Greater reduction of knee than hip pain in osteoarthritis treated with naproxen, as evaluated by WOMAC and SF-36

Abstract

Objectives: To compare the improvement of hip and knee osteoarthritis during treatment with naproxen. Methods: Men and women aged 40 to 75 years with symptomatic osteoarthritis of the knee or hip of at least three months' duration participated in a six week placebo controlled, double blind study with naproxen 500 mg twice daily as one treatment arm. Naproxen was given to 403 patients (280 knee, 123 hip) and placebo to 108 patients (75 knee, 33 hip). WOMAC (Western Ontario and McMaster Universities osteoarthritis index) 3.1 visual analogue scale and SF-36 (36 item short form health survey) were used to assess response to treatment between baseline and week 6. Results: There were no differences at baseline between knee and hip osteoarthritis for any of the WOMAC subscales or SF-36 domains. Improvement was between 4 and 7 mm greater for knee than for hip for all WOMAC subscales (pain, D = 4.7 mm (p = 0.03); stiffness, D = 6.6 mm (p = 0.004); function, D = 4.8 mm (p = 0.06)). Effect size was about 0.8 for all WOMAC subscales for the knee and between 0.5 and 0.6 for the hip. Knee patients treated with naproxen improved 4.6 (p = 0.033) more than hip patients for SF-36 bodily pain and 10.3 (p = 0.014) more for SF-36 role-physical. Conclusions: Patients with knee osteoarthritis improved more with naproxen treatment than patients with hip osteoarthritis, as monitored by WOMAC and the SF-36 domains bodily pain and role-physical. These findings warrant further investigation and strongly suggest that efficacy of treatment of osteoarthritis of knee and hip should be evaluated separately.

Effects of Meditation on Symptoms of Knee Osteoarthritis: A Pilot Study

“…The findings appear comparable or superior to those reported in studies of other nonpharmacologic therapies for knee OA, including acupuncture, 67 yoga, 68 t’ai chi , 69,70 and other forms of exercise. 71 Likewise, the observed reductions in pain and overall improvements in function were also similar to or greater than those reported in previous trials of medications com- monly prescribed for OA, including nonsteroidal anti-inflammatory drugs, 72,73 acetaminophen, 72 and opioids. 74 Notably, the authors of a Cochrane review concluded that the small-to-moderate effects of non-tramadol opioids were outweighed by the potential side-effects and advised clinicians to discuss alternative treatments with patients.…”

Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm

“…While these issues might be considered limitations from an experimental perspective, the study design was chosen to reflect general medical practice. Subgroup analyses in this study showed that the benefit obtained with acupuncture treatment was comparable in patients with OA at different sites, whereas a recent study with naproxen showed a greater reduction of pain in patients with knee OA than in those with hip OA (16).…”

EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

“…91 For these reasons it is impossible to extrapolate clinical trial results between sites and to give a single recommendation for OA irrespective of site. For these multiple reasons EULAR has developed separate treatment recommendations for OA of the knee, 7 8 hip 9 and, now, hand.…”