los hallazgos obtenidos por nosotros mediante procedimientos analíticos bioquímicos. En base a los resultados precedentes podemos sugerir que las alteraciones morfológicas inducidas por la administración de Pir corresponden a las de hepatitis reactivas leves no específicas

Psoríase eritrodérmica induzida por piroxicam: relato de um caso / Psoriatic erythroderma precipitated by piroxicam: a case report

Os autores relatam um caso de psoríase eritrodérmica induzida pelo uso de piroxicam. A retirada da droga e a prednisona näo promoveram controle do quadro, o que se obteve com o etretinato

Empleo de un antiinflamatorio en el control del daño hepático inducido con CCl4 / Use of anti-inflamatory drug on the control of liver cell damage induced by CCl4

El presente trabajo tiene como objetivo estudiar el posible efecto protector de un antiinflamatorio no esteroideo, piroxicam, en el daño hepático crónico inducido con CCl4 en un modelo experimental con ratas. Su evaluación se hace mediante parámetros bioquímicos y el estudio histológico de biopsias hepáticas. En las condiciones empleadas el uso del antiinflamatorio protege al hígado de los animales tratados con el hepatotóxico.