When should COX-2 selective NSAIDs be used for osteoarthritis and rheumatoid arthritis?

Journal of Family Practice, March, 2006 by Vincent Lo, Susan Meadows

(3.) Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000; 284:1247-1255.

(4.) Towheed TE, Judd MG, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev 2003; (2):CD004257.

(5.) Garner SE, Fidan DD, Frankish RR, Maxwell LJ. Rofecoxib for osteoarthritis. Cochrane Database Syst Rev 2005; (1):CD005115.

(6.) Garner S, Fidan D, Frankish R, et al. Celecoxib for rheumatoid arthritis. Cochrane Database Syst Rev 2002; (4):CD003831.

(7.) Garner SE, Fidan DD, Frankish RR, et al. Rofecoxib for rheumatoid arthritis. Cochrane Database Syst Rev 2005; (1):CD003685.

(8.) Silverstein FE, Graham DY, Senior JR, et al. Misoprostol reduced serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1995; 123:241-249.

(9.) Bresalier RS, Sandler RS, Quan H, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 2005; 352:1092-1102.

(10.) Solomon SD, McMurray JJ, Pfeffer MA, et al. Cardiovascular risk associated with celecoxib in clinical trial for colorectal adenoma prevention. N Engl J Med 2005; 352:1071-1080.

(11.) Derry S, Loke YK. Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. BMJ 2000;321:1183-1187.

(12.) Laine L, Mailer ES, Yu C, Quan H, Simon T. Ulcer formation with low-dose enteric-coated aspirin and the effect of COX-2 selective inhibition: A double-blind trial. Gastroenterology 2004;127:395-402.

(13.) Simon LS, Lipman AG, Jacox AK, et al. Pain in Osteoarthritis, Rheumatoid Arthritis and Juvenile Chronic Arthritis. 2nd ed. Glenview, III: American Pain Society; 2002.

(14.) American College of Rheumatology (ACR) Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000; 43:1905-1915.

(15.) American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis Rheum 2002; 46:328-346.

(16.) Managing Osteoarthritia: Helping the Elderly Maintain Function and Mobility Issue 4, AHRQ Pub. No 02-0023, May 2002. Agency for Healthcare Research and Quality. Available at: www.ahrq.gov/research/osteoria/osteoria.htm#self-manage.

Vincent Lo, MD

SUNY Upstate Medical University, Syracuse NY

Susan Meadows, MLS

University of Missouri-Columbia

TABLE 1
Prediction of serious gastrointestinal bleeding

RISK FACTORS PRESENT    RISK OF GI BLEEDING

0 factor                0.4%
Any 1 factor            1.0%
All 4 factors           9.0%

Risk factors include age >75 years, history of peptic ulcer
disease, history of gastrointestinal bleeding, history of
cardiovascular disease

Source: Silverstein et al, Ann Intern Med 1995. (8)

TABLE 2

Risk factors for upper
gastrointestinal adverse events

Age [greater than or equal to] 65 years
Comorbid medical conditions
Oral glucocorticoids
History of peptic ulcer disease
History of upper gastrointestinal bleeding
Anticoagulants

Source: American College of Rheumatology,
Arthritis Rheum 2000. (12)