Osteoarthritis - 2001 National Meeting Reports

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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 trea

ting 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.

Merck withdrew Vioxx from the market after the data safety monitoring board overseeing a long-term study of the drug recommended that the study be halted because of an increased risk of serious cardiovascular events, including heart attacks and strokes, among study patients taking Vioxx compared to patients receiving placebo. The study was being done in patients at risk of developing recurrent colon polyps.

Rates of swelling of the tissues (edema) and elevated blood pressure were reported as being significantly elevated in patients taking Vioxx in comparison with patients taking Celebrex. Although another study comparing rates of edema and high blood pressure to Naproxen showed no difference. 

Dr. Shiel's Perspective: I feel that Vioxx, like any NSAID, should be used with cautious observation in persons with heart or blood vessel conditions or a history of elevated blood pressure (hypertension).

Inheritance
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br /> In a unique study of almost 3,000 patients from Iceland, it was demonstrated that patients with symptoms of osteoarthritis of the hand were more related to each other genetically than other people. 

Dr. Shiel's Perspective: This study strongly supports the role of genes in determining who really develops osteoarthritis of the hands. (This is the first time I had ever spoken with someone who actually lived in Iceland!)

Symptoms

Quadriceps muscle (the muscle in the front of the thigh) weakness and obesity were related to an increase in the development of knee osteoarthritis with pain symptoms. 

Dr. Shiel's Perspective: It has long been known that obesity is a risk factor for osteoarthritis of the knee. This study also provides a potential treatment avenue worth looking into-strengthening exercises for the quadriceps muscles of the front of the thigh.

In a study of total knee replacement in patients with severe osteoarthritis of this joint, it was demonstrated that the patient's overall sense of body pain and physical function significantly improved. 

Dr. Shiel's Perspective: Well, this is what doctors and patients hope to achieve with this procedure, which can be very gratifying for both in my experience.

For more, please see MedicineNet.com' s Osteoarthritis article.

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Reviewed on 7/6/2004

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