The process of inflammation starts with arachidonic acid which is a key ingredient in cell walls. Arachidonic acid is produced when cells are subjected to stress from aging, trauma, or wear and tear. Arachidonic acid is then converted into prostaglandins which are the primary mediators of inflammation. The process of arachidonic acid conversion to prostaglandins is through two enzyme pathways - cyclooxygenease (COX) or lipoxygenase (LOX).

Cyclooxygenease is an enzyme pathway that has two components. The first is COX 1 and the second is COX-2. COX-1 is responsible for the inflammatory response but also plays a role in helping to protect the stomach from ulcers and promoting normal kidney function. COX-2 also has a large role in the inflammatory response. Traditional anti-inflammatory medicines block both COX-1 and COX-2. Examples include ibuprofen, naproxen, sulindac, indomethicin, nabumatone, etc. By doing this they inhibit inflammation but also make the body vulnerable to certain conditions such as stomach ulcers, high blood pressure, and kidney problems.

Drugs that block COX-2 alone also block inflammation. There has been concern that blockade of COX-2 may also have deleterious effects such as elevated blood pressure, reduced kidney function, and possibly an increased tendency for heart attack and stroke. Vioxx was removed from the market after concerns regarding the possibility of an increase in cardiovascular problems related to this drug. Celebrex is the only COX-2 drug that remains on the market. It is currently undergoing extensive trials to further evaluate its safety profile. Interestingly, it appears now that all anti-inflammatory drugs share a similar risk for causing cardiovascular events to occur.

Another important cause of inflammation are Reactive Oxygen Species. These are also known as “oxygen free radicals.” These oxygen free radicals lead to the production of pro-inflammatory proteins.

One medication undergoing clinical trials is a plant-derived anti-inflammatory product called flavocoxid. This medication apparently has effects on COX-1, COX-2, as well as LOX. Clinical data so far has shown that the side-effect profile is significantly lower than that for other anti-inflammatory drugs. Flavocoxid is a blend of phytochemical compounds derived from fruits and vegetables.

Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on flavocoxid as well as arthritis clinical trials, go to http://www.aocm.org

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