A Two-Year, Placebo-Controlled Trial of Non-Steroidal Anti-Inflammatory Therapy in Osteoarthritis of the Knee Joint

Abstract

Eighty-nine patients with established OA of the knee joint, already on regular NSAIDs for joint pain, were randomly allocated to receive 100 mg/day of slow release diclofenac (45 patients) or matching placebo (44), in place of their NSAID, for 2 years. Thirty-eight patients withdrew or dropped out of the study. The major causes for withdrawal were lack of efficacy (three active, 12 placebo, P < 0.01) or side effects (six active, five placebo), and most withdrawals occurred within the first 6 months. Long term follow up of these patients was not possible. Fifty-one patients completed the study (31 active, 20 placebo), 35 of whom reported that they were the same or better at the end of the 2-year period than at the beginning. Most of the recorded clinical parameters showed little or no change over 2 years in these 51 subjects, and in 70% there was no detectable change in the radiographs. We conclude that long term placebo-controlled trials are both feasible and ethical in knee OA, but that conventional clinical and radiographic techniques detect very little change in joint structure or function over a 2-year time period. This may reflect the insensitivity of the methods used to assess progression rather than absence of change. The fact that 20 of 44 patients changed from an NSAID to placebo completed the 2-year study without any symptomatic penalty indicates that not all patients entered needed or responded to NSAIDs.

Intra-articular transplantation of porcine adipose-derived stem cells for the treatment of canine osteoarthritis: A pilot study

“…As the radiographic assessment, which was conducted independently by 5 investigators, did not find structural improvement in the treated joints, it appears that the improved scores in force-plate, orthopedic, and owner's assessments were due to ADSC's anti-inflammatory and/or immunomodulatory effects. Similar negative radiographic findings in OA patients treated with NSAIDs have been reported previously [22] . The present study is also similar to the three aforementioned veterinarian studies in that the presence of the injected ADSCs in the treated joint could not be confirmed due to the fact that these patients are companion dogs, not experimental canine models, and as…”

The Role of Sirtuins in Cartilage Homeostasis and Osteoarthritis

“…Non-steroidal anti-inflammatory drugs (NSAIDs) and opiates are the main drugs that are commonly prescribed to OA patients, but they only provide symptomatic relief [70,71]. It is thus envisioned that a new generation of drugs could fill this gap and significantly slow down the disease process, as well as providing symptomatic relief, addressing the dual need for symptom and structure modification.…”

Updated Management of Osteoarthritis: A Review

“…When medical therapies have failed and the patient has an unacceptable reduction in their quality of life and ongoing pain and disability, then at least for knee and hip OA, total joint arthroplasty is indicated. Intrarticular (IA) corticosteroid injections have been used for decades in clinical practice for pain relief and control of local inflammation in OA (Dieppe et al, 1993). Intrarticular corticosteroid injections are part of the treatment paradigm suggested in the American College of Rheumatology (ACR) practice for the treatment of knee OA 34 .…”