Challenge of the Week / Knee / 09.24.2021

A 53-year-old female patient presents with chronic right knee pain. She states that the pain is located in the medial aspect of her knee. Radiographic assessment of her knee shows medial joint-space narrowing and periarticular osteophytes. When deciding whether to prescribe celecoxib, which of the following should you consider? 

    • Cyclo-oxygenase-2 (COX-2) inhibitors are associated with fewer gastrointestinal (GI) side effects because COX-1 inhibition decreases the protective mucus of the GI tract
    • Celecoxib is a COX-2 selective inhibitor. COX-1 targets the protective mucosa of the GI tract. Selective COX-2 inhibitors minimize gastrointestinal side effects by avoiding inhibition of COX-1.
    • Nonselective cyclo-oxygenase (COX) inhibitors have a lower risk of cardiovascular side effects
    • Certain selective COX-2 inhibitors were associated with unacceptably high cardiovascular side effects and were removed from the market. Celecoxib is a selective COX-2 inhibitor.
    • Cyclo-oxygenase-2 (COX-2) inhibitors preferentially target the COX isoform that is responsible for protecting the gastrointestinal (GI) tract
    • COX-1 is associated with the protective GI tract mucosa. COX-2 inhibitors selectively target the inflammatory pathway.
    • Cyclo-oxygenase-1 (COX-1) inhibitors have been associated with an unacceptably high risk of cardiovascular events
    • COX-2 inhibitors have been associated with an unacceptably high risk of cardiovascular events.

     

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