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NSAIDs Edge Out Tylenol for Arthritis Relief
Aspirin not included in new study but Cox-2
inhibitors were
By Bruce Sylvester, Contributing Writer
Health Behavior News Service
Jan. 25,2006 - Although everyday acetaminophen
reduces pain from osteoarthritis of the hip or knee, people with
moderate to severe pain do better on non-steroidal anti-inflammatory
drugs, a new review of previous studies concluded.
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The review comprised 15 studies involving 5,986
participants. Seven of the trials compared acetaminophen (sold as
Tylenol) to placebo and 10 compared acetaminophen to NSAIDs. Studies
looked at the traditional NSAIDs such as ibuprofen (sold as Advil,
Nuprin, Haltran, Medipren, Motrin, Midol, Brufen and Genpril),
diclofenac (sold as Cataflam, Voltaren and Voltaren-XR), a combination
of diclofenac and misoprostol (sold as Arthrotec) and naproxen (sold as
Aleve).
The studies under review also included two drugs
from the relatively new class of NSAIDs known as Cox-2 inhibitors,
celecoxib (sold as Celebrex) and rofecoxib (which was once sold as Vioxx
and is no longer on the market). Aspirin was not included in the
studies.
The review, led by Tanveer Towheed of Queens
University in Ontario, appears in the new issue of The Cochrane Library,
a publication of The Cochrane Collaboration, an international
organization that evaluates medical research. Systematic reviews draw
evidence-based conclusions about medical practice after considering both
the content and quality of existing medical trials on a topic.
Acetaminophen showed superior effectiveness
compared to placebo for reducing osteoarthritis-related pain. But when
compared to NSAIDs, acetaminophen was less effective. On a scale of
0-100, pain decreased 4 more points for patients who took acetaminophen
versus those who took a fake pill, and pain decreased 6 more points
among those who took NSAIDs instead of acetaminophen.
"There does not appear to be a major difference in
side effects between acetaminophen and NSAIDs, although people taking
traditional NSAIDs were more likely to have stomach problems," the
researcher said. They found that 19 percent of patients in the NSAID
group versus 13 percent in the acetaminophen group experienced
gastrointestinal side effects.
On average, the trials examined lasted only six
weeks, making it difficult to arrive at a solid conclusion about adverse
effects, and the authors recommend that decisions be made on the basis
of patient preference, individual risk factors, cost, availability of
the drugs and the doctors judgment.
Osteoarthritis is the most common form of
arthritis. An estimated 12.1 percent of Americans age 25 and older show
signs and symptoms of osteoarthritis. About 6 percent of Americans who
are 30 and over will develop osteoarthritis of the knee, and about 3
percent will develop osteoarthritis of the hip.
The authors note that the guidelines for treatment
and the opinions of osteoarthritis experts are not uniform in their
recommendations of acetaminophen and non-steroidal anti-inflammatory
drugs as first-line treatments.
Guidelines from the American College of
Rheumatology recommend acetaminophen as initial therapy in patients with
mild to moderate osteoarthritis pain. However, for patients with
moderate to severe pain, NSAIDs are suggested as an alternative initial
therapeutic approach.
Canadian guidelines recommend NSAIDs as the drug of
choice for treatment of moderate to severe osteoarthritis, suggesting
acetaminophen as first-line treatment for patients with mild pain.
"There was a statistically significant improvement
in patients arthritis pain and function in patients taking
acetaminophen compared to placebo, but it is unclear if this of clinical
significance," said Scott Zashin, M.D., author of a book on arthritis
pain and assistant clinical professor at University of Texas
Southwestern Medical School. "In other words, patients did better on the
acetaminophen but it was not by much.
Note
The Cochrane Collaboration is an international
nonprofit, independent organization that produces and disseminates
systematic reviews of health care interventions and promotes the search
for evidence in the form of clinical trials and other studies of
interventions. Visit
http://www.cochrane.org for more information.
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