Journal ArticleDOI
Paracetamol versus nonsteroidal anti-inflammatory drugs for rheumatoid arthritis.
Troels Wienecke,Peter C Gøtzsche +1 more
TLDR
People with rheumatoid arthritis and the researchers in the study did prefer non-steroidal anti-inflammatory drugs more than acetaminophen/paracetamol, and there is a need for a large trial with appropriate randomisation, double-blinding, and with explicit methods to measure and analyse pain and adverse effects.Abstract:
Background
Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually preferred for simple analgesics such as paracetamol for rheumatoid arthritis. It is not clear, however, whether the trade-offs between benefits and harms of NSAIDs are preferable to those of paracetamol (paracetamol is also called acetaminophen).
Objectives
To compare the benefits and harms of paracetamol with NSAIDs in patients with rheumatoid arthritis.
Search methods
PubMed and EMBASE databases were searched up until August 2007. Reference lists of identified articles were also searched.
Selection criteria
Randomised double-blind studies comparing paracetamol with an NSAID.
Data collection and analysis
Decisions on inclusion of trials and data extraction were performed by the two authors independently.
Main results
Four cross-over studies, published between 1968 and 1982, involving 121 patients, and four different NSAIDs were included. The generation of the allocation sequence and the use of methods to conceal the allocation were not described in any of the studies. The studies were double-blind but it was not clear whether the blinding was effective. Methods for collecting adverse effects were not described. The NSAIDs were preferred more often than paracetamol by the patients or the investigator. In the largest trial, 20 out of 54 patients (37%) preferred ibuprofen and 7 out of 54 (13%) paracetamol. Investigators preference (as established by joint tenderness, grip strength and joint circumference) was 17 out of 35 for diclofenac versus 5 out of 35 for paracetamol in another trial. However, because of the weaknesses in the trials, no firm conclusion can be drawn.
Authors' conclusions
When considering the trade off between the benefits and harms of non-steroidal anti-inflammatory drugs and paracetamol/acetaminophen, it is not known whether one is better than the other for rheumatoid arthritis. But people with rheumatoid arthritis and the researchers in the study did prefer non-steroidal anti-inflammatory drugs more than acetaminophen/paracetamol. There is a need for a large trial, with appropriate randomisation, double-blinding, test of the success of the blinding, and with explicit methods to measure and analyse pain and adverse effects.read more
Citations
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Journal ArticleDOI
Pharmacological Management of Persistent Pain in Older Persons
Bruce A. Ferrell,Charles Argoff,J. Epplin,Perry G. Fine,F. M. Gloth,Keela Herr,J. D. Katz,D. R. Mehr,M. C. Reid,Lori Reisner,S. Radcliff,K. Addleman,C. Fierstein,E. Ickowicz,N. Lundebjerg +14 more
Journal ArticleDOI
EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)
Bernard Combe,Robert Landewé,Cédric Lukas,Horatio D Bolosiu,F. C. Breedveld,Maxime Dougados,Paul Emery,Gianfranco Ferraccioli,Jmw Hazes,Lars Klareskog,Klaus P Machold,Emilio Martín-Mola,Henrik Nielsen,Alan J. Silman,Josef S Smolen,Hasan Yazici +15 more
TL;DR: 12 key recommendations for the management of early arthritis or early rheumatoid arthritis were developed, based on evidence in the literature and expert consensus, in accordance with EULAR's "standardised operating procedures".
Journal ArticleDOI
Pharmacological Management of Persistent Pain in Older Persons
E. Ickowicz,Bruce A. Ferrell,Charles Argoff,J. Epplin,Perry G. Fine,F. M. Gloth,Keela Herr,J. D. Katz,D. R. Mehr,M. C. Reid,Lori Reisner,C. Fierstein,N. Lundebjerg +12 more
TL;DR: In this paper, both appropriate and inappropriate medica- tions for older adults are detailed, as well as their contraindications and potential drug-drug or drug-disease interactions.
Journal ArticleDOI
British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years)
Raashid Luqmani,S Hennell,C Estrach,Fraser Birrell,A Bosworth,G Davenport,C Fokke,Nicola J Goodson,P Jeffreson,E Lamb,R Mohammed,S Oliver,Z Stableford,D Walsh,C Washbrook,F Webb +15 more
TL;DR: Guideline for the Management of Rheumatoid Arthritis (The first 2 years) R. Luqmani, S. Oliver, Z. Walsh, C. Washbrook and F. Webb on behalf of the British Society for rheumatology and British Health Professionals in R heumatology Standards, Guidelines and Audit Working Group.
Journal ArticleDOI
Mechanisms, impact and management of pain in rheumatoid arthritis
TL;DR: Pain contributes importantly to the clinical assessment of inflammatory disease activity, and noninflammatory components of RA pain should be considered when gauging eligibility for or response to biologic agents.
References
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Journal ArticleDOI
The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.
Frank C. Arnett,Steven M. Edworthy,Daniel A. Bloch,Dennis J. McShane,James F. Fries,Norman S. Cooper,L. A. Healey,Stephen R. Kaplan,Matthew H. Liang,Harvinder S. Luthra,Thomas A. Medsger,Donald M. Mitchell,David H. Neustadt,Robert S. Pinals,Jane G. Schaller,John T. Sharp,Ronald L. Wilder,Gene G. Hunder +17 more
TL;DR: The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA).
Journal ArticleDOI
Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples.
Richard Peto,M.C. Pike,P. Armitage,N. E. Breslow,David Cox,S V Howard,N Mantel,Klim McPherson,Julian Peto,Pete Smith +9 more
TL;DR: Efficient methods of analysis of randomized clinical trials in which the authors wish to compare the duration of survival among different groups of patients are described.
Journal ArticleDOI
Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.
TL;DR: Empirical evidence is provided that inadequate methodological approaches in controlled trials, particularly those representing poor allocation concealment, are associated with bias.
Journal ArticleDOI
Design and analysis of randomized clinical trials requiring prolonged observation of each patient. I. Introduction and design.
Richard Peto,M.C. Pike,P. Armitage,N. E. Breslow,David Cox,S V Howard,N Mantel,Klim McPherson,Julian Peto,Pete Smith +9 more
TL;DR: This report is the first simple account yet published for non-statistical physicians of how to analyse efficiently data from clinical trials of survival duration, and it may be preferable to use these statistical methods to study time to local recurrence of tumour, or toStudy time to detectable metastatic spread, in addition to studying total survival.