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NSAIDs in osteoarthritis: irreplaceable or troublesome guidelines?
  1. J Bjordal
  1. Correspondence to:
 Dr Bjordal
 Institute of Public Health and Primary Health Care, University of Bergen, Bergen 5018, Norway; jmb{at}hib.no

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Current treatment of osteoarthritis relies too heavily on pharmacological approaches

In sports medicine, non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for relieving pain and modulating inflammation in acute injuries. They have also been used in osteoarthritis (OA) of the knee, which is one of the most common disorders of modern society. Besides genetic and sex dispositions, previous knee injury in sports is one of several identified risk factors. Half of the 8 million patients with OA in the United Kingdom use NSAIDs regularly, and this contributes to the annual estimated 2000 deaths from NSAID side effects in this country.1,2 NSAID safety has been debated widely over the last few months, and the increased risk of cardiovascular infarcts finally led to withdrawal of Vioxx and marketing restrictions for other cyclo-oxygenase-2 inhibitors (coxibs). The high risk of gastrointestinal side effects from non-specific NSAIDs has long been known, whereas coxibs were thought to be safer and equally effective. The NSAID safety controversy seems to have left a gap in OA management. Some doctors and patients with OA have appeared in the media complaining that they miss having coxibs to prescribe/take. The lower risk of gastrointestinal side effects from coxibs compared with unspecific NSAIDs makes this understandable. Some doctors have turned back to …

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