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. Gregory 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 because it was not working 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.
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