[Not Available].

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat pain and inflammation in osteoarthritis and rheumatoid arthritis. However, their long-term use is often limited by gastrointestinal mucosal injury and complications like bleeding, ulceration and perforation. Hence, the hope evolved that selective COX-2 inhibitors, a newly developed class of anti-inflammatory drugs, may be equally effective but better tolerated than nonselective NSAIDs. However, this enthusiasm was partly dampened by the fact that the exclusive use of selective COX-2 inhibitors is probably not justified. Particularly in patients treated with low-dose of aspirin for cardiovascular prophylaxis, the COX-2 inhibitors seem to have no obvious advantages over conventional NSAIDs. Furthermore, use of COX-2 inhibitors has recently been associated with enhanced cardiovascular risk. There is some evidence that COX-2 inhibitors may act via COX independent pathways and might be used for indications other than arthritic pain and inflammation.