Treatment Plan and New Developments

For some people who suffer from pain associated with arthritis, their symptoms can be managed with exercise, heat/cold therapy, joint protection, assistive devices, weight control, or in some severe cases, surgery.  For others, medications are needed to help manage the symptoms associated with arthritis.

COX-2 inhibitors

COX-2 inhibitors are the newest members of the NSAID class of medications.  Available by prescription only, they became widely used in recent years to reduce joint pain and swelling.  COX-2 inhibitors work by selectively blocking, or inhibiting, one of the two enzymes associated with inflammation.  Some experts have hypothesized that this selective inhibition may be the reason for the negative cardiovascular effects currently associated with COX-2 inhibitors.

 Non-selective NSAIDs

Non-selective NSAIDs were developed earlier than COX-2 inhibitors and have been widely used to relieve arthritis pain and inflammation for many years.  Unlike COX-2 inhibitors, non-selective NSAIDs inhibit both major enzymes involved in the inflammatory process, COX-1 and COX-2. The non-selective NSAID category includes a number of different medications that are available in both prescription and over-the-counter (OTC) products.

However, recent controversy about the safety of pain medications for arthritis has left patients and health care professionals alike uncertain about which medications are safe to use.  In fact, a recent survey by the Boston-based Rippe Lifestyle Institute indicated that many people with arthritis are suffering unnecessarily because they have stopped or reduced their use of pain relievers due to confusion about which drugs are considered safe.

To clarify the confusion around recent news about arthritis medications, here are some facts:

On April 7, 2005, the FDA announced the following:

• Bextra, a COX-2 inhibitor manufactured by Pfizer, was being voluntarily withdrawn from the market.
• All prescription NSAIDs must revise their labeling to include a “black box” warning that highlights the potential increased risk for cardiovascular (CV) events as well as the potentially life threatening gastrointestinal (GI) bleeding associated with these drugs.  Celebrex, the only COX-2 inhibitor remaining on the US market, was included in this directive.
• All OTC NSAIDs (except aspirin) will be required to revise their labeling to include more specific information about the potential for GI and CV side effects, a stronger reminder to follow label instructions, as well as a warning about potential skin reactions.

To further evaluate the potential for increased CV risk, the FDA also announced that all NSAIDs must conduct and submit to the Agency a comprehensive review and analysis of pertinent safety data from clinical trials. 

The FDA emphasized that when label directions are followed, OTC pain relievers such as Aleve (naproxen sodium) provide a safe and effective way to treat mild to moderate pain of minor arthritis.  If patients have questions, they should consult their health care professional about which treatment option is most appropriate.

Arthritis Health Tips

Arthritis Types

Osteoarthritis Facts

Living with Osteoarthritis

More Information

For more information about osteoarthritis, and living with it, visit the ALEVE website at http://www.aleve.com.  ALEVE is an over-the-counter (OTC) pain reliever that provides relief for a variety of pain conditions, including minor pains associated with arthritis.

The above information from What is Osteoarthritis?, What Causes Osteoarthritis?, What are the Different Types of Arthritis?, and How is Osteoarthritis Different?  has been excerpted from The Arthritis Foundation’s Guide to Good Living with Osteoarthritis, copyright ©2000, Arthritis Foundation . For more information about this book and other resources about osteoarthritis, call (800) 283-7800.