Acetaminophen is as good as celecoxib for degenerative joint disease.
* Clinical question
Do celecoxib and acetaminophen provide equivalent pain relief for patients with degenerative joint disease?
* Bottom line
In this short-term study emphasizing individual response, acetaminophen and celecoxib (Celebrex) are virtually indistinguishable in improving pain, stiffness, and function in patients with clinically diagnosed degenerative joint disease. Since acetaminophen is less expensive and has fewer safety concerns, it should be the drug of first choice.
Level of evidence
1b: individual randomized controlled trial (with narrow confidence interval)
Cross-over trial (randomized)
Industry and government
Outpatient (primary care)
Randomized trials suffer from limited applicability to patients we see in the real world. The best research design to determine the most effective intervention for a specific patient is the N-of-1 trial. These use methods as rigorous as a clinical trial, yet we rarely see them published.
In this paper, patients with a clinical diagnosis of degenerative joint disease for at least 1 month, and who were candidates for long-term therapy, received sustained-release paracetamol (acetaminophen 1.3 g 3 times daily), sustained-release celecoxib (200 mg daily or 200 mg twice daily), or placebo. These drugs were administered in 2-week cycles, and the order of medication was randomly assigned. Furthermore, the appearance of each medication was masked to ensure blinding. The main outcomes were pain, stiffness, and functional limitation (each on a 10-point scale), as well as medication preference and adverse effects.
The main assessments were made during the second week of each treatment period to minimize the potential of the effects of any drug carrying over into the subsequent treatment period. At the time the study was stopped (because of celecoxib's safety concerns), 41 patients had completed each study period. Most patients were unable to detect differences in pain (59%), stiffness (54%), function (63%), medication preference (68%) or side effects (61%). A few patients had detectable differences in pain (10 of 12 favored celecoxib), stiffness (12 of 14 favored celecoxib), and function (2 of 2 favored celecoxib). In spite of this, 33 patients (80%) failed to identify these differences in terms of overall symptom relief.
Most patients were unable to detect differences in pain, stiffness, and function while on each of the drugs
Yelland MJ, Nikles CJ, McNairn N, Del Mar CB, Schluter PJ, Brown RM. Celecoxib compared with sustained-release paracetamol for osteoarthritis: a series of n-of-1 trials. Rheumatology 2007; 46:135-140.
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|Title Annotation:||Patient Oriented Evidence that Matters|
|Publication:||Journal of Family Practice|
|Article Type:||Drug overview|
|Date:||Mar 1, 2007|
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