Osteoarthritis and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

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1 What is the first-line therapy for osteoarthritis and the mechanism of action?
Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for osteoarthritis (Magni et al., 2021). Its principal mode of action enables it to stop the action of cyclooxygenase (COX), which is necessary to transform arachidonic acid into thromboxanes, prostacyclins, and prostaglandins. Thromboxanes induce platelet aggregation. Prostacyclin and prostaglandin are vasodilators. The former prevents platelet aggregation by inducing cyclic adenosine monophosphate levels, while the latter heightens the set temperature recognition of the hypothalamus and inhibits pain perception (Ghlichloo & Gerriets, 2021).
The two types of NSAIDs are selective and non-selective. The former only inhibits cyclooxygenase 2 (COX-2), an isoenzyme responsible for starting an inflammatory response. The latter inhibits cyclooxygenase 1 (COX-1) and COX-2. The function of COX-1 is mainly on the maintenance of gastrointestinal (GI) mucosal lining, platelet aggregation, and kidney function. Therefore, selective COX-2 inhibitors are anti-inflammatory and gastroprotective, while non-selective NSAIDs invade the gastric mucosa (Ghlichloo & Gerriets, 2021).
2 Sally expresses concern about all the recent news about heart problems and celecoxib (Celebrex). What information should be included in a teaching plan to help her understand taking celecoxib and the benefits and risks?
Celecoxib is a selective COX-2 inhibitor. It is beneficial for patients with osteoarthritis because it has anti-inflammatory, analgesic, and anti-inflammatory effects (Ghlichloo & Gerriets, 2021). However, to better understand the benefits and risks of using this drug, the pathophysiology of the disease must be first explained to Sally in layman’s terms.
This is a sample explanation. The ends of our bones, like in our knees, have articular cartilages, which act as cushions. When two bones connect, a space separates them and cushions to prevent contact and friction between the bone ends. Thus, this helps prevent damage to the bones. However, in osteoarthritis, the cushion is disrupted, and the damage extends to the bone ends. When our body detects the damages, it produces inflammatory agents, which cause swelling in the area. In turn, this results in pain and stiffness that the patient feels (Sen & Hurley, 2021). Celecoxib counteracts inflammation and reduces pain by inhibiting the inflammatory agents (Ghlichloo & Gerriets, 2021).
The patient will also be educated on the cardiovascular risks of taking the drug. Its adverse effects on the cardiovascular system are secondary to inhibiting COX-2 derived prostacyclin without inhibiting COX-1 derived thromboxane A2 (TXA2). This increases the risk for atherothrombotic events such as myocardial infarction and stroke. (Pisano, 2016; Beales, 2018). However, this only happ...