Anti-inflammatory deemed best for arthritic knees

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Anti-inflammatory deemed best for arthritic knees

By Emma Hitt, PhD

NEW YORK, Jan 01 (Reuters Health) - Acetaminophen is recommended for the

relief of arthritis pain, but new study results show that a relatively

high dose of an anti-inflammatory drug provides greater pain relief.

In osteoarthritis--the type of arthritis that usually occurs with

aging--the cartilage cushioning the ends of bones breaks down, leading

to pain and loss of movement in the joints.

Acetaminophen, used in products such as Tylenol, was recommended in 1995

and again in 2000 by the American College of Rheumatology as a

" first-line " therapy for the treatment of joint pain from

osteoarthritis.

This decision was made partly because of concern about stomach upset

with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as

aspirin and ibuprofen, which are commonly used for arthritis pain.

Most NSAIDs block both forms of the enzyme cyclooxygenase (COX). COX-1

helps protect the stomach lining, while COX-2 is involved in

inflammation. A new class of NSAIDs blocks COX-2 but doesn't affect

COX-1, so these drugs--which include Celebrex (celecoxib) and Vioxx

(rofecoxib)--may have the potential to avoid stomach problems.

Researchers led by Dr. P. Geba of Merck & Company, Inc., the

manufacturer of Vioxx, conducted a study comparing the pain relief

abilities of the drug to the rival drug Celebrex (co-marketed by Pfizer

and Pharmacia), and acetaminophen.

A total of 382 patients with knee osteoarthritis received 12.5 or 25

milligrams (mg) of Vioxx, 200 mg of Celebrex or 4,000 mg acetaminophen

daily for 6 weeks.

The researchers evaluated the effectiveness of the medications by asking

patients about their pain on walking, morning stiffness, night pain and

pain at rest.

Thirty-one percent of patients in the acetaminophen group stopped taking

their medication early compared with about 18% to 19% in each of the

other groups.

The researchers found that a 25-mg dose of Vioxx was more effective than

acetaminophen, the lower Vioxx dose, or Celebrex.

The side effects were similar among the four treatment groups and " all

treatments were generally safe and well tolerated, " the researchers note

in the January 2nd issue of The Journal of the American Medical

Association.

In an interview with Reuters Health, study author Geba said the major

benefit of Vioxx and Celebrex is that they require taking only one pill

a day, versus eight daily for acetaminophen.

" This is obviously going to translate into much greater convenience for

patients, " he said. " And on top of it they are going to be getting

additional efficacy. "

SOURCE: The Journal of the American Medical Association 2002;287:64-71.