ScienceDaily (Nov. 25, 2004) — November 22, 2004 -- Patients with knee osteoarthritis should avoid long term use of non-steroidal anti-inflammatory drugs (NSAIDs), say researchers in a study published on bmj.com today.

Current guidelines recommend the use of oral NSAIDs in the treatment of knee osteoarthritis and they are used regularly by half of all patients with painful osteoarthritis.

Researchers in Norway analysed 23 trials to estimate the pain relieving effects of NSAIDs in patients with knee osteoarthritis. The final sample involved 10,845 patients, of whom 7767 received NSAIDs and 3078 received placebo.

The analysis revealed that NSAIDs can reduce short term pain slightly better than placebo, but it does not support long term use of NSAIDs for this condition, say the authors. The advantage of oral NSAIDs over placebo for short term pain relief is small and probably clinically insignificant, they add.

"As use of oral NSAIDs may incur serious adverse effects, they can only be recommended for limited use in osteoarthritis of the knee," they conclude.

Anti-inflammatory drugs are the primary means used by physicians to treat OA.  It is important to understand that none of the anti-inflammatory drugs are considered “disease modifying.”  This means that the main drugs used to support people with OA do not affect the actual state of the joint tissue nor do they slow the progression of joint destruction.  This does not mean that the drugs are not helpful.  But it is important to understand how and why they are to be used.

In one study, only 50% of all people taking regular NSAIDS (non-steroidal antiinflammmatory drugs) report good or complete relief and satisfaction with the treatment.  Also, only 40% of people with OA report adequate pain relief from acetaminophen (Tylenol). [Hawkey, CJ, et al. Aliment Pharmacol Ther 2000;14:177-185.] [Schnitzer, TJ. Clin Ther 2001;23(3):313-326] [March, L, et al. BMJ 1994;309:1041-104]

Selective COX-2 Inhibitors

Selective COX-2 inhibitors are the “newer” class of drugs use to treat OA pain, which includes the likes of Celebrex and Vioxx.  Because of cardiovascular concerns, doctors and patients have grown more cautious about using these compounds.  Vioxx was pulled from the market because of an increased risk of adverse cardiovascular events. The only selective COX-2 inhibitor currently on the market is Celebrex (celecoxib).

The list of selective COX-2 inhibitors is found below:

etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib

Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation

Guidelines for Use of Anti-Inflammatory Drugs

5 Things You Need to Know About NSAIDs

1. Types of NSAIDs.  There are three main classes of NSAIDs.  These include salicylates, non-selective COX inhibitors, and selective COX-2 inhibitors.

2. How they work

3. They don't work for everyone. Individuals vary widely in their response to NSAIDs. Many people must try several different NSAIDs to find one that works best. Some may find that a particular NSAID wanes in its effectiveness, requiring experimentation with a new one. Only some 50 percent of people report good or complete relief with NSAIDs.

4. Pain vs inflammation.  The dose at which NSAIDs relieve pain is much lower than the dose at which they relieve inflammation.  For example, ibuprofen may relieve pain at 200 to 400 mg. But it does not provide much additional benefit by raising the dose to 600 or 800 mg. In fact, side effects are more likely with higher doses.

5. Over-the-counter NSAIDs are not really safer.  There is a commonly held belief that over-the-counter NSAIDs are safer because they are typically sold in lower dosage forms.  However, even these low doses can cause side effects, especially in long long term users or those who have a risk to GI or kidney disease.

NSAIDs Currently Available