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Statement: It
is inappropriate to apply the same restrictions, review
processes and scrutiny to rheumatologists prescribing
Cyclooxygenase 2 inhibitors (COX 2) or other nonsteroidal
antinflammatory (NSAID) medications as those used to
review, restrict or scrutinize other physicians. The
North Carolina Rheumatology Association strongly recommends
alteration of the review processes and restrictive processes
for rheumatologists prescribing any and all anti-inflammatory
agents for the care of patients with serious inflammatory
rheumatic diseases. To continue to do otherwise is counter-productive,
costly, inappropriate and harmful to patient care.
COX 2 anti-inflammatory medications
represent a significant advance in rheumatology therapeutics.
COX 2 agents do not alter platelet function and are
therefore safer in patients with bleeding disorders
and in patients on anticoagulation such as Warfarin,
and COX 2 agents have been shown to cause less gastrointestinal
toxicity compared to other available agents. Appropriate
selection of anti-inflammatory agents for chronic uses
in inflammatory rheumatic diseases is complicated by
other existing comorbid conditions, use of concomitant
medications prescribed by other physicians, patient
age and patient debility. This medical decision making
process differs significantly from NSAIDs selection
for short-term use in acute musculoskeletal traumas
and injuries, minor, short term arthritic problems or
for other non-rheumatic purposes by other specialists.
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