Treatment Of Osteoarthrosis Research Articles

Indoprofen, a new non-steroidal anti-inflammatory drug, in the treatment of osteoarthrosis: report on a multi-centre study in 1629 patients.

A multi-centre trial was carried out in 1629 patients with osteoarthrosis in 233 clinical centres to investigate the therapeutic efficacy and tolerability of indoprofen in this clinical condition. The results from assessments of both subjective and objective variables were comparable to those obtained in Phase 3 studies. Moreover, 87.2% of patients expressed a 'good' or 'very good' opinion on the product's efficacy after treatment, usually with 3 tablets (600 mg) daily for 4 weeks. The benefit/risk relationship was confirmed as very favourable on account of the marked activity of the drug and the acceptable frequency of adverse reactions, which were mainly subjective and slight and confined to the gastro-intestinal tract.

The intra-articular use of sodium hyaluronate for the treatment of osteo-arthrosis in the horse

Abstract Intra-articular sodium hyaluronate was used to treat 16 horses with osteo-arthrosis of the carpus, fetlock, hock and coffin joints. In 11of these horses lameness was completely relieved. In addition, 5 horses that underwent carpal surgery for the removal of chip fractures received sodium hyaluronate 10–14 days later. In thesecases, it appeared to have a beneficial effect, resulting in a greater range of movement of the carpus soon after surgery and less swelling of the joint capsule. The results of synovial fluid analysis in horses with osteo-arthrosis, and with carpal fractures, are also presented.

Articular cartilage pharmacology: I. In vitro studies on glucosamine and non steroidal antiinflammatory drugs

Antiinflammatory drugs, as well as glucosamine salts are widely used for the treatment of osteoarthrosis. Antiinflammatory drugs relieve pain, but they inhibit cartilage proteoglycan (PP) synthesis. A standard method which uses “in vitro” cultures of articular cartilage capsules from rat femoral heads removed from the acetabular cavity and radioactive precursors as well as analytical determinations has been chosen for these studies. Glucosamine HCl enhances tritiated proline as well as radioactive sulfate incorporation by cartilage. Non steroidal antiinflammatory drugs (NSAD) inhibit either protein and sulfated mucopolysaccharides (SMPS) synthesis in agreement with previously reported data in favour of a common control mechanism for both synthesis. Glucosamine reduces slightly the depression caused by NSAD, and this might be explained on the basis of consideration of the biochemical steps of MPS synthesis known to be inhibited by NSAD: glucosamine-GP-synthetase, acetyl-CoA-synthetase, and UDPG-dehydrogenase. Only the first inhibition may be avoided by glucosamine. NSAD with depressing activity on MPS synthesis should used very carefully for osteoarthrosis therapy, because they might exert a negative influence on the already unbalanced articular cartilage metabolism.

Naproxen in osteoarthrosis. Double-blind crossover trial.

In this double-blind crossover trial, naproxen (750 mg/day) was compared to placebo for the treatment of osteoarthrosis of the hip and knee. Patients were randomly assigned to treatment with either naproxen or placebo for 4 weeks and then to treatment with the alternate agent for a second 4-week period. 8 out of 9 objective and subjective measurements of drug efficacy clearly differentiated naproxen from placebo at highly significant levels (P = 0.0001 to 0.0004). Patient daily check lists of osteoarthrotic symptoms also showed a statistically significant difference between naproxen and placebo therapy. Both physicians and patients, when asked to give a 'final drug preference', showed a significant preference for naproxen over placebo. In general, the incidence of side effects was low and approximately the same for both naproxen and placebo. Laboratory assessments showed little difference between groups. The trial showed naproxen to be an effective and well tolerated drug for the treatment of osteoarthrosis of the hip and knee.

Diflunisal in the treatment of osteoarthrosis: a double-blind study comparing diflunisal with ibuprofen

A double-blind trial was carried out in 37 patients with osteoarthrosis to compare the efficacy and tolerance of 250 mg diflunisal twice daily with that of 400 mg ibuprofen 3-times daily over an 8-week period. Rating scale assessments were made, at the end of a preceding 1-week, wash-out period on placebo and at regular fixed intervals, of weight-bearing pain, night pain, a specific functional activity, and of the duration of inactivity stiffness. Patients' and physician's overall evaluations of response, taking side-effects into account, were made on completion of the study. The data collected indicated that in 30 patients completing the trial both treatments produced similar overall results and, with the exception of weight-bearing pain which appeared to be improved more in the ibuprofen group, diflunisal provided equal therapeutic benefit with fewer side-effects.

Diflunisal compared with naproxen in the treatment of osteoarthrosis of hip or knee: a double-blind trial

A randomized double-blind trial was carried out in 20 patients with osteoarthrosis of the hip or knee to compare the efficacy and tolerance of treatment with diflunisal or naproxen. During the first 4 weeks, patients received either 250 mg diflunisal or 250 mg naproxen twice daily and this was increased by 250 mg daily in 5 patients on diflunisal and in 3 on naproxen for the second 4 weeks of the trial. The results of subjective assessments made before and at the end of Week 8 showed a trend in favour of diflunisal for improvement of symptoms, except for weight-bearing pain which was improved in only 1 patient in each group. More of the patients receiving diflunisal than naproxen considered treatment to have been satisfactory, and rated their response as equally as good as or better than previous medication. Diflunisal produced significantly high incidence of gastro-intestinal upsets, leading to the withdrawal of 2 patients at Week 4.

A double-blind comparative study of 150 mg flurbiprofen daily and 75 mg indomethacin daily in the treatment of osteoarthrosis of the hip joint

Thirty patients with osteoarthrosis of the hip were studied in a double-blind crossover comparison of 150 mg flurbiprofen daily and 75 mg indomethacin daily, each drug being given for 2 weeks separated by a wash-out period of 1 week on placebo. Statistical analysis of the results from 26 patients with complete records showed that both drugs produced statistically significant improvements over baseline after 1 and 2 weeks in assessments of severity of pain, night pain, duration of morning stiffness, and intermalleolar straddle. No statistical differences, however, were found between the two drugs. There were no reports of side-effects with flurbiprofen, but 6 reports from 3 patients whilst receiving indomethacin.

7 - Medical Treatment of Osteoarthrosis

7 - Medical Treatment of Osteoarthrosis

Non-operative treatment.

The most important causes of pain and disability from joint disease are rheumatoid arthritis and osteoarthrosis. The lives of patients with rheumatoid arthritis can be considerably improved by a programme which may include exercises, splinting of joints, provision of aids and appliances, and administration of analgesic and anti-inflammatory drugs. Gold salts, immunosuppressive drugs and D-penicillamine produce some amelioration of the disease in the longer term. Adrenal corticosteroids remain the only drugs which effectively suppress rheumatoid inflammation, but side-effects almost preclude their long-term use. Advances in the understanding of rheumatoid disease encourage the hope that really effective treatment or prevention may become a reality. Non-operative treatment of osteoarthrosis consists of physiotherapy, provision of aids and appliances, and the use of analgesic drugs. It is difficult to envisage how a better understanding of this disease process is likely to offer really effective non-operative therapy. Numerically less important joint diseases in which drug therapy plays a more decisive role include gout, haemophilia and bacterial arthritis.

A Double-Blind Comparison between Diclofenac Sodium and Ibuprofen in Osteoarthritis

A new anti-inflammatory agent, diclofenac sodium (Voltaren), has been compared by means of a double-blind cross-over with ibuprofen in the treatment of osteoarthrosis. Twenty hospitalized adult patients (10 men and 10 women) were treated for six weeks (two weeks with each drug and two weeks drug-free wash-out period between the single treatments) with average daily doses of 130 mg (150 mg during the second week) diclofenac sodium and 1407 mg (1593 mg during the second week) ibuprofen. The results obtained in this trial indicate that in some important clinical and laboratory measurements diclofenac sodium presents a significant superiority over ibuprofen, with regard both to efficacy and tolerability. During treatment with diclofenac sodium no significant changes in laboratory data were seen thus confirming the tolerability of the drug.

Section 2 Ibuprofen in the long-term treatment of coxarthrosis

SummaryIn an open controlled trial of ibuprofen in the long-term treatment of osteoarthrosis of the hip, 35 patients received 1200 mg. ibuprofen daily over a period of 6 months. Seven patients discontinued treatment after 2 months because of remission of all symptoms and 7 others were withdrawn (2 due to side-effects, 5 for non-medical reasons). Subjective and objective assessments were carried out at monthly intervals. The results showed that pain was significantly reduced, particularly during the first 2 months, and there was a marked reduction in the need for additional analgesics. There was also a significant improvement in joint mobility within the first few months of treatment. Ibuprofen was well tolerated and side-effects were minimal.

Radiotherapy in the treatment of osteoarthrosis of the knee.

Radiotherapy in the treatment of osteoarthrosis of the knee.