PMID- 26806184
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20220331
IS  - 1532-866X (Electronic)
IS  - 0049-0172 (Linking)
VI  - 45
IP  - 4 Suppl
DP  - 2016 Feb
TI  - Efficacy and safety of oral NSAIDs and analgesics in the management of 
      osteoarthritis: Evidence from real-life setting trials and surveys.
PG  - S22-7
LID - S0049-0172(15)00287-5 [pii]
LID - 10.1016/j.semarthrit.2015.11.009 [doi]
AB  - Non-steroidal anti-inflammatory drugs (NSAIDs) are at the cornerstone of 
      treatment for osteoarthritis (OA). In recent years, the widespread use of oral 
      NSAIDs has been called into question due to the appearance of significant upper 
      gastrointestinal (GI) complications and cardiovascular (CV) adverse events (AEs). 
      However, NSAIDs are non-homogeneous, and there are noticeable differences between 
      them in AE risk for GI and CV events. Nevertheless, if properly prescribed oral 
      NSAIDs can provide an effective and safe treatment for OA in real-life 
      situations. The identification of patients with significant CV and/or GI risk is 
      critical, and the European Society for Clinical and Economic Aspects of 
      Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm provides guidance on 
      appropriate treatments for OA patients with elevated risk. Among non-selective 
      NSAIDs, ibuprofen and naproxen seem preferable to diclofenac, the latter being 
      associated with higher CV risk. Recommendation has been made by some that 
      naproxen may be the preferred agent in patients at high CV risk because of its 
      lower risk of CV events. Low dose celecoxib (200mg/day) is also associated with a 
      lower risk of CV events compared with other coxibs. In addition, drugs with a 
      demonstrated low GI risk profile may be of benefit, such as coxibs and 
      nabumetone. Among patients who fail to respond adequately to sequential ESCEO 
      algorithm Step 1 and Step 2 treatments, the short-term use of weak opioids, such 
      as tramadol, for severely symptomatic OA patients is recommended. Although 
      studies exploring the efficacy of tramadol in OA are limited, there is good 
      evidence that tramadol works if prescribed properly. The sustained-release (SR) 
      formulation of tramadol is preferred as it avoids the peak plasma concentrations 
      reached with immediate-release tramadol, and is believed to reduce the incidence 
      of AEs. Furthermore, slow upwards titration of tramadol SR is recommended to 
      improve tolerability and minimize treatment discontinuations.
CI  - Copyright (c) 2015 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Pelletier, Jean-Pierre
AU  - Pelletier JP
AD  - Osteoarthritis Research Unit, University of Montreal Hospital Research Centre 
      (CRCHUM), Tour Viger, 900 St-Denis Street, Montreal, QC H2X 0A9, Canada. 
      Electronic address: dr@jppelletier.ca.
FAU - Martel-Pelletier, Johanne
AU  - Martel-Pelletier J
AD  - Osteoarthritis Research Unit, University of Montreal Hospital Research Centre 
      (CRCHUM), Tour Viger, 900 St-Denis Street, Montreal, QC H2X 0A9, Canada.
FAU - Rannou, Francois
AU  - Rannou F
AD  - Rehabilitation Unit, Rheumatology Department, Hopital Cochin, AP-HP, INSERM UMR-S 
      1124, Universite Paris Descartes, Paris, France.
FAU - Cooper, Cyrus
AU  - Cooper C
AD  - MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; 
      NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
LA  - eng
GR  - G0400491/MRC_/Medical Research Council/United Kingdom
GR  - MC_U147585819/MRC_/Medical Research Council/United Kingdom
GR  - MC_U147585824/MRC_/Medical Research Council/United Kingdom
GR  - MC_U147585827/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Practice Guideline
DEP - 20151202
PL  - United States
TA  - Semin Arthritis Rheum
JT  - Seminars in arthritis and rheumatism
JID - 1306053
RN  - 0 (Analgesics)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
SB  - IM
MH  - Analgesics/adverse effects/*therapeutic use
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use
MH  - Cardiovascular Diseases/chemically induced
MH  - Evidence-Based Medicine
MH  - Gastrointestinal Diseases/chemically induced
MH  - Humans
MH  - Osteoarthritis/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
OTO - NOTNLM
OT  - Analgesics
OT  - Coxibs
OT  - Cyclo-oxygenase-2 (COX-2) inhibitors
OT  - Knee osteoarthritis
OT  - Oral non-steroidal anti-inflammatory drugs (NSAIDs)
OT  - Tramadol
EDAT- 2016/01/26 06:00
MHDA- 2016/12/15 06:00
CRDT- 2016/01/26 06:00
PHST- 2015/10/12 00:00 [received]
PHST- 2015/11/18 00:00 [revised]
PHST- 2015/11/25 00:00 [accepted]
PHST- 2016/01/26 06:00 [entrez]
PHST- 2016/01/26 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
AID - S0049-0172(15)00287-5 [pii]
AID - 10.1016/j.semarthrit.2015.11.009 [doi]
PST - ppublish
SO  - Semin Arthritis Rheum. 2016 Feb;45(4 Suppl):S22-7. doi: 
      10.1016/j.semarthrit.2015.11.009. Epub 2015 Dec 2.