Osteoarthritis (OA)
This is the most common form of arthritis and is associated with aging, obesity, and morbidity. The etiology of OA has not yet been fully elucidated, but as the result of a workshop held in 1995, some authorities on arthritis proposed the following consensus:
Osteoarthritic diseases are a result of both mechanical and biological events that destabilize the normal coupling of degradation and synthesis of articular cartilage chondrocytes and extracellular matrix, and subchondral bone...when clinically evident, osteoarthritis diseases are characterized by joint pain, tenderness, limitation of movement, crepitus, occasional effusion, and variable degrees of inflammation without systemic effects.
Currently, the most conventional medical treatment for symptomatic OA is nonsteroidal anti-inflammatory drugs (NSAID's) (e.g., ibuprofen and indomethacin) and acetaminophen. Although NSAID's may alleviate pain and reduce inflammation, the relief is only temporary and NSAID's have been associated with side effects, such as gastric irritation.
Furthermore, NSAID's may actually interfere with cartilage healing and thus facilitate the progression of OA. Acetaminophen has a better benefit-to-risk ratio than NSAID's, but it, too, treats only the symptoms without altering the disease process. It's is like putting a band aid on a wound; it doesn't help with healing process, just prevents further bleeding.
Some common prescription medications have also caused a stir in the news as of late. These too are classified as NSAID's and include Vioxx and Celebrex, among others. These are more technically known as cyclooxygenase-2 inhibitors (COX-2 inhibitors).
COX-2 inhibitors are a class of drugs which selectively inhibit COX-2, an enzyme involved in the inflammation pathway, while sparing COX-1, thereby reducing gastrointestinal toxicity. These are the newest classes of NSAID's, but have recently come under fire because of a recent study that will soon be published. Vioxx has been under scrutiny for possibly hiking the risk of heart problems.
This study is among the largest to date to analyze the safety profile of COX-2 inhibitors and will compare experimental Prexige, to two older NSAIDS. The study is expected by some to respond to the safety concerns. More information will surely be emerging over the next few months, but to me it is a no-brainer to be weary of these "safe" medications.
As of now, it appears that those at greatest risk for adverse cardiovascular reactions are those who are already predispositioned for such issues. Remember, though, many folks with OA fall into this category since, if you recall from above, overweight and obesity are linked with the onset of OA.
