Inexpensive painkillers sold over the counter are just as effective as a prescription anti-inflammatory drug in treating FTC arthritis of the knee, a new study has found.
The finding could have a significant effect on medical care because osteoarthritis of the knee, which is related to normal wear and tear, strikes 80 percent of those it afflicts by the time they are 65 and because most doctors prescribe anti-inflammatory drugs when patients complain of knee pain from arthritis.
The study suggests a complete turnaround in the way osteoarthritis should be treated. It shows that doctors who think they are treating the underlying cause, inflammation, are actually treating the symptom, pain.
And it shows that treatment for pain can be accomplished at far less expense and risk with over-the-counter drugs.
The study, by Dr. Kenneth D. Brandt and his colleagues at the Indiana University School of Medicine, is being published today in the New England Journal of Medicine. It involved 184 patients with osteoarthritis.
The researchers found that patients who took either of two over-the-counter pain relievers -- acetaminophen or ibuprofen -- did just as well as those who received a high-dose ibuprofen, a prescription drug that reduces inflammation and relieves pain. Acetaminophen is sold under the brand name Tylenol as well as other brand names. Ibuprofen is sold as Motrin, among other brand names.
"This is a landmark study," Dr. Matthew H. Liang, an arthritis expert at Brigham and Women's Hospital in Boston, said yesterday in a telephone interview. Dr. Liang, who wrote an editorial accompanying the study, added that the findings would be a surprise to most doctors. If acted on, he said, they would change medical practice.
Dr. Michael Lockshin of the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda agreed. "Most doctors and patients will be surprised by this," he said. "The point that Brandt is making is that pain relief is really all that's needed."
Dr. Roland W. Moskowitz, an arthritis expert at Case Western Reserve University in Cleveland, said the study demonstrated that "there may be room for a more conservative approach" to treating the condition and added, "If you can get away with something that the patient tolerates better and that has less hazard, by all means do it."
Dr. Brandt said surveys have shown that most doctors prescribe anti-inflammatory drugs for patients with swollen, painful joints from arthritis. "Anti-inflammatories are overwhelmingly the drug of first choice," he said.
Dr. Liang said that the drugs were heavily promoted by their manufacturers and that patients asked for them. The drugs can cost $60 to $75 a month and can, in the worst cases, lead to severe bleeding in the stomach, he said.
Arthritis experts said patients do feel better when they take the drugs, which are made by many companies under different trade names.
When the anti-inflammatory drugs were tested, drug companies compared them with dummy pills, Dr. Lockshin said, which is why many doctors did not know that pain relievers might be just as good.
For years, doctors have thought that the puffy, tender joints of osteoarthritis were a result of inflammation, which was the rationale for the anti-inflammatory drugs. But recently, researchers have found evidence that inflammation may be only coincidentally associated with the problem.