Nonsteroidal antiinflammatory drugs in rheumatoid arthritis and osteoarthritis. Support for the concept of “responders” and “nonresponders”

Abstract

Objective. A range of functional, biochemical, and psychological indicators was used to test the concept of “responders”/“nonresponders” and to seek predictors of response to 2 nonsteroidal antiinflammatory drugs in 9 patients with rheumatoid arthritis (RA) and 11 with osteoarthritis (OA). Methods. In a balanced, randomized, doubleblind, latin‐square study design that involved four 4‐ week treatment periods, patients received ketoprofen or piroxicam (each for 2 of the 4 periods). Clinical and laboratory responses (pain, tenderness, swelling, patient and physician global assessments, acute‐phase protein levels, and disability) were assessed in the last 2 weeks of each period. Responders were those who showed >30% improvement in at least 5 of 7 measures of disease activity. Mood was also assessed. Results. At baseline, variables were higher in RA than in OA patients. The drugs produced clear improvements in patients' visual analog scale scores, physicians' overall assessments, and patients' responses to the McGill Pain Questionnaire, as well as plasma prostaglandin concentrations. In patients with either RA or OA, responders could be distinguished from nonresponders; about one‐third of patients were unambiguous responders. In RA, there were responder nonresponder differences in lymphocyte counts, erythrocyte sedimentation rate (ESR), and levels of tumor necrosis factor α, but no differences were seen in OA patients. However, caution in interpretation of the data is necessary because of the small number of patients. Responders had improved mood scores compared with nonresponders in both disease groups. Baseline ESR and white blood cell counts were correlated with responder status in RA patients. Conclusion. This study provides support for the responder/nonresponder concept. It also indicates that in RA, pretreatment ESR and lymphocyte counts are possibly useful indicators of therapeutic response.

Tramadol allows reduction of naproxen dose among patients with naproxen-responsive osteoarthritis pain: A randomized, double-blind, placebo-controlled study

“…Pretreatment measurement of the erythrocyte sedimentation rate and total white blood cell count may be useful in predicting response status in patients with RA, but laboratory values appear to have no value in predicting NSAID responsiveness in patients with OA (21). Recent work by Walker et al (21) showed that in patients with OA, 27% were NSAID responders, 55% were nonresponders, and 18% had questionable response. The results of this study are similar to those of Walker.…”

Discovery of distinctive gene expression profiles in rheumatoid synovium using cDNA microarray technology: evidence for the existence of multiple pathways of tissue destruction and repair

“…4 Likewise, there is a large interindividual variation in clinical response to methotraxate 5 and NSAID's. 6 The clinical presentation, diagnostic criteria, and variance in treatment response indicate that RA is a heterogeneous disease. The heterogeneous character of RA is confirmed by the wide variation in cytokine synthesis in the synovial membrane among patients with RA 7 and the interindividual differences in organization of infiltrated immune cells in RA synovium.…”

Clinical assessment and significance of inflammation in knee osteoarthritis

“…Walker et al [16] sought to identify differences in functional, biochemical, and psychological variables between responders and nonresponders to NSAIDs. Response was defined as at least 30% improvement in 5 out of 7 clinical measures.…”