When Osteoarhtritis patients were allowed to try NSAID instead of acetaminophen, “proportion of patients on acetaminophen treatment during the study decreased from 74.8 % at baseline to 23.9 %, while the proportion on non-steroidal anti-inflammatory drugs (NSAIDs) increased from 59.8 to 85.8 %.”
Rheumatol Int. 2013 Dec 21. [Epub ahead of print]
Clinical management of patients with hip and knee osteoarthritis: patient satisfaction with treatment switch.
Gimenez S, Armada B, Iriso JI, Mendoza LG, Fernández-Morales B.
- Adequate control was considered <4/10
- self measures included exercise, education, “self-management”, and weight loss through diet
- Potential hazards of NSAIDs include GI distress and bleeds (watch history and check helicobacter pylori serology) and cardiovascular disease
- Using Celebrex or adding a PPI ulcer pill would cut GI risk;
- A new mix Vimovo (375 mg naproxen and 20 mg Nexium in a delayed action format) has less GI effects and naproxen is supposed to have less cardiovascular risks – I start with vimovo samples but switch to generic naproxen SR 375 bid and omeprazole 20 mg bid if they have no coverage.
- Sticking to only 200 mg of Celebrex or using Naproxen can decrease cardiovascular risk though they make it clear it not for use post bypass period.
- Using Ibuprofen in those who have tolerated it before would be an option and there is evidence combining it with H2 blocker or PPI would cut risks of stomach bleeds.
Comment – fact patients perferred NSAID’s to acetaminophen is no surprise. One of my old teachers found response varied from NSAID to NSAID and would try varying forms until patient was more satisfied as well… Recently attended a course where a rheumaotologist found flurbipofen worked better for resistent inflammatory arthritis cases.