sulindac and Osteoarthritis

Pain is the predominant reason for seeking treatment in patients with osteoarthritis. Management is multifactorial, involving psychological, physical, pharmaceutical, and sometimes surgical measures. Nonsteroidal anti-inflammatory agents play a valuable role in the overall treatment program. A review of 28 clinical trials involving ibuprofen for osteoarthritis shows sometimes conflicting results in efficacy, often because of inadequacies in study design or dosage. In fact, 17 of these 28 studies employed doses of less than 1,600 mg/day. Nonetheless, several trends are clear. Ibuprofen at a dose of over 1,200 mg daily was superior to placebo and at doses of 1,200 to 1,800 mg/day was as effective or more effective than 3,200 to 3,600 mg/day of aspirin or 4,500 mg/day of aspirin plus acetaminophen. In trials with a wide variety of other nonsteroidal anti-inflammatory drugs, ibuprofen was often as effective as the comparison agent. Tolerability was consistently excellent with ibuprofen, and adverse reactions were few.

Topics: Acetaminophen; Anti-Inflammatory Agents; Aspirin; Clinical Trials as Topic; Diflunisal; Drug Tolerance; Fenoprofen; Humans; Ibuprofen; Indomethacin; Meclofenamic Acid; Naproxen; Osteoarthritis; Phenylbutazone; Sulindac; Tolmetin

Topics: Adult; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Aspirin; Clinical Trials as Topic; Diclofenac; Double-Blind Method; Drug Eruptions; Drug Interactions; Female; Gastrointestinal Diseases; Headache; Humans; Indomethacin; Male; Middle Aged; Osteoarthritis; Sulindac

To evaluate the therapeutic effect of Chinese patent drug Shu Feng Huo Luo Pian ([symbol: see text] Pill for Dispelling Wind and Activating Collaterals) for the treatment of osseous arthritis.. 50 cases of osseous arthritis were divided randomly into two groups, the Shu Feng Huo Luo Pian group (the experimental group), including 30 cases (aged 63.5 +/- 4 years), treated with 2 such pills, p.o., bid; and the control group, including 19 cases (aged 63 +/- 5 years), treated with Sulindac 0.2 g, p.o., bid. The two groups were all supplemented by medication of calcium Caltrate D 0.6 g, p.o., qd. The above-mentioned medications were administered for 2 courses, 2 weeks constituting a course.. The total effective rate of the experimental group evaluated by the doctors was 83.3%, and that evaluated by the patients was 90%, with mild side effects.. Shu Feng Huo Luo Pian is an effective Chinese patent drug for treating osseous arthritis, with less and mild side effects.

Topics: Aged; Calcium; Drug Combinations; Drug Therapy, Combination; Drugs, Chinese Herbal; Female; Humans; Male; Middle Aged; Osteoarthritis; Sulindac; Tablets; Vitamin D

To determine the impact of three non-steroidal anti-inflammatory drugs on the efficacy of two anti-hypertensive drugs.. Fifteen women with arthritis and hypertension who were receiving lisinopril and HCT, and administered sequentially in random order ibuprofen, sulindac, and diclofenac for one month each, with an intervening two-week washout period between each treatment period. During the washout period, subjects received paracetamol.. Hypertension Clinic, Medical Centre, Harare, Zimbabwe.. Fifteen female hypertensive women with documented arthritis.. Blood pressure at the end of two weeks of paracetamol was compared with blood pressure after one month of treatment with each of the NSAID.. Mean blood pressure was unchanged before and after all NSAIDs: 108 +/- 7 versus 107 +/- 9 for diclofenac, 108 +/- 9 versus 108 +/- 9 for sulindac, and 108 +/- 8 versus 107 +/- 9 for ibuprofen. The 24 hour urinary sodium excretion was not significantly different.. The three NSAIDs investigated did not neutralise the antihypertensive effect of the combination of lisinopril and HCT, and hence the blood pressure lowering action of the combination may not be prostaglandin dependent.

Topics: Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Antihypertensive Agents; Blood Pressure; Diclofenac; Drug Interactions; Drug Therapy, Combination; Female; Humans; Hydrochlorothiazide; Hypertension; Ibuprofen; Lisinopril; Middle Aged; Osteoarthritis; Sulindac; Treatment Outcome

We assessed the effects of nabumetone, sulindac, and placebo on renal function and renal excretion of vasodilatory prostaglandins in older female patients (age >50 years) with osteoarthritis and normal renal function. Using a prospective, crossover design, we compared the effects of nabumetone 2000 mg/d and sulindac 400 mg/d with placebo on glomerular filtration rate (GFR), renal plasma flow (RPF), and urinary excretion of prostaglandin E2 and 6-keto-prostaglandin F1alpha in 12 patients. Urinary excretion of vasodilatory prostaglandins was not decreased after 14 days of treatment with either nabumetone or sulindac. Likewise, treatment with nabumetone or sulindac did not significantly alter renal function compared with placebo. There were no differences in mean changes in GFR or RPF from baseline after treatment with nabumetone or sulindac compared with placebo. The mean (+/- SD) changes in GFR from baseline were 0%+/-8% in patients receiving nabumetone, -8%+/-15% in patients receiving sulindac, and -7%+/-15% in patients receiving placebo. The results of this study demonstrate that treatment with nabumetone or sulindac caused no deterioration in renal function in older female patients with osteoarthritis and normal renal function.

Topics: 6-Ketoprostaglandin F1 alpha; Anti-Inflammatory Agents, Non-Steroidal; Butanones; Cross-Over Studies; Dinoprostone; Female; Glomerular Filtration Rate; Humans; Kidney; Nabumetone; Osteoarthritis; Placebos; Potassium; Prospective Studies; Renal Circulation; Sodium; Sulindac

The effect of etodolac 50-600 mg/d on renal function was assessed in four- to 52-week trials in 1,382 patients with arthritides. No patient was withdrawn from treatment due to an abnormal renal function test related to etodolac administration. There were no significant differences in the incidence of definite renal function abnormalities between patients receiving etodolac and those receiving placebo. Both etodolac and placebo groups had a significantly lower incidence of deviant BUN results than either aspirin- or sulindac-treated patients. Fewer than 2% of patients receiving etodolac showed either a persistent or variably persistent pattern of deviant renal function tests. The results in these studies indicate that chronic etodolac therapy did not adversely affect renal function in patients with arthritis.

Topics: Acetates; Aged; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Rheumatoid; Aspirin; Blood Urea Nitrogen; Clinical Trials as Topic; Creatinine; Double-Blind Method; Etodolac; Humans; Ibuprofen; Kidney Function Tests; Middle Aged; Osteoarthritis; Sulindac

In this double-blind, randomized trial involving 143 patients with osteoarthritis of the hip and/or knee, the efficacy and safety of twice-daily dosing with flurbiprofen (Ansaid, Upjohn), which has a half-life of 5.5 hours, were compared with those of sulindac, which has a half-life of 7.8 hours. Patients were treated with flurbiprofen (50 mg orally twice a day) or sulindac (150 mg orally twice a day) for six weeks. Based on evaluations by both patients and physicians, there were no statistically significant differences between the two treatment groups in most of the efficacy parameters studied. In addition, there were no statistically significant differences between the two treatment groups in the incidence or type of side effects, which were primarily gastrointestinal in origin. This study indicates that flurbiprofen, taken as 50 mg twice daily, is equally as effective as 150 mg of sulindac twice a day in the treatment of osteoarthritis.

Topics: Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Female; Flurbiprofen; Humans; Indenes; Male; Middle Aged; Osteoarthritis; Propionates; Random Allocation; Sulindac

Despite a wide range of study designs, a multiplicity of international trials of diclofenac in osteoarthritis have disclosed similar results. These include double-blind comparisons with indomethacin, aspirin, naproxen, ibuprofen, sulindac, and diflunisal, as well as open trials from European field studies. The results of this review document that diclofenac is as effective as other nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis.

Topics: Aspirin; Clinical Trials as Topic; Diclofenac; Diflunisal; Double-Blind Method; Gastrointestinal Diseases; Humans; Ibuprofen; Indomethacin; Naproxen; Osteoarthritis; Random Allocation; Sulindac

Ninety-five geriatric patients with osteoarthritis of the hip and/or knee were entered into an open parallel group study of sulindac (400 mg/day) and naproxen (500 mg/day), both given in twice-daily regimens. Patients received the drugs for 12 weeks. Both drugs produced improvements in the patients' overall condition. There were no statistically significant differences between the effects of the two drugs. Overall, both drugs proved beneficial and well tolerated.

Topics: Aged; Clinical Trials as Topic; Female; Humans; Indenes; Male; Naproxen; Osteoarthritis; Sulindac; Time Factors

Pain is the predominant reason for seeking treatment in patients with osteoarthritis. Management is multifactorial, involving psychological, physical, pharmaceutical, and sometimes surgical measures. Nonsteroidal anti-inflammatory agents play a valuable role in the overall treatment program. A review of 28 clinical trials involving ibuprofen for osteoarthritis shows sometimes conflicting results in efficacy, often because of inadequacies in study design or dosage. In fact, 17 of these 28 studies employed doses of less than 1,600 mg/day. Nonetheless, several trends are clear. Ibuprofen at a dose of over 1,200 mg daily was superior to placebo and at doses of 1,200 to 1,800 mg/day was as effective or more effective than 3,200 to 3,600 mg/day of aspirin or 4,500 mg/day of aspirin plus acetaminophen. In trials with a wide variety of other nonsteroidal anti-inflammatory drugs, ibuprofen was often as effective as the comparison agent. Tolerability was consistently excellent with ibuprofen, and adverse reactions were few.

Topics: Acetaminophen; Anti-Inflammatory Agents; Aspirin; Clinical Trials as Topic; Diflunisal; Drug Tolerance; Fenoprofen; Humans; Ibuprofen; Indomethacin; Meclofenamic Acid; Naproxen; Osteoarthritis; Phenylbutazone; Sulindac; Tolmetin

Topics: Aged; Female; Humans; Ibuprofen; Indenes; Male; Middle Aged; Osteoarthritis; Sulindac

Twenty-nine patients with osteoarthritis of the hip and/or knee(s) were entered into an 8-week, open, parallel group study of sulindac (400 mg daily) and piroxicam (20 mg daily). The results showed that both drugs produced improvements in the patients' overall condition with a trend for sulindac to be superior to piroxicam. There was no difference between the two drugs in terms of adverse reactions. Overall, both drugs proved beneficial and had an acceptable side-effect profile.

Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Female; Hip; Humans; Indenes; Knee; Male; Middle Aged; Osteoarthritis; Piroxicam; Random Allocation; Sulindac; Thiazines

A study was carried out in 30 elderly patients, aged between 65 and 89 years, with osteoarthritis of the hip and/or knee joints to assess the efficacy and tolerance of sulindac compared with ibuprofen. Patients were allocated at random to receive either 200 mg sulindac twice daily or 400 mg ibuprofen 3-times daily for 12 weeks. The results showed that whilst both drugs produced improvement in the patient symptoms assessed, the only improvements reaching a statistically significant level were those for weight-bearing pain, pain on passive movement of the left lower limb joints and disease activity in the sulindac group. Both drugs were well tolerated and few side-effects were reported. However, 1 patient in the sulindac group had haematemesis and melaena (Week 1) and 1 in the ibuprofen group developed a rash (Week 9) and had to be withdrawn.

Topics: Aged; Female; Humans; Ibuprofen; Indenes; Male; Osteoarthritis; Sulindac

The efficacy and safety of benoxaprofen and sulindac were compared in patients with rheumatoid arthritis and osteoarthritis. A double-blind, crossover protocol was used with three placebo periods. Fixed doses--600 mg of benoxaprofen once a day and 200 mg of sulindac twice a day--were used. Rheumatoid arthritis patients showed significant improvement in most measurements with both drugs, but overall results favored benoxaprofen, particularly in erythrocyte sedimentation rate and physician's global assessment. Results were fairly equal in osteoarthritis patients. Propoxyphene consumption was less during the benoxaprofen therapy period for both groups of patients. Adverse reactions in combined rheumatoid arthritis and osteoarthritis patients generally were mild to moderate. Gastrointestinal complaints were more common with sulindac, while skin reactions were more common with benoxaprofen. No serious abnormalities in laboratory values were noted.

Topics: Adult; Aged; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Indenes; Male; Middle Aged; Osteoarthritis; Propionates; Sulindac; Time Factors

Topics: Adult; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Aspirin; Clinical Trials as Topic; Diclofenac; Double-Blind Method; Drug Eruptions; Drug Interactions; Female; Gastrointestinal Diseases; Headache; Humans; Indomethacin; Male; Middle Aged; Osteoarthritis; Sulindac

Thirty patients with osteoarthritis of the hip or knee were entered into a double-blind, cross-over study of naproxen (750 mg/day) and sulindac (400 mg/day) both given in twice-daily regimens. Patients received each drug for four weeks. Both drugs produced improvements in the patients' overall condition. There were no statistically significant differences between the effects of the two drugs. There were few side-effects. Overall, both drugs proved beneficial and safe.

Topics: Aged; Clinical Trials as Topic; Double-Blind Method; Female; Hip Joint; Humans; Indenes; Knee Joint; Male; Middle Aged; Naproxen; Osteoarthritis; Random Allocation; Sulindac

Thirty-two elderly patients with symptomatic osteoarthritis predominantly of the hip and/or knee joints were randomly treated on an open basis for 12 weeks with either 400 mg sulindac or 1200 mg ibuprofen per day. Clinical assessments were made before and after 1, 3, 6, 9 and 12 weeks of treatment, of disease activity, weight bearing pain, and pain on active and passive movement. Objective measurements were also made of duration of inactivity stiffness, knee flexion and hip abduction. The results showed that there was significant symptomatic improvement after treatment in the patients in both groups and that, apart from night pain, the differences between the groups in the subjective parameters at Week 12 were significant in favour of sulindac. Overall assessment of response to treatment also showed a significant preference for sulindac by patients and physician. Sulindac and ibuprofen were well-tolerated during the trial period, although 1 patient on sulindac had to be withdrawn because of a skin rash.

Topics: Aged; Female; Humans; Ibuprofen; Indenes; Male; Osteoarthritis; Random Allocation; Sulindac

Patients with osteoarthritis were entered into a single-blind trial comparing the effects on the gastric mucosa of a four week course of indomethacin, sulindac and a compound of paracetamol and dextropropoxyphene (Distalgesic). The presence and severity of both acute and chronic gastritis were assessed by histological examination of endoscopic biopsy specimens taken from five standard sites in th stomach of each patient before and at the end of the four week period. The presence and severity of chronic gastritis was not affected by the treatment in any of the groups. The pattern of acute gastritis was complex, many of the patients having acute inflammatory changes in their initial biopsy specimens. At least one patient in each treatment group developed marked acute gastritis during the treatment period, but a significant overall increase in the severity of these changes was only found in the group treated with sulindac.

Topics: Acetaminophen; Acute Disease; Adult; Anti-Inflammatory Agents; Chronic Disease; Dextropropoxyphene; Drug Combinations; Female; Gastric Mucosa; Gastritis; Humans; Indenes; Indomethacin; Male; Middle Aged; Osteoarthritis; Sulindac

Topics: Arthritis, Rheumatoid; Aspirin; Clinical Trials as Topic; Humans; Indenes; Osteoarthritis; Placebos; Sulindac

Topics: Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Hip Joint; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Research Design; S-Adenosylmethionine; Sulindac

Forty-six patients (seventeen male, twenty-nine female) with musculo-skeletal disease were put on a controlled clinical study comparing sulindac with ibuprofen and soluble aspirin. Twenty patients were treated with sulindac 200 mg twice daily, twelve received sulindac 100 mg twice daily, eight had ibuprofen 400 mg thrice daily and six treated with soluble aspirin 600 mg thrice daily. All patients did well on these drugs, but the ones on sulindac 200 mg twice daily showed better response than sulindac 100 mg twice daily. It proved to have the same efficiency as ibuprofen and soluble aspirin; but had less side-effects and also patients required to take the drug only twice daily to get relief because of its prolonged duration of action.

Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Arthritis; Arthritis, Rheumatoid; Aspirin; Back Pain; Clinical Trials as Topic; Female; Humans; Ibuprofen; Indenes; Lumbosacral Region; Male; Middle Aged; Osteoarthritis; Random Allocation; Sulindac; Tenosynovitis

Topics: Adult; Aged; Diclofenac; Double-Blind Method; Female; Humans; Indenes; Male; Middle Aged; Osteoarthritis; Phenylacetates; Sulindac

Topics: Clinical Trials as Topic; Drug Evaluation; Drug Therapy, Combination; Hip Joint; Humans; Indenes; Osteoarthritis; Sulindac

Osteoarthritis (OA), a most common and highly prevalent joint disease, is closely associated with dysregulated expression and modification of RXRα. However, the role of RXRα in the pathophysiology of OA remains unknown. The present study aimed to investigate whether RXRα modulator, such as K-80003 can treat OA. Experimental OA was induced by intra-articular injection of monosodium iodoacetate (MIA) in the knee joint of rats. Articular cartilage degeneration was assessed using Safranin-O and fast green staining. Synovial inflammation was measured using hematoxylin and eosin (H&E) staining and enzyme-linked immunosorbent assay (ELISA). Expressions of MMP-13, ADAMTS-4 and ERα in joints were analyzed by immunofluorescence staining. Western blot, RT-PCR and co-Immunoprecipitation (co-IP) were used to assess the effects of K-80003 on RXRα-ERα interaction. Retinoid X receptor α (RXRα) modulator K-80003 prevented the degeneration of articular cartilage, reduced synovial inflammation, and alleviated osteoarthritic pain in rats. Furthermore, K-80003 markedly inhibited IL-1β-induced p65 nuclear translocation and IκBα degradation, and down-regulate the expression of HIF-2α, proteinases (MMP9, MMP13, ADAMTS-4) and pro-inflammatory factors (IL-6 and TNFα) in primary chondrocytes. Additionally, knockdown of ERα with siRNA blocked these effects of K-80003 in chondrocytes. In conclusion, RXRα modulators K-80003 suppresses inflammatory and catabolic responses in OA, suggesting that targeting RXRα-ERα interaction by RXRα modulators might be a novel therapeutic approach for OA treatment.

Topics: Animals; Cartilage; Cells, Cultured; Chondrocytes; Disease Models, Animal; Estrogen Receptor alpha; HEK293 Cells; Humans; Inflammation; Joints; Male; NF-kappa B; Osteoarthritis; Pain; Protective Agents; Protein Binding; Rats, Sprague-Dawley; Retinoid X Receptor alpha; Signal Transduction; Sulindac; Synovial Membrane; Synovitis; Up-Regulation

We report a case of aseptic meningitis thought to be associated with chronic sulindac use in a patient with osteoarthritis. The patient was hospitalized with an acute onset of headache, nuchal rigidity, nausea, and blurred vision. Brain imaging was unremarkable and a lumbar puncture revealed a lymphocytic pleocytosis. No infectious source was identified. The patient reported taking sulindac over the past year, it was discontinued, and symptoms promptly resolved. This case underscores the importance of obtaining a thorough drug history in conjunction with the knowledge of causative medications associated with aseptic meningitis. Given the widespread use of nonsteroidal anti-inflammatory drugs, clinicians must recognize that aseptic meningitis is a possible adverse effect of these medications.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Humans; Male; Meningitis, Aseptic; Osteoarthritis; Risk Factors; Sulindac

Aberrant crypt foci of the colon are possible precursors of adenoma and cancer, but these lesions have been studied mainly in surgical specimens from patients who already had colon cancer.. Using magnifying endoscopy, we studied the prevalence, number, size, and dysplastic features of aberrant crypt foci and their distribution according to age in 171 normal subjects, 131 patients with adenoma, and 48 patients with colorectal cancer. We also prospectively examined the prevalence of aberrant crypt foci in 11 subjects (4 normal subjects, 6 with adenoma, and 1 with cancer) before and after the administration of 100 mg of sulindac three times a day for 8 to 12 months and compared the results with those in 9 untreated subjects (4 normal subjects and 5 with adenoma). All 20 subjects had aberrant crypt foci at base line.. We identified 3155 aberrant crypt foci, 161 of which were dysplastic; the prevalence and number increased with age. There were significant (P<0.001) correlations between the number of aberrant crypt foci, the presence of dysplastic foci, the size of the foci, and the number of adenomas. After sulindac therapy, the number of foci decreased, disappearing in 7 of 11 subjects. In the untreated control group, the number of foci was unchanged in eight subjects and slightly increased in one (P<0.001 for the difference between the groups).. Aberrant crypt foci, particularly those that are large and have dysplastic features, may be precursors of adenoma and cancer.

Topics: Adenoma; Aged; Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies; Colon; Colonic Neoplasms; Colonoscopy; Female; Genes, ras; Heart Diseases; Humans; Male; Methylene Blue; Middle Aged; Osteoarthritis; Point Mutation; Precancerous Conditions; Prevalence; Prospective Studies; Sulindac

As part of a multidisciplinary approach to the management of osteoarthritis, 77 patients with a mean age of 69 years were assessed by physical therapists. Goniometrics and strength evaluations of the shoulder, elbow, hip, and knee were performed at the initial and final assessment of this 12-week study. Biweekly gait evaluations consisted of timed free-speed walking over a 12-foot distance. Although the patients with osteoarthritis had joint pain with movement and limitations in joint range of motion and muscle strength, statistically significant improvements were obtained in a number of variables over the course of the study. The gait speed had a direct correlation with joint range of motion and muscle strength and an inverse correlation with pain.

Topics: Aged; Combined Modality Therapy; Gait; Humans; Movement; Osteoarthritis; Patient Care Team; Physical Therapy Modalities; Sulindac; Time Factors

As part of the multidisciplinary assessment of osteoarthritis, two occupational therapists evaluated the signs and symptoms of osteoarthritis in the hands of 77 patients. The patients were seen every two weeks for 12 weeks. Initially 58% considered themselves disabled; their mean disability score, on a scale of 0 to 3, was 1.7. Crepitus and pain of the joints and tendons occurred in 36% of the patients. Three hundred fifty-five cysts/nodules, primarily bony, were identified, the mean number being significantly greater (P less than 0.05) for women (8.8) than for men (5.3). Despite considerable disability due to osteoarthritis, none of these patients had ever consulted an occupational therapist. At the end of the study, the mean disability score was 1.2, significantly (P less than 0.05) lower than the initial score. Osteoarthritis of the hand was associated with considerable disability, more so in women than in men, and improvement was evident when an occupational therapist participated in the management of this disease.

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Disability Evaluation; Female; Hand; Humans; Male; Middle Aged; Occupational Therapy; Osteoarthritis; Patient Care Team; Sulindac; Time Factors

The nutritional composition of diets and prevalence of obesity in 77 osteoarthritis patients were assessed biweekly for 12 weeks as part of a multidisciplinary approach to the management of osteoarthritis. Height was measured at the first visit, and weight was measured at each of the seven biweekly follow-up visits. A body mass index was calculated, based on height and weight, to determine obesity. Nutrient information was obtained by use of a 24-hour dietary recall and a food frequency questionnaire. Seventy-nine percent of the patients were obese. Obesity was positively related to pain from osteoarthritis and was more prevalent among these osteoarthritis patients than it is among the general geriatric population. Dietary intakes of vitamin D, folacin, vitamin B6, zinc, and pantothenic acid were below 80% of the recommended dietary allowance. Osteoarthritis patients may benefit from weight loss if they are obese and from eating more foods that supply the nutrients in which they are deficient. In addition to providing nutritional recommendations to avoid dietary deficiencies, a registered dietitian can assist in the multidisciplinary treatment of osteoarthritis by providing weight-control counseling and follow-up.

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Diet; Diet, Reducing; Energy Intake; Female; Humans; Male; Middle Aged; Obesity; Osteoarthritis; Patient Care Team; Sulindac; Time Factors

Osteoarthritis, the most common form of arthritis, influences a person's mental well-being, ability to work or perform activities of daily living, and personal and family relationships. Ideally, the management of this disease is multidisciplinary, involving not only the use of medication but also exercise instruction, dietary counseling, and psychosocial interventions. The effects of such a comprehensive treatment program have not been well studied. A 12-week trial of multidisciplinary assessment and management of osteoarthritis was conducted. In addition to receiving the anti-inflammatory agent sulindac, patients were evaluated and followed up by health professionals in the disciplines of medicine, physical therapy, occupational therapy, nutrition, social work, and psychology. An initial assessment of the degree of pain, swelling, tenderness, stiffness, and ability to conduct activities of daily living was made, which represented patients' entry status. Subsequent assessments were made by the multidisciplinary team every two weeks for 12 weeks. Seventy-seven patients completed at least ten of the 12 weeks. On entering the study, two thirds of the patients had pain, tenderness, or swelling affecting the hip, knee, or hand. At the end of 12 weeks, 80% of the patients had improvement in their osteoarthritis, and 71% improved in their ability to conduct activities of daily living. The results support the view that a comprehensive approach to osteoarthritis can significantly reduce disability and pain.

Topics: Activities of Daily Living; Aged; Combined Modality Therapy; Disability Evaluation; Female; Humans; Male; Middle Aged; Osteoarthritis; Pain Measurement; Patient Care Team; Sulindac; Time Factors

The disposition and effect on hemostasis of a single 150 mg dose of sulindac was studied in young healthy subjects and in older patients with arthritis. Older patients were restudied after 2 weeks of sulindac, 150 mg b.i.d. The only difference in disposition of the first dose was a reduced plasma sulfone metabolite concentration in the elderly patients with arthritis. Chronic sulindac dosing resulted in accumulation of the drug and its sulfone and sulfide metabolites in plasma to a greater extent than previously reported for young subjects. No differences in renal clearance of sulindac and its sulfone metabolite related to age or chronic drug dosing were observed. No renal excretion of the active sulfide metabolite was detected. Bleeding time in the elderly patients was shorter than in the young healthy subjects before sulindac dosing, but was prolonged in the elderly patients after 2 weeks of dosing to values similar to control data from the young healthy subjects. This change correlated weakly with plasma sulfide metabolite concentrations. Differences in bleeding time were not reflected in changes in platelet aggregation induced by adenosine diphosphate either with respect to age or chronic drug dosing. Our data provide no justification for lowering the recommended dose of sulindac for patients older than 65 years of age.

Topics: Adult; Aged; Aging; Arthritis, Rheumatoid; Blood Coagulation; Female; Humans; Indenes; Kinetics; Male; Osteoarthritis; Platelet Aggregation; Sulindac

A number of adverse reactions have been associated with sulindac, a nonsteroidal anti-inflammatory drug, but acute hemolytic anemia associated with sulindac has not yet been reported, to our knowledge. We encountered two cases of severe immune hemolytic anemia, one fatal, which appear to have been related to sulindac. In vitro studies provided evidence that antibodies to sulindac and its metabolites were present in the serum of both patients.

Topics: Aged; Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Antibodies; Erythrocytes; Female; Humans; Indenes; Osteoarthritis; Serologic Tests; Sulindac

Topics: Arthritis, Rheumatoid; Aspirin; Diclofenac; Double-Blind Method; Humans; Indomethacin; Naproxen; Osteoarthritis; Sulindac; Tolmetin

According to in vivo experimental data, salicylates and several other nonsteroidal anti-inflammatory agents suppress proteoglycan biosynthesis in normal and degenerating articular cartilage. Therapeutic levels of aspirin in vivo had a similar adverse effect on degenerating cartilage, as noted in two canine models of osteoarthritis and cartilage atrophy. Because the effective daily antirheumatic dose of nonsteroidal anti-inflammatory drugs is lower than that of salicylates, these drugs may have less negative effects on degenerating articular cartilage. However, clinical significance cannot be extrapolated from these experimental data.

Topics: Animals; Anti-Inflammatory Agents; Aspirin; Atrophy; Cartilage, Articular; Dogs; Extracellular Matrix; Glycosaminoglycans; Indomethacin; Osteoarthritis; Prostaglandin Antagonists; Proteoglycans; Salicylates; Sulfur Radioisotopes; Sulindac; Uronic Acids

Topics: Aged; Blood Cell Count; Female; Humans; Indenes; Leukocyte Count; Meningitis; Meningitis, Aseptic; Osteoarthritis; Recurrence; Sulindac

Thirty-two elderly patients with symptomatic osteoarthritis, mainly of the hip and/or knee joints, were treated at random with either 400 mg sulindac or 1200 mg ibuprofen per day for 12 weeks. Clinical assessments were made before, during and after treatment of disease activity, weight-bearing pain, night pain, and pain on active and passive movement. Objective measurements were also made of duration of inactivity stiffness, knee flexion and hip abduction. The results showed that after treatment there was significant symptomatic improvement in the patients in both groups. Apart from night pain, the differences between the groups in the subjective parameters at Week 12 were significant in favour of sulindac. Overall assessment of response to treatment also showed a significant preference for sulindac by patients and physician. Both drugs were well-tolerated although 1 patient on sulindac had to be withdrawn because of a skin rash.

Topics: Aged; Female; Hip Joint; Humans; Ibuprofen; Indenes; Knee Joint; Male; Osteoarthritis; Sulindac

An open, multi-centre study was carried out in 239 elderly out-patients referred with symptomatic osteoarthritis of the hip and/or knee to assess the effectiveness of 200 mg sulindac twice daily compared with either 400 mg ibuprofen 3-times daily, 250 mg naproxen twice daily or 25 mg diclofenac 3-times daily. Assessments were made before and during the 12-week trial period of disease activity, weight-bearing pain, pain on active and passive movement, night pain, and inactivity stiffness. The results showed that there was significant improvement in all of the parameters with each of the treatments, and the difference between treatments was significant in favour of sulindac compared with ibuprofen in disease activity, weight-bearing pain and pain on active movement. In the overall assessment of response to treatment at the end of the trial it was the patients' opinion that the degree of improvement was better on sulindac than on the comparative drugs. The main side-effect leading to some patients withdrawing from the trial was abdominal pain.

Topics: Aged; Diclofenac; Female; Hip Joint; Humans; Ibuprofen; Indenes; Knee Joint; Male; Naproxen; Osteoarthritis; Sulindac

A study of 690 osteoarthrosis (OA) patients with corresponding controls, and 475 soft-tissue rheumatism (STR) patients with the same number of controls was made in Finnish health centres. The aim of the study was to clarify certain etiological, social and therapeutical aspects. No clear differences were found in the working conditions of patients with OA, STR, or their controls, or in their occupational classes. OA patients were less satisfied with their working conditions than were the other. OA and STR patients had been more actively engaged in sports earlier in life, but during the study there were no differences; nor did the localisation of OA differ. The weight index qas slightly higher in OA, particularly when knee and ankle were affected, but not with arthrosis of the hip. There were no clear associations with other diseases. The maximum duration of a treatment period in this study was 1 month. The average sick leave in OA was 17.8 days, in STR 13.4 and in controls 15.4 days. After treatment, 31% of OA patients, and 56% of STR were recommended to resume work; 4% were recommended to change their occupation; 21% of OA and 7% of STR patients were recommended to retire on pension. Sulindac, indomethacin and many other drug combinations were used for medication. Certain side effects were found in about 5% of sulindac- and in 8-10% of indomethacin-treated patients. In 17% of OA and in 12% of STR patients, it was found necessary to consult a specialist for diagnosis or treatment.

Topics: Body Weight; Community Health Centers; Female; Finland; Humans; Indomethacin; Leisure Activities; Male; Middle Aged; Osteoarthritis; Rheumatic Diseases; Sulindac; Work

Topics: Adult; Aged; Back Pain; Female; Humans; Ibuprofen; Indenes; Knee Joint; Lumbar Vertebrae; Male; Middle Aged; Osteoarthritis; Sulindac

The effects of oral administration of the anti-inflammatory drug, (Z)-5-fluoro-2-methyl-1-[p-(methylsulfinyl)-benzylidene]-indene-3-acetic acid (sulindac, Clinoril) 400 mg/d for 8 days, on basal and submaximal (3 micrograms/kg b.2. i.m.) and maximal (6 micrograms/kg b.w.) pentagastrin-stimulated gastric acid secretion as well as on serum gastrin concentration have been evaluated in female patients affected with osteoarthrosis. No significant changes in either gastric acid or gastrin secretion were induced by the treatment. Serum gastrin levels were also unaltered after acute administration of 200 mg sulindac. These results confirm and extend previous observations suggesting that the drug does not exert major actions on the stomach.

Topics: Adult; Aged; Female; Gastric Acid; Gastrins; Humans; Indenes; Middle Aged; Osteoarthritis; Pentagastrin; Sulindac; Time Factors

Topics: Adult; Aged; Hip Joint; Humans; Indenes; Joints; Knee Joint; Middle Aged; Osteoarthritis; Periarthritis; Shoulder Joint; Spinal Diseases; Sulindac

Topics: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Female; Hip Joint; Humans; Indenes; Knee Joint; Male; Middle Aged; Osteoarthritis; Sulindac

Topics: Analgesics; Anti-Inflammatory Agents; Exercise Therapy; Hip Joint; Humans; Osteoarthritis; Physical Therapy Modalities; S-Adenosylmethionine; Sulindac