ARE SIGNS OF JOINT INFLAMMATION AN INDICATION FOR AN NSAID AS THE INITIAL DRUG FOR OA?
Few studies have directly compared ACET to placebo in patients with knee OA. Amadio and Cummings12 documented the superiority of ACET (4000 mg/day), relative to placebo, in a 6 week randomized double blind crossover study of 25 patients with symptomatic knee OA. Global evaluations by both patient and investigator revealed significantly greater improvement with ACET than with placebo, and although signs of inflammation (joint swelling and warmth) were not affected by ACET, the drug significantly reduced the time required to walk 50 ft, reflecting also functional improvement. There is no question that NSAID provide superior efficacy to ACET in some patients with knee OA4,13-16. Randomized clinical trials comparing a simple analgesic to an NSAID in patients with OA of other joints (e.g., hand, hip, spine) are not available. However, there is presently no way to predict in which OA patient an NSAID will be more effective than ACET. In particular, there is no evidence that NSAID are more ef
