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Emerging Controversies in the Treatment of Osteoarthritis in Older Individuals

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Objective: To discuss emerging controversies in the treatment of osteoarthritis, particularly as they apply to older individuals.

Data Sources: A MEDLINE search covering articles from 1966 to July 2003 was conducted for English-language literature on clinical trials comparing nonsteroidal anti-inflammatory drugs and acetaminophen for osteoarthritis treatment. Search terms were NSAIDs, nonsteroidal anti-inflammatory drugs, osteoarthritis, and acetaminophen.

Study Selection: All controlled trials comparing acetaminophen and NSAIDs were reviewed.

Data Extraction: Data from therapeutic end points comparing drugs being studied were extracted and summarized.

Data Synthesis: Early studies comparing ibuprofen and acetaminophen for knee osteoarthritis identified that therapeutic end points were similar for these two drugs. These data were the basis for clinical practice guidelines published by the American College of Rheumatology in 1995 and updated in 2000. More recent clinical trials using validated instruments to measure osteoarthritis outcomes showed that NSAIDs are better than acetaminophen. There are also recent data that showed aceta-minophen is equivalent to placebo in osteoarthritis outcomes. The mean age of study subjects in all the controlled trials of NSAIDs and acetaminophen was less than 65 years, making extrapolation of data from these studies to an elderly population risky. Furthermore, use of NSAIDs in older people has more risks than acetaminophen.

Conclusions: Current clinical practice guidelines for osteoarthritis are based on questionable data, and new data contradicts the guideline recommendations. More studies using a geriatric population are needed to clarify if acetaminophen or NSAIDs is the better choice for initial management of osteoarthritis.
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Keywords: Acetaminophen; Nonsteroidal anti-inflammatory drugs; Osteoarthritis

Document Type: Research Article

Publication date: 2004-02-01

More about this publication?
  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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