Non-steroidal antiinflammatory drugs (NSAIDs) are slightly more effective than acetaminophen in treating the symptoms of osteoarthritis (OA), according to a retrospective review of 15 randomized controlled trials.
For the review, which was recently published in The Cochrane Library, researchers assessed results from seven trials that compared acetaminophen to placebo, and 10 trials that compared acetaminophen to NSAIDs.

In the study review of nearly 6,000 patients with OA of the hip or knee, the authors found that on a scale of 1 to 100, there was a four-point greater decrease in pain for those who took acetaminophen daily compared to those in the placebo group. According to the study, there was a six-point greater decrease for those who took NSAIDs as opposed to acetaminophen.

The studies revealed that patients taking NSAIDs had less pain and stiffness, and more improved physical function than those who took acetaminophen. While acetaminophen demonstrated a greater reduction in pain than the placebo, researchers note that the effects on physical function and stiffness were similar.
“It appears that acetaminophen has a relatively small degree of benefit in patients with symptomatic OA of the hip and knee,” says Tanveer Towheed, BA, MD, the lead author of the study review and an Associate Professor at Queens University in Ontario, Canada.

A review of studies found that patients taking NSAIDs for osteoarthritis had less pain and more improved physical function than those who took acetaminophen.

The authors of the study review note that the NSAIDs studied included ibuprofen, diclofenac and naproxen as well as COX-II inhibitors such as celecoxib and rofecoxib (with the latter drug no longer available). Aspirin was not included in the study, according to the researchers.

In terms of side effects, NSAIDs have been associated with potential cardiovascular and gastrointestinal risks. In the study review, the authors found that those taking traditional NSAIDs (ibuprofen, naproxen) had a slightly higher risk of gastrointestinal side effects than those who took acetaminophen. Otherwise, the study found no significant difference in side effects (even with the COX-II inhibitors).

However, Dr. Towheed cautions that the studies in the review lasted only six weeks on average. Accordingly, he says it is difficult to come away with strong conclusions about side effects from “relatively short-term clinical trials.”

When it comes to treating OA, Dr. Towheed also points out there is often “some degree of trial and error” with different therapeutic options and adjustments of treatment strategies. Overall, he notes that NSAIDs and acetaminophen are “useful options” in managing OA.

Mona M. Counts, PhD, CRNP, FNAP, FAANP, says patients with OA have had pain relief with some of the non-traditional NSAIDs. Dr. Counts, an Elouise Ross Eberly Professor at the School of Nursing at Pennsylvania State University, adds that a large number of patients “still lament the loss” of the COX-II inhibitors.

Overall, when it comes to using NSAIDs or acetaminophen for OA, Dr. Counts says clinicians should monitor for possible gastrointestinal side effects or increases in any bleeding related disorders. She says clinicians should emphasize a yearly hemacult screening for patients.

New Study Shows Women Prefer Ibandronate Over Alendronate
A recent study of 342 postmenopausal women with osteoporosis shows they favor the once-a-month ibandronate over the once-a-week alendronate.

The prospective, randomized, multicenter study, which was recently published in Current Medical Research and Opinion, found that 66.1 percent of the study participants preferred ibandronate (Boniva, Roche) while 26.5 percent chose alendronate (Fosamax, Merck).

“There were no real surprises in the study as patients tend to favor less frequent dosing as (ibandronate) is a very potent bisphosphonate,” notes Ronald Emkey, MD, the lead investigator of the study. “It was pleasing in the MOBILE Study (Monthly Oral iBandronate In LadiEs), that the single monthly dosing was superior to the daily dosing in bone mineral density (BMD) increases at all sites (hip and spine).”

Dr. Emkey adds that the less frequent dosing of ibandronate may facilitate greater patient compliance for longer periods of time. In fact, patients in the study cited ease of compliance as the most common reason for preferring ibandronate, which received FDA approval last year for the treatment of osteoporosis in postmenopausal women.

A new study reveals that postmenopausal women prefer ibandronate for osteoporosis.

Dr. Emkey says the more common side effects seen in these studies are upper respiratory infection, back pain, dyspepsia and bronchitis. However, Dr. Emkey notes these side effects occurred across the board in the study and are “very similar” to side effects reported with other bisphosponate medications, but not necessarily to the study medication.

Given that osteoporosis is generally asymptomatic, he says clinicians should educate their patients on the severity and potential complications of the disease, and emphasize the need for proper evaluation and treatment.

When it comes to prescribing ibandronate, he suggests clinicians should advise patients to stand or sit upright when taking the medication and take it with only water at least an hour before eating or drinking.
— A.L.

Arthroscopic Procedure May Provide Relief For Elbow Arthritis
After reviewing 36 patients with radiocapitellar elbow arthritis, researchers suggest that arthroscopic radial head excision may provide better postoperative pain relief and movement than a radial head excision in association with ulnohumeral arthoplasty.

Patients with radiocapitellar arthritis may experience pain and loss of function and movement due to etiologies that range from posttraumatic to inflammatory arthritis. Conservative therapies include antiinflammatory medications and physical therapy. However, Don Flinn, PA-C, notes that conservative measures fail about 30 percent of the time for patients who have radiocapitellar arthritis.

In the retrospective study, which was recently published in Arthroscopy: The Journal of Arthroscopic and Related Surgery, researchers evaluated eight patients who had early radial head excision and 28 patients who had late radial head excision combined with ulnohumeral arthroplasty. The postoperative follow-up for patients in the study ranged from 18 to 91 months with 52 months being the average follow-up.

Those who had radial head excision only had significantly better improvements in motion than those who had the combined procedure. According to the study, the patients who had the sole arthroscopic procedure experienced a 29º improvement in average flexion, a 38º improvement in average extension loss and a 62º improvement in their total arc of motion. These results were 10º, 11º and 16º higher respectively than the results for patients who underwent the combined procedure.

Flinn, who has been in practice for 25 years at the McBride Clinic Orthopedics & Arthritis in Oklahoma City, says the arthroscopic procedure has “good to excellent” results in approximately 80 percent of patients undergoing this procedure.

The procedure may have potential complications such as infection, wound healing problems and deep venous thrombosis but Flinn says these are common risks with any type of surgery. Flinn notes that these complications are in the .5 to 1 percent range for any surgical procedure. Overall, he says the results of the arthroscopic procedure outweigh the risks.
— A.L.