Donnette

Ever since the huge tidal wave of publicity that surrounded COX-2 drugs hit the American public, patients with arthritis have had to deal with the consequences. While some deaths possibly could have been attributed to cardiovascular side-effects, there has been a huge downside. This has been the radical removal of medicines which had been the source of better quality of life for thousands of patients.

So what are the options?

Well for one, there is still one COX-2 drug available. Celebrex has been shown to be effective for pain associated with osteoarthritis and rheumatoid arthritis. The down side is that patients with a history of allergy to sulfa should not take it because of cross-reactivity. Also, despite the touted safety for patients with prior peptic ulcer disease, the benefit of COX-2 drugs has been negated when patients have had to take concomitant aspirin therapy. Nonetheless, Celebrex remains a viable option for patients who are in need of the benefits of COX-2 inhibition.

Older non-steroidal drugs also remain on the market. These include drugs like Relafen, Lodine, Mobic, Daypro, Motrin, Naprosyn, and Voltaren. Unfortunately, data has indicated that all non-steroidal drugs share an increased risk of cardiovascular events. In fact, it appears that many of the older drugs such as Clinoril, Voltaren, and Indocin probably have a higher cardiovascular risk than many of the newer medications.

A new plant-based cyclooxygenase inhibitor called Limbrel appears to be both effective as well as safe. Clinical trials in osteoarthritis are ongoing.

Interest in nutritional supplements has also offered a possible alternative. The recent NIH GAIT (Glucosamine/Chondroitin Arthritis Trial) has been called a negative study by some. Nonetheless, 66% of patients taking glucosamine/chondroitin benefited vs. 60% in the placebo group. While the numbers may not be statistically significant, no one can explain why the actual treatment group did better than the placebo group and why animals studies also show a benefit. (Its hard to fake placebo effect in animals).

Non-drug therapies such as weight loss, thermal modalities (heat and cold), topical agents (rubs), and exercise play an important role in the management of arthritis.

Integrative therapies such as acupuncture, various herbal supplements, and hypnosis might benefit some people.

Newer therapies such as electrical pulsed coils might also help. This type of therapy has drawn much interest because of its non-invasive, non-drug properties.

Its important that patients consult knowledgeable rheumatologists to assist them in their quest for safe, effective relief from arthritis pain.

Dr. Wei (pronounced way) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: Types of Arthritis