Osteoarthritis (OA) is responsible for more disability of the lower extremities in the elderly than any other disease in the US. The pain associated with OA is the primary symptom leading to disability in these patients. Current ACR guidelines recommend consideration of acetaminophen for mild-to-moderate pain and conventional non-steroidal anti-inflammatory drugs (NSAIDs) or COX-2 specific inhibitors for moderate-to-severe OA symptoms. The aim of this study was to compare the efficacy and safety of the COX-1 sparing, COX-2 specific inhibitor, celecoxib, with the conventional NSAID naproxen, and placebo, in the treatment of OA of the hip. In this multicenter, randomized, placebo-controlled trial, 1061 patients with symptomatic OA of the hip were randomized to receive celecoxib at doses of 100 mg, 200 mg, or 400 mg/day; naproxen 1000 mg/day; or placebo, for 12 weeks. Patients were evaluated using standard measures of efficacy at baseline, 2-4 days after discontinuing previous NSAID or analgesic therapy, and after 2, 6, and 12 weeks of treatment. All doses of celecoxib and naproxen significantly improved the symptoms of OA, at all time points compared with placebo. This sustained treatment effect of celecoxib was dose dependent. In terms of pain relief and improvement in functional capacity, celecoxib 200 mg/day and 400 mg/day were similarly efficacious and were comparable to naproxen. Both drugs were generally well tolerated. Celecoxib at a dose of 200 mg/day is as effective as a standard therapeutic dose of the conventional NSAID, naproxen, in reducing the pain associated with OA of the hip.

Adult↗

PubMedDate not supplied

The role of anti-inflammatory drugs in the treatment of osteoarthritis: a United States viewpoint.

Guidelines for the treatment of osteoarthritis (OA), first published in 1995 under the auspices of the American College of Rheumatology, were updated with publication of revised recommendations in September 2000 to take account of significant advances in OA management. These advances include increased understanding of the disease process and the introduction of new medications, including the cyclooxygenase-2 (COX-2) selective inhibitors and the intra-articular hyaluronans. In addition, studies demonstrating superior efficacy of non-steroidal anti-inflammatory agents (NSAIDs) vs acetaminophen in the treatment of OA led to a re-evaluation of indications for initial pharmacologic approaches, given the availability of safer NSAIDs. In contrast to the previous recommendation that acetaminophen was the drug of choice for the initial treatment of all patients with OA, the new recommendations support consideration of the use of NSAIDs as initial treatment--either COX-2 selective inhibitors or classical NSAIDs with gastroprotective agents--particularly in patients with moderate to severe pain and inflammation. The important role of non-pharmacologic approaches including weight loss, avoidance of joint overuse, appropriate exercises and orthotics was re-emphasized. It is anticipated that guideline revisions will take place at more frequent intervals in the future, given today's rapid advances in therapeutic approaches, not only for symptomatic therapy but also for therapy targeted to structural disease modification.

Acetaminophen↗

PubMedDate not supplied

A histopathologic differentiation of tissue types in human osteoarthritic cartilage.

A histopathologic system of classifying minced human hip and knee osteoarthritic cartilage often used in organ cultures was developed. The tissue types characterizing the cartilage fragments were correlated with characteristics noted in full thickness cartilage specimens from young normal, aged and osteoarthritic cartilage. In the minced tissue specimens 3 distinct tissue types (A, B, and C) were discerned. Tissue types A and B were seen in nonfibrillated discolored as well as fibrillated osteoarthritic cartilage. Type C tissue was derived principally from chondroosteophytic spurs. Each tissue type differed in the number and organization of chondrocytes and orthochromatic and metachromatic staining of the perilacunar region and interterritorial matrix. No A, B or C tissue types were seen in normal cartilage samples derived from patients below the age of 50. Cartilage from patients above this age contained elements of all 3 tissue types.

Adult↗

PubMedDate not supplied

Pathologic and metabolic responses of experimental osteoarthritis to estradiol and an estradiol antagonist.

Tamoxifen, an estradiol antagonist, and estradiol were separately evaluated in a rabbit experimental osteoarthritis. Cartilage from anatomically defined regions of individual rabbit knees was assayed for sulfate and thymidine incorporation. Tamoxifen reduced erosive osteoarthritic pathology, while estradiol worsened it. There was no effect on the incidence of osteophytes. Metabolic studies in organ culture showed no changes relating to treatment. The results suggest that specific medical therapy for osteoarthritis is within the realm of possibility.

Animals↗

PubMedDate not supplied

A trial of intraarticular orgotein, a superoxide dismutase, in experimentally-induced osteoarthritis.

Intraarticular injections of orgotein, a metalloprotein with superoxide dismutase activity, did not ameliorate experimentally-induced osteoarthritis in the rabbit. Reduction of sulfate incorporation by cartilage of operated osteoarthritic knees with injection of saline-sucrose placebo and orgotein in saline-sucrose vehicle was observed. Repeated intraarticular injections of both orgotein in a sucrose-saline vehicle, and sucrose-saline placebo administered separately induced a severe synovitis in both osteoarthritic and normal knees.

Animals↗

PubMedDate not supplied

[Mutation of collagen genes and familial osteoarthritis].

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Collagen↗