Outcome of specific COX-2 inhibition in rheumatoid arthritis.

We reviewed data suggesting the hypothesis that specific inhibition of the inducible isoform of cyclooxygenase, COX-2, would provide therapeutic benefit in patients with rheumatoid arthritis (RA) with less gastrointestinal toxicity and presented the results of a therapeutic trial to test this hypothesis. Various doses of the selective COX-2 inhibitor, celecoxib, or placebo were used to treat patients with RA in a 4 week, double blind, placebo controlled trial. Celecoxib provided significant improvement in patient global assessment, morning stiffness, and the number of painful and tender joints compared with placebo. In addition, the number of withdrawals in celecoxib treated patients was significantly less than in the placebo group. No significant adverse events and no difference in the total number of adverse events were noted between the placebo and celecoxib groups. At the doses employed, celecoxib inhibited only COX-2 and not COX-1. Specific COX-2 inhibition with celecoxib causes significant improvement in the signs and symptoms of RA.