Reports From National Arthritis Meeting

Dr. Shiel Gives Perspectives Of Interest On Osteoarthritis From
2001 Annual Scientific Meeting Of The American College Of Rheumatology

Below are perspectives on key reports presented at the national meeting of the American College of Rheumatology:

Introduction

Osteoarthritis is a type of arthritis that is caused by breakdown of cartilage, with the eventual loss of the cartilage of the joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common and affects over 15 million people in the United States. Before age 45, osteoarthritis occurs more frequently in males. After age 55, it occurs more frequently in females. In the United States, all races appear to be equally affected. A higher incidence of osteoarthritis exists in the Japanese population, while South African blacks, East Indians, and southern Chinese have lower rates. Osteoarthritis usually affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees.

Medications

VALDECOXIB

Valdecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that is being studied for use in the treatment of rheumatoid arthritis and osteoarthritis. It is not yet commercially available. Prostaglandins are chemicals that are important contributors to the inflammation of arthritis, which causes pain, fever, swelling, and tenderness. Valdecoxib blocks the enzyme that makes prostaglandins (specifically, cyclooxygenase 2 or Cox-2), thereby resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling, and tenderness are reduced. Cox-2 Inhibitors differ from traditional NSAIDs in that they cause less inflammation and ulceration of the stomach and intestine and do not interfere with the clotting of blood.

Valdecoxib was shown to be beneficial in treating osteoarthritis of the hip. 

Dr. Shiel's Perspective: This drug may be an additional Cox-2 on the menu in the near future.

ETORICOXIB

Etoricoxib is another Cox-2 NSAID that is being investigated for the treatment of rheumatoid arthritis and osteoarthritis (see Valdecoxib above). Previous studies have demonstrated its effectiveness in relieving the signs and symptoms of joint inflammation.

This experimental drug was shown to be effective in the treatment of osteoarthritis of the knee and hip in over 200 patients. 

Dr. Shiel's Perspective: The drug also may be an additional Cox-2 on the menu in the near future.

Fewer patients treated with etoricoxib had to discontinue the medication because of gastrointestinal complications as compared with the traditional NSAIDs, Voltaren, and Naprosyn. 

Dr. Shiel's Perspective: This is an example of a safety study that must be performed before a drug is approved to demonstrate its value. Because it is billed as a Cox-2 inhibitor, etoricoxib should, and apparently does, have advantages with regard to the stomach and intestines.

Complementary and alternative medicines (CAM) are being used by 33% of osteoarthritis patients. It was also shown that these patients seem to be more cautious about their health, seeking specialists' care more commonly. 

Dr. Shiel's Perspective: As a practicing rheumatologist for two decades, this is not really news. I frankly believe that this study grossly underestimates the number of persons using CAM. It does, however, highlight the need for doctor-patient communication with regard to all manners of treatment.

GLUCOSAMINE

Glucosamine (a radioactive form that could be identified in tissues) taken by mouth was found to be incorporated into the cartilage of Beagle dogs. 

Dr. Shiel's Perspective: This study implies that glucosamine supplements taken by mouth actually can become bioavailable to the cartilage of the joints. Perhaps this will be shown to not only provide some relief of symptoms (already reported in some patients), but it may also be shown in future studies to protect the osteoarthritis joints (being looked into at the NIH).

Drug Complications

September 30, 2004 the Food and Drug Administration (FDA) today acknowledged the voluntary withdrawal from the market of Vioxx (chemical name rofecoxib), a nonsteroidal antiinflammatory drug (NSAID) manufactured by Merck & Co. FDA today also issued a Public Health Advisory to inform patients of this action and to advise them to consult with a physician about alternative medications.



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