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-1.875 -1.25 Td
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T*
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T*
[(treatment. )54.8 (Arthritis Care Res 1996;9:292-301.)]TJ
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[(51.)-625.1 (Rene J, )17.7 (W)79.9 (einber)17.7 (ger M, Mazzuca SA, Brandt KD, Katz BP)110.7 (.)]TJ
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(Reduction of joint pain in patients with knee osteoarthritis who have)Tj
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(received monthly telephone calls from lay personnel and whose)Tj
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[(1992;35:51)36.9 (1-5.)]TJ
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[(52.)-625.1 (Pahor M, Guralnik JM, )17.7 (W)79.9 (an JY)128.8 (, et al. Lower body osteoarticular)]TJ
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(1999;89:930-4.)Tj
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T*
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1.375 -1.2375 Td
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1.375 -1.2625 Td
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-1.375 -1.2625 Td
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1.375 -1.2625 Td
(Based Guideline Development Project: summary guideline for non-)Tj
T*
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T*
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-1.375 -1.2625 Td
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1.375 -1.2625 Td
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T*
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T*
[(Studies Including )17.7 (Therapeutic )17.7 (T)35 (rials. )54.8 (Ann Rheum Dis 2000;)]TJ
0 Tc 0 Tw T*
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-0.00011 Tc 0.02499 Tw -1.375 -1.2625 Td
[(6.)-625.1 (Dieppe P)110.7 (, Chard J, Faulkner )54.8 (A, Lohmander S. Osteoarthritis. In:)]TJ
1.375 -1.2625 Td
[(Godlee F)79.7 (, Barton S, Donald )54.8 (A, editors. Clinical evidence. London:)]TJ
T*
(BMJ Publishing Group; 2000;3:530.)Tj
-1.375 -1.275 Td
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1.375 -1.275 Td
(market patient analysis by age. Project Number 88-1039 MCP01.)Tj
-1.375 -1.275 Td
[(8.)-625.1 (Moskowitz R. Issues in osteoarthritis care: concepts and)]TJ
1.375 -1.275 Td
[(controversies. )54.8 (A)74 (vailable at http://www)64.8 (.medscape.com/Medscape/)]TJ
0 -1.275 TD
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[(9.)-625.1 (Rochon P)91.7 (A, Gurwitz JH, Simms R)54.8 (W)91.8 (, et al. )54.8 (A)-220.1 (study of manufacturer)19.7 (-)]TJ
1.375 -1.275 Td
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T*
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-1.875 -1.275 Td
[(10.)-625.1 (Dickersin K, Min )36.8 (Y)110.8 (-I, Meinert CL. Factors influencing publication)]TJ
1.875 -1.275 Td
(of research results: Follow-up of applications submitted to two)Tj
T*
[(institutional review boards. JAMA)-220.2 (1992;267:374-8.)]TJ
-1.8381 -1.275 Td
[(1)36.8 (1)-0.1 (.)-625.1 (Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR. Publication)]TJ
1.8381 -1.275 Td
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-1.875 -1.25 Td
[(12.)-625.1 (Amadio P)110.7 (, Cummings DM. Evaluation of acetaminophen in the)]TJ
1.875 -1.25 Td
[(management of osteoarthritis of the knee. Curr )17.7 (Ther Res)]TJ
0 Tc 0 Tw 0 -1.25 TD
(1993;34:59-66.)Tj
-0.00011 Tc 0.02499 Tw -1.875 -1.25 Td
[(13.)-625.1 (W)79.9 (olfe F)79.7 (, Zhao S, Lane N. Preference for nonsteroidal)]TJ
1.875 -1.25 Td
(antiinflammatory drugs over acetaminophen by rheumatic disease)Tj
T*
[(patients. )54.8 (A)-220.1 (survey of 1,799 patients with osteoarthritis, rheumatoid)]TJ
T*
[(arthritis, and fibromyalgia. )54.8 (Arthritis Rheum 2000;43:378-85.)]TJ
31.125 80.1084 Td
[(14.)-625.1 (Pincus )17.7 (T)74 (, Callahan LF)79.7 (, Fort J, et al. )54.8 (ACT)79.7 (A)-220.1 (Study Investigators.)]TJ
1.875 -1.25 Td
[(Comparison of )17.7 (WOMAC scores in osteoarthritis patients in the)]TJ
T*
[(ACT)79.7 (A)-220.1 ([Arthrotec \(Diclofenac/Misoprostol\) compared to)]TJ
T*
[(acetaminophen] clinical trial [abstract]. )54.8 (Arthritis Rheum 1999;42)]TJ
0 Tw T*
(Suppl:S74.)Tj
0.02499 Tw -1.875 -1.25 Td
[(15.)-625.1 (Pincus )17.7 (T)74 (, Callahan LF)79.7 (, Fort J, et al. )54.8 (ACT)79.7 (A)-220.1 (Study Investigators.)]TJ
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(Comparison of quality of life assessments in osteoarthritis patients)Tj
T*
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T*
[(acetaminophen] clinical trial [abstract]. )54.8 (Arthritis Rheum 1999;42)]TJ
0 Tw T*
(Suppl:S74.)Tj
0.02499 Tw -1.875 -1.275 Td
[(16.)-625.1 (Pincus )17.7 (T)74 (, Callahan LF)79.7 (, )17.7 (W)79.9 (olfe F)79.7 (, et al. )54.8 (Arthrotec compared to)]TJ
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(Suppl:S404.)Tj
0.02499 Tw -1.875 -1.275 Td
[(17.)-625.1 (Bradley JD, Brandt KD, Katz BP)110.7 (, Kalasinski LA, R)39.7 (yan SI.)]TJ
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(Comparison of an anti-inflammatory dose of ibuprofen, an analgesic)Tj
T*
(dose of ibuprofen, and acetaminophen in the treatment of patients)Tj
T*
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[(18.)-625.1 (Bradley JD, Brandt KD, Katz BP)110.7 (, Kalasinski LA, R)39.7 (yan SI.)]TJ
1.875 -1.275 Td
[(T)35 (reatment of knee osteoarthritis: relationship of clinical features of)]TJ
T*
(joint inflammation to the response to a nonsteroidal anti-)Tj
T*
(inflammatory drug or pure analgesic. J Rheumatol 1992;19:1950-4.)Tj
-1.875 -1.275 Td
[(19.)-625.1 (Jones )54.8 (A, Doherty M. Intra-articular corticosteroids are ef)17.7 (fective in)]TJ
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(Rheum Dis 1996;55:829-32.)Tj
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[(20.)-625.1 (Moxley )17.7 (TE, Royer GL, Hearron MS, Donovan JF)79.7 (, Levi L. Ibuprofen)]TJ
1.875 -1.275 Td
[(versus buf)17.7 (fered phenylbutazone in the treatment of osteoarthritis:)]TJ
T*
[(double-blind trial. J )54.8 (Am Geriatr Soc 1975;23:343-9.)]TJ
-1.875 -1.275 Td
[(21.)-625.1 (Cimmino MA, Cutolo M, Samant\210 E, )54.8 (Accardo S. Short-term)]TJ
1.875 -1.275 Td
(treatment of osteoarthritis: a comparison of sodium meclofenamate)Tj
T*
(and ibuprofen. J Intern Med Res 1982;10:46-52.)Tj
-1.875 -1.275 Td
[(22.)-625.1 (Stamp J, Rhind )17.7 (V)128.9 (, Haslock I. )54.8 (A)-220.1 (comparison of nefopam and)]TJ
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(flurbiprofen in the treatment of osteoarthritis. Br J Clin Pract)Tj
0 Tc 0 Tw T*
(1989;43:24-6.)Tj
-0.00011 Tc 0.02499 Tw -1.875 -1.275 Td
[(23.)-625.1 (Bradley J, Katz B, Brandt K. Severity of knee pain does not predict)]TJ
1.875 -1.275 Td
(a better response to an anti-inflammatory dose of ibuprofen than to)Tj
T*
(analgesic therapy in patients with osteoarthritis. J Rheumatol)Tj
T*
(2001;28: In press. )Tj
-1.875 -1.275 Td
[(24.)-625.1 (Altman RD. Ibuprofen, acetaminophen and placebo in osteoarthritis)]TJ
1.875 -1.275 Td
[(of the knee: a six-day double-blind study [abstract]. )54.8 (Arthritis Rheum)]TJ
0 Tc T*
(1999;42 Suppl:S403.)Tj
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[(25.)-625.1 (Collins SL, Moore RA, McQuay HJ, )17.7 (W)39.8 (i)0.3 (f)17.7 (fen PJ, Edwards JE. Single)]TJ
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[(dose ibuprofen and diclofenac for postoperative pain. )17.7 (The Cochrane)]TJ
T*
(Database of Systematic Reviews, Issue 4, 2000.)Tj
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[(26.)-625.1 (Physician\325)54.8 (s Desk Reference, 54th ed. Montvale, NJ: Medical)]TJ
1.875 -1.275 Td
(Economics; 2000:1694.)Tj
-1.875 -1.275 Td
[(27.)-625.1 (Simon LS, Lanza FL, Lipsky PE, et al. Preliminary study of the)]TJ
1.875 -1.275 Td
[(safety and ef)17.7 (ficacy of SC-58365, a novel cyclooxygenase 2)]TJ
T*
[(inhibitor)54.8 (. )54.8 (Arthritis Rheum 1998;41:1591-602.)]TJ
-1.875 -1.275 Td
[(28.)-625.1 (Hubbard R, Geis GS, )17.7 (W)79.9 (oods E, )36.8 (Y)110.8 (u)-0.1 ( S, Zhao )17.7 (W)91.9 (. Ef)17.7 (ficacy)64.8 (, tolerability)64.8 (,)]TJ
1.875 -1.275 Td
(and safety of celecoxib, a specific COX-2 inhibitor [abstract].)Tj
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0.0834 Tw T*
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0.217 Tw T*
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0.1481 Tw T*
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[(Cabuslay)64.8 (, )]TJ
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[(Approximate retail cost, in US dollars, for 30 days of treatment of OA)-220.2 (pain with variou regimens*.)]TJ
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[(phone survey)64.8 (, found that among 150 patients presumed to)]TJ
0.29131 Tw T*
[(have OA)-486.4 (\(medical records and/or radiographs were not)]TJ
0.015 Tw T*
(available to confirm the diagnosis in an unspecified propor-)Tj
0.0081 Tw T*
[(tion of these subjects\) who had taken )54.9 (ACET)-240.3 (and had named)]TJ
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0.0027 Tw T*
[(ACET)73.9 (, 73% felt it was an NSAID, and 6% designated some)]TJ
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0.0164 Tw T*
(uation because of toxicity were seen with NSAID than with)Tj
0.0356 Tw T*
[(ACET)73.9 (. )17.7 (The authors concluded that )54.8 (ACET)-267.8 (\322...was an appro-)]TJ
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0.02499 Tw T*
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0.14461 Tw 1.2 -1.2 Td
(Second, in a recent survey of 668 patients with hip or)Tj
0.1058 Tw -1.2 -1.2 Td
[(knee OA)-300.9 (who were asked to rate the ef)17.7 (fectiveness of, and)]TJ
0.186 Tw T*
[(their overall satisfaction with, )54.8 (ACET)-418.3 (in comparison with)]TJ
0.08791 Tw T*
[(NSAID they had received, about 45% reported that )54.8 (ACET)]TJ
0.2677 Tw T*
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(NSAID. Furthermore, the proportion of patients expressing)Tj
0.24561 Tw T*
[(a preference for )54.8 (ACET)-477.9 (increased with age. )17.7 (The authors)]TJ
0.0937 Tw T*
(concluded that, \322if safety and cost are issues, ...the [ACR])Tj
0.02499 Tw T*
[(recommendation that )54.8 (ACET)-257.3 (be tried first seems correct....\323)]TJ
0.01891 Tc 0.356 Tw 1.2 -1.2 Td
(Third, in a 6 week double blind crossover study)Tj
0.0199 Tc 0.4046 Tw -1.2 -1.2 Td
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-0.00011 Tc 0.05769 Tw T*
[(ACET)-290 (in patients with OA)-252.9 (of the hip or knee, even though)]TJ
0.0979 Tw T*
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0.2037 Tw T*
(quality of life was greater with the NSAID, 22% of the)Tj
0.10091 Tw T*
[(patients reported no dif)17.7 (ference between the two drugs and)]TJ
0.1911 Tw T*
[(an additional 20% found )54.8 (ACET)-423.4 (to be \322better\323 or \322much)]TJ
0.0022 Tc 0.3727 Tw T*
[(better\323 than diclofenac/misoprostol \(Pincus )17.5 (T)74 (, personal)]TJ
-0.00011 Tc 0.12289 Tw T*
[(communication\). Ratings of overall ef)17.7 (ficacy by the physi-)]TJ
0.02499 Tw T*
(cian were similar to those by the patient.)Tj
0.0941 Tw 1.2 -1.2 Td
(In considering the initial recommendation of a drug for)Tj
0.2126 Tw -1.2 -1.2 Td
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0.1954 Tw T*
(physician should be aware that, as noted above, existing)Tj
0.02859 Tw T*
[(data indicate that nearly 50% of patients with OA)-223.8 (pain may)]TJ
-0.0163 Tw T*
[(find )54.9 (ACET)-215.9 (as ef)17.7 (fective as a nonselective NSAID \(and hence)]TJ
0.3532 Tw T*
[(presumably as ef)17.7 (fective as a COX-1 sparing NSAID\).)]TJ
-0.02229 Tw T*
(Furthermore, COX-1 sparing NSAID are much more expen-)Tj
0.0448 Tw T*
[(sive than )54.9 (ACET)-277 (\(T)69.7 (able 1\). However)39.7 (, studies comparing the)]TJ
-0.0121 Tw T*
[(cost ef)17.7 (fectiveness of )54.8 (ACET)-220.2 (and NSAID in OA)-183.1 (are not avail-)]TJ
0 Tw T*
(able.)Tj
-0.02251 Tw 1.2 -1.2 Td
[(Because of their apparent lack of ef)17.7 (fect on the GI mucosa)]TJ
-0.0161 Tw -1.2 -1.2 Td
(and the platelet, COX-1 sparing NSAID represent an impor-)Tj
0.14011 Tw T*
(tant expansion of the pharmacologic options available for)Tj
-0.02991 Tw T*
[(treatment of OA)-165.3 (symptoms. In view of their limited ef)17.7 (ficacy)64.8 (,)]TJ
0.31039 Tw T*
[(adverse ef)17.7 (fects, and cost, however)39.7 (, they should not be)]TJ
-0.0202 Tw T*
(considered the \322standard of care\323 for )Tj
/T1_1 1 Tf
0 Tw [-0.4 (initial)]TJ
/T1_0 1 Tf
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(treatment of OA)Tj
0.1225 Tw -17.4881 -1.2 Td
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0.02 Tw T*
(antiinflammatory and analgesic drugs in symptomatic treat-)Tj
-0.0266 Tw T*
[(ment of OA)-168.6 (are needed. Nonetheless, a considerable body of)]TJ
0.119 Tw T*
(evidence exists that can inform the physician intending to)Tj
0.3112 Tw T*
[(prescribe pharmacologic therapy for relief of OA)-506.4 (pain.)]TJ
0.0369 Tw T*
(Based on this evidence, we would conclude that there is no)Tj
0.17419 Tw T*
[(reason to modify the recommendations in the 1995 )54.8 (ACR)]TJ
0.0183 Tw T*
[(Guidelines: )54.8 (ACET)-250.6 (is the drug of choice for initial treatment)]TJ
0.0285 Tw T*
[(of OA)-223.7 (pain \321 regardless of the severity of joint pain or the)]TJ
0.02499 Tw T*
(presence of clinical signs of joint inflammation.)Tj
0.0822 Tw 1.2 -1.2 Td
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0.00999 Tc 0.3649 Tw -1.2 -1.2 Td
[(agent needed for palliation of OA)-570 (pain. If suf)17.8 (ficient)]TJ
-0.00011 Tc 0.03239 Tw T*
(improvement does not occur within a reasonable time \(e.g.,)Tj
0 Tw T*
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0.0966 Tw T*
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(relevance of the results to management of the chronic pain)Tj
0.02499 Tw 0 -1.2 TD
[(of OA, therefore, is unclear)54.8 (.)]TJ
0.02541 Tw 1.2 -1.2 Td
(What, then, is the basis for the widely held view that the)Tj
0.20309 Tw -1.2 -1.2 Td
[(usefulness of )54.8 (ACET)-435.4 (in management of OA)-398.3 (is limited to)]TJ
0.13741 Tw T*
(treatment of )Tj
/T1_1 1 Tf
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/T1_0 1 Tf
0.13741 Tw 12.7679 0 Td
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0.15359 Tw -12.7679 -1.2 Td
[(consider )54.8 (ACET)-385.9 (an ef)17.7 (fective analgesic for management of)]TJ
0.1554 Tw T*
(the severe pain due, e.g., to a ruptured aneurysm, kidney)Tj
0.2594 Tw T*
[(stone, or bony metastasis. However)39.7 (, other than the two)]TJ
-0.0255 Tw T*
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(23,24)Tj
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0.2487 Tw -9.0198 -1.2 Td
[(the ef)17.7 (fectiveness of )54.8 (ACET)-481 (or NSAID in relation to the)]TJ
0.0006 Tw T*
[(severity of OA)-195.8 (pain. )17.7 (The view that )54.8 (ACET)-232.9 (is not an ef)17.7 (fective)]TJ
-0.01421 Tw T*
[(analgesic in patients with more severe OA)-180.9 (pain is reinforced)]TJ
0.2439 Tw T*
[(by the information on )17.7 (T)69.9 (ylenol)]TJ
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(\250)Tj
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[(in the Physicians\325)-420 (Desk)]TJ
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/T1_0 1 Tf
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0.0611 Tw -2.7917 -1.2 Td
(the exception of the 6 day clinical trial cited above)Tj
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-0.00011 Tc 0.061 Tw 10 0 0 10 268.4066 521.1616 Tm
(, there)Tj
0.0155 Tw -21.4407 -1.2 Td
[(is no evidence that )54.8 (ACET)-247.8 (is less ef)17.7 (fective in patients whose)]TJ
0.2475 Tw T*
[(OA)-442.7 (pain is greater than \322minor\323 or \322mild-to-moderate.\323)]TJ
0.1302 Tw T*
[(Indeed, the study by Bradley)64.8 (, )]TJ
/T1_1 1 Tf
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(et al)Tj
/T1_0 1 Tf
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(that this is not the case. More studies are needed to answer)Tj
0.02499 Tw T*
(this question.)Tj
/T1_2 1 Tf
0 -2.4 TD
[(HOW)-257.3 (EFFECTIVE )54.8 (ARE NSAID IN )17.7 (TREA)73.9 (TING OA)]TJ
0 Tw 0 -1.2 TD
[(P)74 (AIN?)]TJ
/T1_0 1 Tf
0.07021 Tw T*
(Given the enthusiastic use of coxibs in treatment of OA, it)Tj
0.1153 Tw T*
(should be noted that celecoxib and rofecoxib are no more)Tj
-0.0347 Tw T*
[(ef)17.7 (fective in treating OA)-160.4 (pain than nonselective NSAID, such)]TJ
0.0076 Tc 0.36729 Tw T*
(as ibuprofen, diclofenac, or naproxen)Tj
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(27-31)Tj
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(. Indeed, the)Tj
-0.00011 Tc 0.05901 Tw -18.2312 -1.2 Td
[(impact of NSAID on OA)-254.2 (pain is, on average, only modest.)]TJ
0.06329 Tw T*
(The magnitude of reduction in joint pain and improvement)Tj
0.0191 Tw T*
(in mobility with NSAID use is only about 20\32025%, relative)Tj
0.2421 Tw T*
[(to the baseline value, with 10\32020% dif)17.7 (ferences between)]TJ
-0.0233 Tw T*
(NSAID and placebo)Tj
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(32,33)Tj
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[(. )17.7 (This \(in addition to adverse events\))]TJ
0.133 Tw -9.5236 -1.2 Td
(accounts, in part, for the limited satisfaction with NSAID)Tj
0.02251 Tw T*
[(treatment of OA)-217.7 (pain shared by patients and physicians and)]TJ
0.1136 Tw T*
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/T1_1 1 Tf
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(et al)Tj
/T1_0 1 Tf
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(that only)Tj
0.006 Tc 0.3689 Tw -20.3591 -1.2 Td
[(15% of patients with OA)-570.3 (for whom an NSAID was)]TJ
-0.00011 Tc 0.20239 Tw T*
(prescribed were still taking the same NSAID 12 months)Tj
-0.022 Tw T*
[(later)54.8 (. )17.7 (This high rate of discontinuation is seldom observed in)]TJ
0.02499 Tw T*
(the artificial environment of a randomized clinical trial.)Tj
0.24001 Tw 1.2 -1.2 Td
(Comparable data relative to durability of use are not)Tj
0.13901 Tw -1.2 -1.2 Td
[(available for )54.8 (ACET)73.9 (. In a 2 year clinical trial of naproxen)]TJ
0.0955 Tw T*
[(versus )54.8 (ACET)73.9 (, in which the overall dropout rate was about)]TJ
0.302 Tw T*
(65%, the proportion of patients discontinuing treatment)Tj
0.03149 Tw T*
[(because of poor ef)17.7 (ficacy was somewhat greater with )54.8 (ACET)]TJ
0.1595 Tw T*
(than with the NSAID, while the proportion discontinuing)Tj
0.0045 Tw T*
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(. On the other hand, in a recently reported)Tj
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0.09821 Tw T*
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0.11189 Tw T*
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0.2547 Tw T*
(with a variety of painful conditions in general practice,)Tj
0.3624 Tw T*
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0.0009 Tw 26.4 63.6 Td
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0.0047 Tc 0.37019 Tw T*
(ments and total gastrointestinal \(GI\) events, including)Tj
-0.00011 Tc 0.3028 Tw T*
(dyspepsia and abdominal pain, were less frequent with)Tj
0.24319 Tw T*
[(ibuprofen \(4% and 2.8%, respectively\) than with )54.8 (ACET)]TJ
0.02499 Tw T*
(\(5.3% and 3.9%, respectively; p < 0.035 in each case\))Tj
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-0.00011 Tc 0.08591 Tw -21.2021 -1.2 Td
[(In our 4 week study in patients with knee OA)-281 (in which)]TJ
0.1705 Tw -1.2 -1.2 Td
[(ACET)73.9 (, 4 g daily)64.8 (, was compared with ibuprofen, 1200 or)]TJ
0.0296 Tw T*
[(2400 mg/day)64.8 (, with about 60 patients in each treatment arm,)]TJ
0.03259 Tw T*
[(GI adverse events were reported by 16%, 1)36.8 (1%, and 23% of)]TJ
0.1935 Tw T*
[(each group, respectively)64.8 (, and 5%, 3%, and 10%, respec-)]TJ
-0.02229 Tw T*
[(tively)64.8 (, of each group failed to complete treatment because of)]TJ
0.08659 Tw T*
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(17)Tj
-0.00011 Tc 0.08659 Tw 10 0 0 10 379.5256 581.1616 Tm
(. Clinical trials now in progress, comparing)Tj
0.2186 Tw -6.1526 -1.2 Td
[(ACET)-450.9 (to COX-1 sparing NSAID over several weeks of)]TJ
0.02499 Tw T*
(treatment, will provide useful comparisons.)Tj
0.0661 Tw 1.2 -1.2 Td
(In a recent report of a 6 week double blind clinical trial)Tj
0.06461 Tw -1.2 -1.2 Td
[(comparing rofecoxib, 12.5 or 25 mg/day)64.8 (, to celecoxib, 200)]TJ
0.248 Tw T*
[(mg/day)64.8 (, or acetaminophen, 1000 mg/qid, both rofexocib)]TJ
0.1837 Tw T*
[(doses were statistically superior to )54.8 (ACET)-416 (and the higher)]TJ
0.043 Tw T*
(dose of rofecoxib was statistically superior to celecoxib for)Tj
0.03999 Tw T*
(relief of joint pain)Tj
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(37)Tj
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[(. However)39.7 (, only an abstract of the find-)]TJ
0.10651 Tw -8.0169 -1.2 Td
(ings is available at this time and the results reported were)Tj
0.06641 Tw T*
[(limited to the first week of treatment. )17.7 (This study and other)]TJ
0.04269 Tw T*
(clinical trials currently in progress will soon provide useful)Tj
0.1283 Tw T*
[(information about the tolerability)64.9 (, side ef)17.7 (fect profiles, and)]TJ
0.2935 Tw T*
[(ef)17.7 (ficacy of COX-1 sparing NSAID in comparison with)]TJ
-0.00011 Tw T*
[(those of )54.9 (ACET)73.9 (. Such data are needed to inform the question)]TJ
0.0587 Tw T*
[(of which OA)-253.9 (patient will do as well \(or better\) with )54.8 (ACET)]TJ
0.02499 Tw T*
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/T1_2 1 Tf
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[(HOW)-257.3 (SAFE )54.8 (ARE COXIBS IN )17.7 (TREA)73.9 (TING OA?)]TJ
/T1_0 1 Tf
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(Endoscopic studies have shown that celecoxib and rofe-)Tj
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0.0499 Tw T*
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0.12041 Tw T*
(comparable to that of placebo)Tj
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(38)Tj
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[(. Lar)17.7 (ge scale clinical trials)]TJ
0.11279 Tw -13.0148 -1.2 Td
(designed to ascertain whether the striking gastroprotective)Tj
0.1077 Tw T*
[(ef)17.7 (fect that is seen endoscopically with coxibs is accompa-)]TJ
0.0722 Tw T*
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0.2144 Tw T*
(cally important GI bleeding, obstruction, and perforation)Tj
0.0446 Tw T*
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0.0199 Tc 0.43069 Tw T*
[(from the )17.7 (V)59.8 (ioxx Gastrointestinal Outcomes Research)]TJ
-0.00011 Tc 0.207 Tw T*
[(\(VIGOR\) )17.7 (T)35 (rial, which involved more than 8000 patients)]TJ
0.04111 Tw T*
(with rheumatoid arthritis \(RA\) and compared rofecoxib, 50)Tj
0.00191 Tw T*
[(mg/day)64.8 (, to naproxen, 500 mg/bid, the incidence of upper GI)]TJ
-0.03169 Tw T*
(perforations, obstructions, bleeding, and symptomatic ulcers)Tj
0.0981 Tw T*
(was reduced by more than 50% in the rofecoxib group, in)Tj
-0.037 Tw T*
(comparison with the naproxen group \(p < 0.001\) \(Merck and)Tj
-0.0002 Tw T*
[(Co., Inc., data on file\). )17.7 (The results of this study have not yet)]TJ
0.02499 Tw T*
(been published in a peer reviewed journal.)Tj
0.2108 Tw 1.2 -1.2 Td
[(However)39.7 (, data from the Celecoxib Longterm )54.8 (Arthritis)]TJ
0.0199 Tc 0.45399 Tw -1.2 -1.2 Td
(Safety Study \(CLASS\), a double blind randomized)Tj
-0.00011 Tc -0.0271 Tw T*
[(controlled trial in which more than 8000 patients with OA)-168.1 (or)]TJ
0.1678 Tw T*
[(RA)-363 (were enrolled and some 4500 \(57%\) continued treat-)]TJ
0.0238 Tw T*
(ment for 6 months, have recently been published)Tj
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(39)Tj
-0.00011 Tc 0.0238 Tw 10 0 0 10 521.1017 89.1616 Tm
(. Patients)Tj
0.1227 Tw -20.3102 -1.2 Td
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(sion and tenderness to palpation,\323 only about 5% indicated)Tj
0.32091 Tw 0 -1.2 TD
[(they would initially prescribe )54.8 (ACET)73.9 (, while about 75%)]TJ
0.02499 Tw T*
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-0.00011 Tc 0.0706 Tw -13.1649 -1.2 Td
[(Who is right? Industry? )17.7 (The new )54.9 (ACR Guidelines? )17.7 (The)]TJ
0.2459 Tw -1.2 -1.2 Td
[(other OA)-441.1 (Guidelines? )17.7 (The physicians who are currently)]TJ
0.0067 Tc 0.36819 Tw T*
[(prescribing coxibs for OA)-570.2 (patients with extraordinary)]TJ
-0.00011 Tc 0.1602 Tw T*
(frequency? Is the paradigm shift exemplified above, with)Tj
-0.0027 Tw T*
(expansion of NSAID use to include initial pharmacotherapy)Tj
0.0648 Tw T*
[(for OA)-260 (pain, supported by the evidence? )17.7 (This paper exam-)]TJ
0.0235 Tw T*
(ines the data and the gaps in our knowledge relevant to that)Tj
0 Tw T*
(question.)Tj
0.0863 Tw 1.2 -1.2 Td
(It should be noted that clinical trials of the coxibs have)Tj
0.00439 Tw -1.2 -1.2 Td
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/T1_0 1 Tf
0 Tc 0 Tw 6.5 0 0 6.5 290.7502 572.4615 Tm
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(found that commercially funded studies of drug therapy of)Tj
0.0287 Tw T*
[(OA)-223.9 (are significantly more likely to support the intervention)]TJ
0.0634 Tw T*
(under investigation than similar studies that are not funded)Tj
0.0728 Tw T*
[(by industry)64.8 (. In addition, examination of the results of clin-)]TJ
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[(10,1)56.7 (1)]TJ
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(. Publication)Tj
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(docu-)Tj
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[(mented the superiority of )54.8 (ACET)-287.5 (\(4000 mg/day\), relative to)]TJ
0.1851 Tw T*
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0.20551 Tw T*
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0.0656 Tw T*
[(OA)-260.8 (among 133 subjects who completed a 4 week random-)]TJ
-0.00951 Tw T*
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0.06171 Tw T*
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0.27609 Tw T*
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0.17349 Tw T*
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0.32269 Tw T*
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(The)Tj
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