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Study: Anti-Inflammation Drug Not Always Needed for Knee Arthritis

July 10, 1991

NEW YORK (AP) _ An over-the-counter dosage of pain-reliever worked as well as a prescription-strength anti-inflammation drug for pain from knee osteoarthritis, according to a study.

The study challenges the practice of routinely prescribing anti- inflammation drugs that risk side effects.

Patients got a similar amount of pain relief from acetaminophen as from low or high doses of ibuprofen, a non-steroidal anti-inflammatory drug or NSAID.

NSAIDs relieve pain as well as fight inflammation. Ibuprofen is in such products as Advil, Medipren, Motrin and Nuprin. Acetaminophen is simply a pain reliever, contained in products including Anacin-3, Excedrin and Tylenol.

″It is not always necessary to use an anti-inflammatory agent to relieve the pain in patients with osteoarthritis,″ said study co-author Dr. Kenneth Brandt, director of the Indiana University Specialized Center of Research in Osteoarthritis in Indianapolis.

Surveys suggest that doctors frequently begin treating osteoarthritis with an NSAID, often at a high dose, Brandt said. At low or high doses, those drugs carry risks of such side effects as ulcers, gastrointestinal bleeding and reduced kidney function, he said.

Despite his study finding, Brandt said NSAIDs do work better than other pain relievers for some osteoarthritis patients, such as those with marked inflammation. He also cautioned that his results may neither pertain to NSAIDs other than ibuprofen, nor to joints other than the knee. Other NSAIDs include aspirin, naproxen, indomethacin and piroxicam.

An estimated 5 million Americans have osteoarthritis of the knee. Osteoarthritis results from damage to cartilage. It differs from rheumatoid arthritis, which is an inflammation of the lining of a joint.

The study is an important challenge to ″reflexive″ prescribing of NSAIDs for osteoarthritis, which is a common practice, commented Dr. Matthew Liang of Harvard Medical School.

It was funded by the federal government and published in Thursday’s New England Journal of Medicine.

Dr. Arthur Grayzel, senior vice president for medical affairs of the Arthritis Foundation, said the study confirms what he called good practice. Most osteoarthritis patients need just pain relief, which can often be achieved with low doses of acetaminophen or NSAIDs, he said.

As for safety, the choice of low-dose acetaminophen versus low-dose ibuprofen is ″still an open one,″ he said.

Kaye Bennett, a spokeswoman for Upjohn Co., which sells Motrin, said the study’s conclusion is limited by its short duration of four weeks and the fact that no placebo was given for comparison.

The study was conducted on 184 patients with knee pain from mild to moderate osteoarthritis. They were randomly assigned to receive acetaminophen or low or high levels of ibuprofen.

One group received 4,000 milligrams a day of acetaminophen - the equivalent of eight extra-strength Tylenols. The second group got a low dose of 1,200 milligrams of ibuprofen a day, the same as six tablets of Advil. The third group received twice that dosage, a prescription strength.

Brandt said the low dose of ibuprofen would just relieve pain while the higher dose would fight inflammation.

Patients were not told what drug they were getting. After four weeks, all three groups showed less pain and disability, to a virtually identical degree. The only significant difference was that both ibuprofen groups showed a greater decrease in pain at rest than the acetaminophen group.

Brandt emphasized that treatment of osteoarthritis needs to include more than drugs. Taking measures to protect the knee, exercises to strengthen muscles around the knee, and proper shoes or shoe inserts ″can make an enormous difference in symptoms of patients″ with knee osteoarthritis, he said.

A patient whose doctor has prescribed an NSAID should discuss that choice with the physician, as well as the use of non-drug strategies, Brandt said.

Liang said a patient who is doing well without side effects on an NSAID should continue with it. If the patient is taking it continuously, he might still benefit by taking it only as needed, Liang said.

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