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René Dávila

MÉXICO.-Las expectativas de vida, con calidad, rebasan actualmente los 60 años de edad, gracias a los estudios a nivel mundial; sin embargo, en determinadas enfermedades como la osteoartritis y artritis reumatoide, los pacientes van con el médico general o recurren a la consulta telefónica del médico familiar, lo que es un error, ya que no acude con el especialista, lo que a la larga se verá más afectado en su padecimiento.

De ahí, que las investigaciones se centra en la búsqueda de nuevos fármacos, como los denominados productos biológicos de Merck Sharp & Dohme (MSD), que está por arriba de los demás laboratorios en este padecimiento con su Arcoxia, con lo que cada vez más se ofrecerán opciones terapéuticas.

El Dr. Hilario Ernesto Ávila Armengol, médico especialista en medicina interna y reumatología por parte de la Facultad de Medicina de la Universidad de Guadalajara, México, destaca en entrevista, que dos millones de mexicanos sufren de artitris reumatoide, en cuya enfermedad de tipo inflamatorio ocurre un proceso de producción de sustancias que van a inflamar, lo que normalmente recubre y origina la producción de liquido dentro de una articulación y esta membrana que produce este liquido, es la que va a originar el daño y posteriormente la presencia de sustancias que causan dolor y a la larga explosión del tejido articular, principalmente del cartílago que cubre el hueso.

A la larga, el proceso básico es la inflamación y se presenta más comúnmente en las mujeres y puede presentarse desde los 25 años; afectando principalmente a las mujeres, y puede llegar a provocar incapacidad, desde el no poderse vestir o bañarse.

Para el especialista, en unos cinco años más, Merck Sharp & Dohme, en el área de reumatología, se colocará a la vanguardia en dicha enfermedad, así como en la osteoporosis, entre otros padecimientos, ya que constantemente lleva a cabo programas como el MEDAL, que es el único estudio clínico a nivel mundial que investiga la seguridad cardiovascular de un inhibidor selectivo de COX-2, en comparación con un AINE tradicional.

El Programa está conformado por 3 estudios (EDGE, EDGE II y MEDAL) que evaluó la seguridad cardiovascular y tolerabilidad gastrointestinal en 34,701 pacientes con osteoartritis y artritis reumatoide. El 47 por ciento de los pacientes incluidos en el estudio tenían hipertensión arterial y 38 por ciento tenían factores de riesgo cardiovacular (tabaquismo, diabetes, hiperlipidemia, entre otros). El estudio MEDAL mostró que Etoricoxib (COX-2) en comparación con Diclofenaco, comparten un nivel de seguridad cardiovascular similar en pacientes que requieren tratamiento con antiinflamatorios por largo plazo.

Pese a todo ello, el doctor Ávila Armengol, reconocido como miembro fundador de la Clínica de Osteoporosis y Reumatología en la ciudad de Guadalajara, en donde actualmente se desempeña como jefe, lamenta que la gente no acuda al médico especialista,

porque en los primeros síntomas, sólo siente un poco de malestar o fatiga, por algunos días, y lo atribuye a otras causas, hasta cuando se va a gravando y sufre de las articulaciones, es cuando piensan en ir al médico, no sin antes automedicarse.

Decide tomar cualquier tipo de antiinflamatorio, lo que a la larga le va a afectar más, y si se suma el hecho de que va con el médico general, al cabo de los años, lo que ocasiona que la oferta del tratamiento pueda ser solo para frenar el desarrollo de la enfermedad o sólo para tratar de disminuir las incapacidades.

Desde hace 30 años la artritis reumatoide ha sido tratada con productos que disminuyen los síntomas, como los antiinflamatorios (el tratamiento estándar o conocido es de los 2.500 pesos al mes en promedio), pero que no son capaces de frenar la artritis, y la otra, son los modificadores de la enfermedad, éstos se encargan de evitar que progrese la inflamación y por tanto la incapacidad, pero desde hace siete años existen productos biológicos, que van a generar una respuesta de beneficio más rápida. Sin embargo, hasta el momento el inconveniente es el alto costo del tratamiento que en promedio es de 12 a 24 mil pesos al mes, y con duración de hasta un año, lo que representa un impacto en la economía del paciente.

Pero, la combinación de los tratamientos, dependiendo del paciente (antiinflamatorios y los que detienen la enfermedad), es bastante positivo, lo que esos tratamientos hacen hablar a la gente de los buenos beneficios.

Cabe destacar que el tratamiento del dolor, exclusivamente, no es el punto central del manejo de la artritis, y más aun que mucha gente y los médicos no especialistas en el área, pueden abusar del uso de antiinflamatorios, ocasionando un gran número de sangrados del tracto digestivo, y eso muy frecuente, por lo que para evitar esto, fueron creados desde el año 2000 los medicamentos Inhibidores de la Diclo Oxigenasa 2 (COX-2) que son tan semejantes como un antiinflamatorio y evitan el daño gastrointestinal, que es lo que ocurre con los tradicionales, con ello, hasta 30 o 40 por ciento de eventos menos de sangrados o de perforaciones o complicaciones intestinales.

Entre los COX-2 está el que se conoce en el mercado como Arcoxia que reduce el riesgo de sangrados y complicaciones intestinales hasta en un 40 por ciento y que son seguros desde el punto de vista cardiovascular. Este tipo de medicamentos es capaz de reducir en 24 horas la sensación de dolor, mejorar la movilidad, pero combinado con modificadores de la enfermedad o los tratamientos biológicos.

Para el especialista, que ha sido coordinador y profesor del programa tutorial para residentes de primer año de la especialidad de Medicina Interna y profesor del área de Reumatología y de Medicina Basada en Evidencias, del Centro Universitario de los Altos, Universidad de Guadalajara, el Arcoxia se puede emplear para tratar el dolor e inflamación generado por la artritis reumatoide, la ostroartrosis y el dolor de la disminorrea o de la menstruación.

El medicamento bloquea o disminuye la encima ciclooxigenasa2 que es la que promueve la inflamación, así que al bloquear ésta, ya no se presente la síntesis de prostaglandina con lo que ya no hay el proceso de inflamación, su periodo de acción empieza a actuar a los 20 o 30 minutos, y su efecto promedio es de unas 20 horas.

No obstante, aclara el reumatólogo e internista adscrito a la División de Medicina Interna, además de contar con una certificación por parte del Consejo Mexicano de Reumatología, la prescripción es de una dosis y no debe ser utilizado en pacientes que hayan tenido en los últimos seis meses un infarto de miocardio, que hayan tenido cirugía cardiovascular o que tengan angina de pecho no controlada, entre otras afecciones. Y, aunque el consumo de dos o tres o más tabletas de manera incidental, el daño intestinal sería una de las primeras aquejas y el daño hepático.

El medicamento innovador con algún tiempo ya en el mercado y que su gran ventaja es la seguridad cardiovascular y gastrointestinal, es el único medicamento que no tiene un riesgo alto y que también tiene beneficios en la Espondilitis Anquilosante, entre otras enfermedades reumatológicas, a pesar de que aún no se encuentra en el cuadro básico de la Secretaría de Salud.

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hola yo tengo artritis reumatoide desde hace 4 años y eh probado arcoxia con exelentes resultados pero eh tenido que dejarla por su elevado costo,deberia conciderar que las personas con artritis tenemos muchos gastos con doctores, medicamentos, analisis, deberian el laboratorio deberia de dar apoyo al paciente con esta medicamento ya que en mi caso es muy neesario. gracias

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