Preserved human remains, artefacts and works of art contain records of the existence and prevalence of arthropathies, even in the absence of medical texts or formal written accounts, although these also exist for some epochs and cultures. Example objects from the Museum of Medical History in Brussels have been used to illustrate the magnitude of the burden of pain throughout the ages and how rheumatic diseases have indiscriminately afflicted people regardless of their positions in life or occupations. These include both osteoarthritis (OA) and rheumatoid arthritis (RA), as well as the seemingly ubiquitous gout and various skeletal deformities. Adequate pain management has been severely hampered, historically, by obstacles to a comprehensive and systematic classification of diseases posed by the social, religious and philosophical mores of the time, which made differential diagnosis almost impossible to achieve. However, despite this shortcoming, serendipitous events meant that precursors of modern medicines, such as willow bark extracts, were in routine use from the earliest recorded times. It has taken several millennia, however, before empirical treatment has given way to pharmacological rationale. The first clinically acceptable synthetic derivative of the active principle in willow, aspirin, became available only at the turn of the nineteenth century, while non-steroidal anti-inflammatory drugs (NSAIDs) did not arrive on the market until some 60 yr later. At the cusp of the twentieth and twenty-first centuries, physicians have a wider choice of analgesics available than ever before, including the cyclooxygenase-2 inhibitors, which represent the first major advance in NSAID development since the synthesis of the latter compounds themselves.

Non-steroidal anti-inflammatory drugs (NSAIDs) have frequently been linked with unpleasant gastrointestinal (GI) side-effects such as dyspepsia and ulcers. The present study investigated the burden of NSAID therapy from a patient perspective and also reviewed previously published data on satisfaction with a less gastrotoxic anti-inflammatory drug, rofecoxib. A questionnaire was sent to > 6000 members of the Norwegian Rheumatism Association requesting information on use and toxicity of NSAID therapy and requirements for supplementary gastroprotective and analgesic medication. The questionnaire confirmed a high incidence of NSAID use. About two-thirds of users changed brands of NSAIDs at least once, usually because of adverse effects and poor efficacy. Supplementary over-the-counter (OTC) and prescription analgesics were required by 72 and 59% of patients, respectively, while OTC and prescription gastroprotective agents to treat NSAID toxicity were required by 35 and 30%. This new patient-focused survey showed that treatment with conventional NSAIDs was unsatisfactory in terms of GI toxicity and sub-optimal pain relief. Reviewing EVA (Experience with VIOXX in Arthritis) data showed that there was a high level of approval for rofecoxib, with > 80% of 74,192 osteoarthritis (OA) patients expressing a preference for continuing such therapy. Preference for rofecoxib was significantly higher among patients with prior experience of conventional NSAIDs or other OA-specific medication. In EVA, the reduced GI toxicity of rofecoxib previously reported in other studies appeared to translate into a strong preference to continue this therapy in a large sample of patients. This is not surprising, given the poor satisfaction with NSAIDs highlighted by the Norwegian survey.

Rheumatoid arthritis (RA) and osteoarthritis (OA) are chronic conditions requiring long-term therapy for pain relief. Currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) provide symptomatic efficacy, but are frequently associated with gastrointestinal (GI) toxicities such as dyspepsia and ulcerations. In a small but significant number of cases, complications including perforations and massive bleeding develop and these may be fatal. A desirable therapeutic strategy would maintain efficacy while minimizing gastric intolerance. Two potential approaches have been suggested: (i) administration of NSAIDs in combination with gastroprotective compounds; or (ii) administration of potentially safer anti-inflammatory compounds which act via selective inhibition of cyclooxygenase-2 (COX-2). The selective COX-2 inhibitors rofecoxib and celecoxib consistently demonstrate efficacy comparable to conventional NSAIDs in patients with RA and OA, but have a significantly reduced propensity to cause GI toxicity. In many cases, the gastric effects of therapeutically active doses of COX-2 inhibitors are indistinguishable from placebo. The safety benefits of COX-2 inhibitors given alone appear similar to combined therapy with conventional NSAIDs and gastroprotective agents. Findings warrant the consideration of COX-2 inhibitors as first-line therapy in patients requiring long-term pain relief.

To establish opinion and clinical practice of senior clinicians working with children with rheumatic diseases with regard to immunization and to determine whether or not this is in accordance with current recommendations. To review published guidelines on the subject and examine the evidence base supporting them.

To investigate the involvement of neuroendocrine candidate genes in the aetiopathogenesis of juvenile idiopathic arthritis (JIA).

Antiphospholipid antibodies (aPL) are major risk factors for thrombosis. Other clinical factors exist in antiphospholipid syndrome (APS) patients which may have an additive or preventive effect on thrombosis. We therefore performed a cross-sectional study to analyse additive clinical thrombotic risk factors and possible preventive treatments in APS patients, and to compare the results with those obtained in asymptomatic aPL-positive (no history of vascular thrombosis or pregnancy morbidity) patients.